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

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Stein, Dan J. ^{[1, 2, 3]} ; Kazdin, Alan E. ^[4] ; Ruscio, Ayelet Meron ^[5] ; Chiu, Wai Tat ^[6] ; Sampson, Nancy A. ^[6] ; Ziobrowski, Hannah N. ^[6] ; Aguilar-Gaxiola, Sergio ^[7] ; Al-Hamzawi, Ali ^[8] ; Alonso, Jordi ^{[9, 10, 11]} ; Altwaijri, Yasmin ^[12] ; Bruffaerts, Ronny ^[13] ; Bunting, Brendan ^[14] ; de Girolamo, Giovanni ^[15] ; de Jonge, Peter ^{[16, 17]} ; Degenhardt, Louisa ^[18] ; Gureje, Oye ^[19] ; Haro, Josep Maria ^[20] ; Harris, Meredith G. ^{[21, 22]} ; Karam, Aimee ^[23] ; Karam, Elie G. ^{[23, 24, 25]} ; Kovess-Masfety, Viviane ^[26] ; Lee, Sing ^[27] ; Medina-Mora, Maria Elena ^[28] ; Moskalewicz, Jacek ^[29] ; Navarro-Mateu, Fernando ^{[30, 31, 32]} ; Nishi, Daisuke ^{[33, 34]} ; Posada-Villa, Jose ^[35] ; Scott, Kate M. ^[36] ; Viana, Maria Carmen ^[37] ; Vigo, Daniel V. ^{[38, 39]} ; Xavier, Miguel ^[40] ; Zarkov, Zahari ^[41] ; Kessler, Ronald C. ^[6] ; Colla, WHO World Mental Hlth Survey

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^[1] Univ Cape Town, Dept Psychiat & Mental Hlth, Cape Town - South Africa

^[2] Groote Schuur Hosp, Cape Town - South Africa

^[3] Univ Cape Town, South African Med Council Res Unit Risk & Resilie, Cape Town - South Africa

^[4] Yale Univ, Dept Psychol, New Haven, CT - USA

^[5] Univ Penn, Dept Psychol, 3815 Walnut St, Philadelphia, PA 19104 - USA

^[6] Harvard Med Sch, Dept Hlth Care Policy, Boston, MA - USA

^[7] UC Davis Hlth Syst, Ctr Reducing Hlth Dispar, Sacramento, CA - USA

^[8] Al Qadisiya Univ, Coll Med, Diwaniya Governorate, Al Diwaniyah - Iraq

^[9] Pompeu Fabra Univ UPF, Barcelona - Spain

^[10] IMIM Hosp Mar Med Res Inst, Hlth Serv Res Unit, Barcelona - Spain

^[11] CIBER Epidemiol & Salud Pirbl CIBERESP, Madrid - Spain

^[12] King Faisal Specialist Hosp & Res Ctr, Epidemiol Sect, Riyadh - Saudi Arabia

^[13] Univ Psychiat Ctr Katholieke Univ Leuven, Campus Gasthuisberg, Leuven - Belgium

^[14] Ulster Univ, Sch Psychol, Londonderry - North Ireland

^[15] IRCCS Ist Ctr San Giovanni Dio Fatebenefratelli, Brescia - Italy

^[16] Univ Groningen, Dept Dev Psychol, Groningen - Netherlands

^[17] Univ Med Ctr Groningen, Interdisciplinary Ctr Psychopathol & Emot Regulat, Groningen - Netherlands

^[18] Univ New South Wales, Natl Drug & Alcohol Res Ctr, Sydney, NSW - Australia

^[19] Univ Coll Hosp, Dept Psychiat, Ibadan - Nigeria

^[20] Univ Barcelona, CIBERSAM, Parc Sanitari St Joan Deu, Barcelona - Spain

^[21] Queensland Ctr Mental Hlth Res, Pk Ctr Mental Hlth, Wacol, Qld 4072 - Australia

^[22] Univ Queensland, Sch Publ Hlth, Herston, Qld 4006 - Australia

^[23] Inst Dev Res Advocacy & Appl Care IDRAAC, Beirut - Lebanon

^[24] St George Hosp Univ Med Ctr, Dept Psychiat & Clin Psychol, Beirut - Lebanon

^[25] Balamand Univ, Fac Med, Beirut - Lebanon

^[26] Paris Descartes Univ, Ecole Hautes Etud Sante Publ EHESP, EA 4057, Paris - France

^[27] Chinese Univ Hong Kong, Dept Psychiat, Tai Po, Hong Kong - Peoples R China

^[28] Natl Inst Psychiat Ramon Fuente Muniz, Mexico City, DF - Mexico

^[29] Inst Psychiat & Neurol, Warsaw - Poland

^[30] IMIB Arrixaca, Murcia - Spain

^[31] UDIF SM, Serv Murciano Salud, Murcia - Spain

^[32] CIBERESP Murcia, Reg Murcia, Murcia - Spain

^[33] Univ Tokyo, Grad Sch Med, Dept Mental Hlth, Tokyo - Japan

^[34] Natl Ctr Neurol & Psychiat, Tokyo - Japan

^[35] Cundinamarca Univ, Fac Social Sci, Colegio Mayor, Bogota - Colombia

^[36] Univ Otago, Dept Psychol Med, Dunedin - New Zealand

^[37] Univ Fed Espirito Santo, Dept Social Med, Postgrad Program Publ Hlth, Vitoria, ES - Brazil

^[38] Univ British Columbia, Dept Psychiat, Vancouver, BC - Canada

^[39] Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA - USA

^[40] Univ Nova Lisboa, NOVA Med Sch Fac Ciencias Med, Lisbon Inst Global Mental Hlth & Chron Dis Res Ct, Lisbon - Portugal

^[41] Natl Ctr Publ Hlth & Anal, Dept Mental Hlth, Sofia - Bulgaria

• Tipo de documento: Artigo Científico
• Fonte: BMC Psychiatry; v. 21, n. 1 AUG 9 2021.
• Citações Web of Science: 0

Resumo

Background 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. (AU)

• Processo FAPESP: 03/00204-3 - Estudo epidemiológico dos transtornos psiquiátricos na região metropolitana de São Paulo: prevalências, fatores de risco e sobrecarga social e econômica
• Beneficiário: Laura Helena Silveira Guerra de Andrade
• Modalidade de apoio: Auxílio à Pesquisa - Temático