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dc.contributor.authorStein, Dan Jen_US
dc.contributor.authorKazdin, Alan Een_US
dc.contributor.authorRuscio, Ayelet Meronen_US
dc.contributor.authorChiu, Wai Taten_US
dc.contributor.authorSampson, Nancy Aen_US
dc.contributor.authorZiobrowski, Hannah Nen_US
dc.contributor.authorAguilar-Gaxiola, Sergioen_US
dc.contributor.authorAl-Hamzawi, Alien_US
dc.contributor.authorAlonso, Jordien_US
dc.contributor.authorAltwaijri, Yasminen_US
dc.contributor.authorBruffaerts, Ronnyen_US
dc.contributor.authorBunting, Brendanen_US
dc.contributor.authorde Girolamo, Giovannien_US
dc.contributor.authorde Jonge, Peteren_US
dc.contributor.authorDegenhardt, Louisaen_US
dc.contributor.authorGureje, Oyeen_US
dc.contributor.authorHaro, Josep Mariaen_US
dc.contributor.authorHarris, Meredith Gen_US
dc.contributor.authorKaram, Aimeeen_US
dc.contributor.authorKaram, Elie G.en_US
dc.contributor.authorKovess-Masfety, Vivianeen_US
dc.contributor.authorLee, Singen_US
dc.contributor.authorMedina-Mora, Maria Elenaen_US
dc.contributor.authorMoskalewicz, Jaceken_US
dc.contributor.authorNavarro-Mateu, Fernandoen_US
dc.contributor.authorNishi, Daisukeen_US
dc.contributor.authorPosada-Villa, Joséen_US
dc.contributor.authorScott, Kate Men_US
dc.contributor.authorViana, Maria Carmenen_US
dc.contributor.authorVigo, Daniel Ven_US
dc.contributor.authorXavier, Miguelen_US
dc.contributor.authorZarkov, Zaharien_US
dc.contributor.authorKessler, Ronald Cen_US
dc.description.abstractBackground 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. Methods 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. Results 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. Conclusions 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.en_US
dc.subjectGeneralized anxiety disorderen_US
dc.subjectPathways to treatmenten_US
dc.subjectPatient-centered outcomesen_US
dc.subjectTreatment helpfulnessen_US
dc.subjectHealth Surveysen_US
dc.subjectAnxiety Disordersen_US
dc.subjectDiagnostic and Statistical Manual of Mental Disordersen_US
dc.subjectSurveys and Questionnairesen_US
dc.titlePerceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys reporten_US
dc.typeJournal Articleen_US
dc.contributor.affiliationFaculty of Medicineen_US
dc.relation.ispartoftextBMC Psychiatryen_US
dc.description.campusSGH campusen_US
Appears in Collections:Faculty of Medicine
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