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Original Investigation
May 20, 2020

Findings From World Mental Health Surveys of the Perceived Helpfulness of Treatment for Patients With Major Depressive Disorder

Author Affiliations
  • 1The University of Queensland School of Public Health, Herston, Queensland, Australia
  • 2Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
  • 3Department of Psychology, Yale University, New Haven, Connecticut
  • 4Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 5Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California
  • 6Al-Qadisiya University College of Medicine, Diwaniya Governorate, Iraq
  • 7IMIM–Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain
  • 8Departament de Ciències Experimentals i de la Salut, Pompeu Fabra University, Barcelona, Spain
  • 9CIBER en Epidemiología y Salud Pública, Barcelona, Spain
  • 10Epidemiology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
  • 11Núcleo de Epidemiologia Psiquiátrica (LIM 23), Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  • 12Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
  • 13Anxiety Disorders Center, Buenos Aires, Argentina
  • 14National School of Public Health, Management and Development, Bucharest, Romania
  • 15Department of Psychiatry, University College Hospital, Ibadan, Nigeria
  • 16Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, China
  • 17Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
  • 18Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
  • 19Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
  • 20Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
  • 21UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
  • 22Ulster University School of Psychology, Londonderry, United Kingdom
  • 23Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
  • 24The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, New South Wales, Australia
  • 25Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
  • 26Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
  • 27Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
  • 28National Institute of Public Health–National Institute of Hygiene, Warsaw, Poland
  • 29National Center of Public Health and Analyses, Directorate of Mental Health and Prevention of Addictions, Sofia, Bulgaria
  • 30Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
JAMA Psychiatry. Published online May 20, 2020. doi:10.1001/jamapsychiatry.2020.1107
Key Points

Question  What proportion of patients with depression perceive treatment as helpful?

Findings  This study of 80 332 respondents surveyed in 16 countries found that 68.2% of adults with a lifetime history of DSM-IV major depressive disorder (n = 2726) obtained treatment that they considered helpful; other patients stopped seeking treatment after early unhelpful treatment. Most patients (93.9%) were helped if they persisted through 10 treatment professionals, but only 21.5% of patients were that persistent.

Meaning  Many more patients with major depressive disorder might obtain helpful treatment if they persist after early unhelpful treatment.


Importance  The perceived helpfulness of treatment is an important patient-centered measure that is a joint function of whether treatment professionals are perceived as helpful and whether patients persist in help-seeking after previous unhelpful treatments.

Objective  To examine the prevalence and factors associated with the 2 main components of perceived helpfulness of treatment in a representative sample of individuals with a lifetime history of DSM-IV major depressive disorder (MDD).

Design, Setting, and Participants  This study examined the results of a coordinated series of community epidemiologic surveys of noninstitutionalized adults using the World Health Organization World Mental Health surveys. Seventeen surveys were conducted in 16 countries (8 surveys in high-income countries and 9 in low- and middle-income countries). The dates of data collection ranged from 2002 to 2003 (Lebanon) to 2016 to 2017 (Bulgaria). Participants included those with a lifetime history of treated MDD. Data analyses were conducted from April 2019 to January 2020. Data on socioeconomic characteristics, lifetime comorbid conditions (eg, anxiety and substance use disorders), treatment type, treatment timing, and country income level were collected.

Main Outcomes and Measures  Conditional probabilities of helpful treatment after seeing between 1 and 5 professionals; persistence in help-seeking after between 1 and 4 unhelpful treatments; and ever obtaining helpful treatment regardless of number of professionals seen.

Results  Survey response rates ranged from 50.4% (Poland) to 97.2% (Medellín, Columbia), with a pooled response rate of 68.3% (n = 117 616) across surveys. Mean (SE) age at first depression treatment was 34.8 (0.3) years, and 69.4% were female. Of 2726 people with a lifetime history of treatment of MDD, the cumulative probability (SE) of all respondents pooled across countries of helpful treatment after seeing up to 10 professionals was 93.9% (1.2%), but only 21.5% (3.2%) of patients persisted that long (ie, beyond 9 unhelpful treatments), resulting in 68.2% (1.1%) of patients ever receiving treatment that they perceived as helpful. The probability of perceiving treatment as helpful increased in association with 4 factors: older age at initiating treatment (adjusted odds ratio [AOR], 1.02; 95% CI, 1.01-1.03), higher educational level (low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), shorter delay in initiating treatment after first onset (AOR, 0.98; 95% CI, 0.97-0.99), and medication received from a mental health specialist (AOR, 2.91; 95% CI, 2.04-4.15). Decomposition analysis showed that the first 2 of these 4 factors were associated with only the conditional probability of an individual treatment professional being perceived as helpful (age at first depression treatment: AOR, 1.02; 95% CI, 1.01-1.02; educational level: low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high-average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), whereas the latter 2 factors were associated with only persistence (treatment delay: AOR, 0.98; 95% CI, 0.97-0.99; treatment type: AOR, 3.43; 95% CI, 2.51-4.70).

Conclusions and Relevance  The probability that patients with MDD obtain treatment that they consider helpful might increase, perhaps markedly, if they persisted in help-seeking after unhelpful treatments with up to 9 prior professionals.

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