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Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report

2021; BioMed Central; Volume: 21; Issue: 1 Linguagem: Inglês

10.1186/s12888-021-03363-3

1471-244X

Dan J. Stein, Alan E. Kazdin, Ayelet Meron Ruscio, Wai Tat Chiu, Nancy A. Sampson, Hannah N. Ziobrowski, Sergio Aguilar‐Gaxiola, Amit Malik, Jordi Alonso, Yasmin Altwaijri, Ronny Bruffaerts, Brendan Bunting, Giovanni de Girolamo, Peter de Jonge, Louisa Degenhardt, Oye Gureje, Josep María Haro, Meredith Harris, Aimée Karam, Elie G. Karam, Viviane Kovess–Masféty, Sing Lee, María Elena Medina‐Mora, Jacek Moskalewicz, Fernando Navarro‐Mateu, Daisuke Nishi, José Posada‐Villa, Kate M. Scott, María Carmen Viana, Daniel Vigo, Miguel Xavier, Zahari Zarkov, Ronald C. Kessler, Sergio Aguilar‐Gaxiola, Amit Malik, Mohammed Salih Al-Kaisy, Jordi Alonso, Yasmin Altwaijri, Laura Helena Andrade, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Evelyn J. Bromet, Ronny Bruffaerts, Brendan Bunting, José Miguel Caldas‐de‐Almeida, Graça Cardoso, Somnath Chatterji, H. Alfredo, Louisa Degenhardt, Koen Demyttenaere, Silvia Florescu, Giovanni de Girolamo, Oye Gureje, Josep María Haro, Meredith Harris, Hristo Hinkov, Chiyi Hu, Peter de Jonge, Aimée Karam, Elie G. Karam, Norito Kawakami, Ronald C. Kessler, Andrzej Kiejna, Viviane Kovess–Masféty, Sing Lee, Jean‐Pierre Lépine, John J. McGrath, María Elena Medina‐Mora, Zeina Mneimneh, Jacek Moskalewicz, Fernando Navarro‐Mateu, Marina Piazza, José Posada‐Villa, Kate M. Scott, Tim Slade, Juan Carlos Stagnaro, Dan J. Stein, Margreet ten Have, Yolanda Torres, María Carmen Viana, Daniel Vigo, Harvey Whiteford, David R. Williams, Bogdan Wojtyniak,

Mental Health Treatment and Access

Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment.Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment being perceived as helpful and of persisting in help-seeking after prior unhelpful treatment.The overall prevalence rate of GAD was 4.5%, with lower prevalence in low/middle-income countries (2.8%) than high-income countries (5.3%); 34.6% of respondents with lifetime GAD reported ever obtaining treatment for their GAD, with lower proportions in low/middle-income countries (19.2%) than high-income countries (38.4%); 3) 70% of those who received treatment perceived the treatment to be helpful, with prevalence comparable in low/middle-income countries and high-income countries. Survival analysis suggested that virtually all patients would have obtained helpful treatment if they had persisted in help-seeking with up to 10 professionals. However, we estimated that only 29.7% of patients would have persisted that long. Obtaining helpful treatment at the person-level was associated with treatment type, comorbid panic/agoraphobia, and childhood adversities, but most of these predictors were important because they predicted persistence rather than encounter-level treatment helpfulness.The majority of individuals with GAD do not receive treatment. Most of those who receive treatment regard it as helpful, but receiving helpful treatment typically requires persistence in help-seeking. Future research should focus on ensuring that helpfulness is included as part of the evaluation. Clinicians need to emphasize the importance of persistence to patients beginning treatment.