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Title: Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report
Authors: Stein, Dan J
Kazdin, Alan E
Ruscio, Ayelet Meron
Chiu, Wai Tat
Sampson, Nancy A
Ziobrowski, Hannah N
Aguilar-Gaxiola, Sergio
Al-Hamzawi, Ali
Alonso, Jordi
Altwaijri, Yasmin
Bruffaerts, Ronny
Bunting, Brendan
de Girolamo, Giovanni
de Jonge, Peter
Degenhardt, Louisa
Gureje, Oye
Haro, Josep Maria
Harris, Meredith G
Karam, Aimee
Karam, Elie G.
Kovess-Masfety, Viviane
Lee, Sing
Medina-Mora, Maria Elena
Moskalewicz, Jacek
Navarro-Mateu, Fernando
Nishi, Daisuke
Posada-Villa, José
Scott, Kate M
Viana, Maria Carmen
Vigo, Daniel V
Xavier, Miguel
Zarkov, Zahari
Kessler, Ronald C
Affiliations: Faculty of Medicine 
Keywords: Generalized anxiety disorder
Pathways to treatment
Patient-centered outcomes
Treatment helpfulness
Health Surveys
Anxiety Disorders
Diagnostic and Statistical Manual of Mental Disorders
Surveys and Questionnaires
Issue Date: 2021
Part of: BMC Psychiatry
Volume: 21
Issue: 1
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.
DOI: 10.1186/s12888-021-03363-3
Open URL: Link to full text
Type: Journal Article
Appears in Collections:Faculty of Medicine

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