Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disorders: results from the World Mental Health Survey.
| Title: | Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disorders: results from the World Mental Health Survey. |
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| Authors: | Kazdin AE; Department of Psychology, Yale University, Henry Koerner Center, 149 Elm Street, New Haven, CT 06511, USA.; Pozuelo JR; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA.; Department of Psychiatry, University of Oxford, Oxford, UK.; Harris MG; School of Public Health, The University of Queensland, c/o QCMHR, Locked Bag 500, Archerfield, QLD 4108, Australia.; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wolston Park Rd, Wacol, QLD 4076, Australia.; Stein DJ; Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, ZA 7925, Rondebosch, South Africa.; Viana MC; Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Av. Marechal Campos, 1468, Vitória, Espírito Santo (ES), CEP 29.043-900, Brazil.; Hwang I; Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.; Kessler TL; The Watson Institute for International and Public Affairs, Brown University, 111 Thayer St., Providence, RI 02912, USA.; Manoukian SM; Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.; Sampson NA; Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.; Aguilar-Gaxiola S; Department of Internal Medicine, Center for Reducing Health Disparities, UC Davis Health System, 2921 Stockton Blvd., Suite 1408, Sacramento, CA, 95817, USA.; Alonso J; Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, Barcelona, 08003, Spain.; CIBER en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Madrid, 0 28029, Planta, Spain.; Pompeu Fabra University (UPF),, Plaça de la Mercè, 10-12, Barcelona, 08002, Spain.; Andrade LH; University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica - LIM 23, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, 05403-010, CEP, Brazil.; Ayinde OO; Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, PMB 5116, Nigeria.; Borges G; National Institute of Psychiatry Ramón de la Fuente Muñiz, Calz. Mexico-Xochimilco 101, San Lorenzo Huipulco, México, 14370, Ciudad de, Mexico.; Bruffaerts R; Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven (KUL), Campus Gasthuisberg, Herestraat 49, Leuven, B-3000, Belgium.; Bunting B; School of Psychology, Ulster University, Coleraine Campus, Coleraine, BT52 1SA, UK.; Cardoso G; Lisbon Institute for Global Mental Health, Comprehensive Health Research Centre Nova University of Lisbon, Rua do Instituto Bacteriológico, Lisbon, 5, 1150 - 190, Portugal.; Chardoul S; Survey Research Center, Institute for Social Research, University of Michigan, 330 Packard, Room G358, Ann Arbor, MI, 48104, USA.; Domenech C; Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain.; Gureje O; Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, PMB 5116, Nigeria.; Karam EG; Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon.; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Ashrafieh, 166378, Beirut, Lebanon.; Kovess-Masfety V; Institut de Psychologie, UR 4057, Université Paris Cité, 71 avenue Édouard Vaillant - 92100, Paris, Boulogne Billancourt, France.; Navarro-Mateu F; CIBER en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, Pabellón 11, Madrid, 0 28029, Planta, Spain.; Unidad de Docencia, Investigacion y Formación en Salud Mental, Servicio Murciano de Salud, Murcia Health Service, C/Lorca, nº 58. -El Palmar, Murcia, 30120, Spain.; Instituto Murciano de Investigación Biosanitaria, Virgen de la Arrixaca, Murcia, 30120, El Palmar, Spain.; Nishi D; Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113 - 0033, Japan.; Posada-Villa J; Colombian Institute of the Nervous System, Clinica Montserrat University Hospital, Calle 134 No. 17-71, Bogotá, Colombia.; Rapsey C; Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.; Roest AM; Department of Developmental Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/, 9712 TS, Groningen, The Netherlands.; Department of Child and Adolescent Psychiatry, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.; Stagnaro JC; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos 85 Aires, Paraguay 2155, Ciudad Autónoma de Buenos Aires, Argentina.; Torres Y; Center for Excellence on Research in Mental Health, CES University, Calle 10 A #2-04, Medellín, El Poblado, Colombia.; Vladescu C; National Institute for Health Services Management, 31 Vaselor Str., Bucharest, 21253, Romania.; University Titu Maiorescu, 67 A Gheorghe Petraşcu Str., Bucharest, 031593, Romania.; Wciórka J; Department of Psychiatry, Institute of Psychiatry and Neurology, Jana III Sobieskiego 9, Warsaw, 02-957, Poland.; Wojtyniak B; Department of Population Health Monitoring and Analysis, National Institute of Public Health -National Institute of Hygiene, Chocimska 24, Warsaw, 00-791, Poland.; Zarkov Z; National Center for Public Health and Analyses, 15 Acad. Ivan Geshov Blvd., Sofia, 1431, Bulgaria.; Kessler RC; Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. kessler@hcp.med.harvard.edu.; Vigo DV; Department of Psychiatry & School of Population and Public Health, Faculty of Medicine, University of British Columbia UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook MallUBC Vancouver Campus, Vancouver BC, V6T 2A1, Canada. |
| Corporate Authors: | World Mental Health Survey collaborators |
| Source: | International journal of mental health systems [Int J Ment Health Syst] 2026 Feb 24; Vol. 20 (1). Date of Electronic Publication: 2026 Feb 24. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 101294224 Publication Model: Electronic Cited Medium: Print ISSN: 1752-4458 (Print) Linking ISSN: 17524458 NLM ISO Abbreviation: Int J Ment Health Syst Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: London : BioMed Central, 2007- |
| Abstract: | Background: The quality of mental disorder treatment varies widely, with many patients not receiving treatments based on evidence-based guidelines. We examine data from the World Mental Health (WMH) surveys to investigate prevalence and correlates of receiving effective treatment coverage (ETC) among patients receiving minimally adequate treatment (MAT) in the 12 months before interview.; Methods: Data come from 25 WMH surveys carried out in 21 countries that included n = 1,119 participants who met the criteria for at least one of nine 12-month disorders considered here who received MAT for n = 2,313 disorders. MAT was defined as either (i) medication with 4 + healthcare visits or (ii) 8 + counseling sessions. ETC was defined as a subset of MAT that additionally required (i) medication appropriate for the disorder (e.g., mood stabilizers, anticonvulsant, or antipsychotic for bipolar disorder) taken with adequate control and adherence; and/or (ii) 8 + counseling sessions with a mental healthcare provider. Multivariable regression analysis with person-disorder treated as the case was used to examine associations of socio-demographic, disorder-related, and treatment-related factors with receiving ETC given MAT.; Results: Fewer than half (47.1%) the cases with MAT received treatment qualifying as ETC. The strongest predictors of ETC given MAT were high patient education, mild/moderate disorder severity, treatment by a mental health specialist rather than primary care provider, and receipt of combined treatment with both medication and counseling rather than only one of these types of treatment. Importantly, combined treatment was associated with a significantly higher relative-risk of ETC if it was provided by a psychiatrist rather than a combination of a general medical provider and a non-psychiatrist mental health provider.; Conclusions: Noteworthy limitations include the data being cross-sectional, the predictor set being restricted, and the outcome being defined in terms of structural characteristics rather than fidelity of implementation. Within the context of these limitations, results suggest that fewer than half of cases with minimally adequate treatment receive treatment meeting published guidelines for effective treatment coverage. This finding underscores the importance of improving treatment. Future research should focus on targets to improve each stage of the help-seeking process beginning with entry into treatment through receipt of ETC.; (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: At all survey sites, the local ethics or institutional review committee reviewed and approved the protocol to ensure protection of human subjects, in line with appropriate international and local guidelines. Details of the ethics committees for the WMH surveys can be viewed at this link: https://www.hcp.med.harvard.edu/wmh/ftpdir/IRB_ethics_approval_WMH-CIDI.pdf. Consent for publication: Not applicable. Competing interests: In the past 3 years, Dr. Kessler was a consultant for Cambridge Health Alliance, Child Mind Institute, Massachusetts General Hospital, RallyPoint LLC., Sage Therapeutics, University of Michigan, and University of North Carolina. He has stock options in Cerebral Inc., Mirah, PYM (Prepare Your Mind), and Verisense Health. He owns an interest in Menssano LLC. DJS has received consultancy honoraria from Discovery Vitality, Johnson & Johnson, Kanna, LOreal, Lundbeck, Orion, Servier, Seaport Therapeutics, Takeda, Vistagen, and Wellcome. DVV reports grant support from Health Canada, Canadian Institutes for Health Research, Provincial Health Services Authority and an internal research grant from the University of British Columbia. The BC Ministry of Health and the Department of Interior Health made payments to Dr. Vigo with respect to contracts for projects related to mental health service provision. The remaining authors have no conflicts of interest to declare. |
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| Grant Information: | R01 MH070884 United States MH NIMH NIH HHS; R13-MH066849 U.S. Public Health Service; FIRCA R03-TW006481 United States TW FIC NIH HHS |
| Contributed Indexing: | Investigator: A Al-Hamzawi; YA Altwaijri; L Atwoli; C Benjet; EJ Bromet; JM Caldas-de-Almeida; AH Cía; L Degenhardt; G de Girolamo; JM Haro; H Hinkov; CY Hu; P de Jonge; AN Karam; G Karam; N Kawakami; A Kiejna; JJ McGrath; ME Medina-Mora; J Moskalewicz; M Piazza; KM Scott; M Ten Have; N Tintle; M Xavier; AM Zaslavsky; Keywords: Adequacy of treatment; Cross-national; Effective treatment coverage; Mental disorders treatment; World Mental Health Survey Consortium |
| Entry Date(s): | Date Created: 20260224 Date Completed: 20260331 Latest Revision: 20260402 |
| Update Code: | 20260507 |
| PubMed Central ID: | PMC13037245 |
| DOI: | 10.1186/s13033-026-00698-w |
| PMID: | 41736041 |
| Database: | MEDLINE |
Journal Article