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Background <p>Treatments for mental disorders vary widely in type and quality, with many patients failing to receive treatments that meet even minimally adequate standards. We use data from the World Mental Health (WMH) surveys to investigate this variation by examining the prevalence and correlates of minimally adequate treatment (MAT) among patients receiving treatment for common mental disorders.</p> Methods <p>Data comes from 25 WMH cross-sectional surveys implemented in 21 countries (n = 1,838 respondents with n = 3,538 12-month treated disorders). MAT was defined according to widely used criteria: pharmacotherapy (≥ 1&#xa0;month of medication with ≥ four visits to a healthcare provider) or counseling (≥ eight sessions with any provider). Multivariable regression analyses were used to examine associations of socio-demographic, disorder-related, and treatment-related factors with MAT.</p> Results <p>Approximately two-thirds (66.2%) of treated cases met MAT criteria. There was limited variation in MAT prevalence across disorder types, number of disorders, or years since disorder onset, but MAT prevalence was positively associated with increased disorder severity. Socio-demographic differences were nonsignificant. Relatively substantial differences in MAT prevalence were found by treatment sector (highest MAT prevalence among patients treated by mental health specialists and those treated by multiple provider types). Further analysis showed that these associations were explained by differences in premature discontinuation, completion of a full course of treatment that did not qualify as MAT, and still being in treatment at the time of interview that did not yet qualify as MAT. Low perceived disorder severity unrelated to more objective measures of severity was a central factor in accounting for premature discontinuation.</p> Conclusions <p>While approximately two-thirds of treated cases meet MAT criteria, significant gaps remain involving both premature discontinuation and cases where respondents reported completing a ‘full recommended course of treatment’ that did not involve enough visits or medication duration to meet the MAT standards. Expanding access to mental health specialty providers and increasing patient education about disorder severity would be useful in increasing the proportion of treated cases that receive MAT. Future research should focus on validating MAT definitions against clinical outcomes, standardizing assessment frameworks, and exploring provider- and system-level determinants of treatment adequacy.</p>

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Predictors and barriers to minimally adequate treatment among treated individuals with mental disorders: results from the World Mental Health Surveys

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月18日

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  • Julia R. Pozuelo,
  • Daniel V. Vigo,
  • Alan E. Kazdin,
  • Meredith G. Harris,
  • Dan J. Stein,
  • Maria Carmen Viana,
  • Irving Hwang,
  • Timothy L. Kessler,
  • Sophie M. Manoukian,
  • Nancy A. Sampson,
  • Sergio Aguilar-Gaxiola,
  • Jordi Alonso,
  • Laura Helena Andrade,
  • Olatunde O. Ayinde,
  • Ronny Bruffaerts,
  • Brendan Bunting,
  • José Miguel Caldas-de-Almeida,
  • Stephanie Chardoul,
  • Giovanni de Girolamo,
  • Cristina Domenech,
  • Oye Gureje,
  • Elie G. Karam,
  • Andrzej Kiejna,
  • Viviane Kovess-Masfety,
  • Maria Elena Medina-Mora,
  • Jacek Moskalewicz,
  • Fernando Navarro-Mateu,
  • Daisuke Nishi,
  • Marina Piazza,
  • José Posada-Villa,
  • Kate M. Scott,
  • Margreet ten Have,
  • Yolanda Torres,
  • Cristian Vladescu,
  • Ronald C. Kessler,
  • Ali Al-Hamzawi,
  • Yasmin A. Altwaijri,
  • Lukoye Atwoli,
  • Corina Benjet,
  • Guilherme Borges,
  • Evelyn J. Bromet,
  • Jose Miguel Caldas-de-Almeida,
  • Graça Cardoso,
  • Alfredo H. Cía,
  • Louisa Degenhardt,
  • Josep Maria Haro,
  • Hristo Hinkov,
  • Chi-yi Hu,
  • Peter de Jonge,
  • Aimee Nasser Karam,
  • Georges Karam,
  • Norito Kawakami,
  • John J. McGrath,
  • Annelieke Roest,
  • Juan Carlos Stagnaro,
  • Nathan Tintle,
  • Cristian Vladescu,
  • David R. Williams,
  • Bogdan Wojtyniak,
  • Miguel Xavier,
  • Alan M. Zaslavsky

摘要

Background

Treatments for mental disorders vary widely in type and quality, with many patients failing to receive treatments that meet even minimally adequate standards. We use data from the World Mental Health (WMH) surveys to investigate this variation by examining the prevalence and correlates of minimally adequate treatment (MAT) among patients receiving treatment for common mental disorders.

Methods

Data comes from 25 WMH cross-sectional surveys implemented in 21 countries (n = 1,838 respondents with n = 3,538 12-month treated disorders). MAT was defined according to widely used criteria: pharmacotherapy (≥ 1 month of medication with ≥ four visits to a healthcare provider) or counseling (≥ eight sessions with any provider). Multivariable regression analyses were used to examine associations of socio-demographic, disorder-related, and treatment-related factors with MAT.

Results

Approximately two-thirds (66.2%) of treated cases met MAT criteria. There was limited variation in MAT prevalence across disorder types, number of disorders, or years since disorder onset, but MAT prevalence was positively associated with increased disorder severity. Socio-demographic differences were nonsignificant. Relatively substantial differences in MAT prevalence were found by treatment sector (highest MAT prevalence among patients treated by mental health specialists and those treated by multiple provider types). Further analysis showed that these associations were explained by differences in premature discontinuation, completion of a full course of treatment that did not qualify as MAT, and still being in treatment at the time of interview that did not yet qualify as MAT. Low perceived disorder severity unrelated to more objective measures of severity was a central factor in accounting for premature discontinuation.

Conclusions

While approximately two-thirds of treated cases meet MAT criteria, significant gaps remain involving both premature discontinuation and cases where respondents reported completing a ‘full recommended course of treatment’ that did not involve enough visits or medication duration to meet the MAT standards. Expanding access to mental health specialty providers and increasing patient education about disorder severity would be useful in increasing the proportion of treated cases that receive MAT. Future research should focus on validating MAT definitions against clinical outcomes, standardizing assessment frameworks, and exploring provider- and system-level determinants of treatment adequacy.