Findings From World Mental Health Surveys of the Perceived Helpfulness of Treatment for Patients With Major Depressive Disorder
Findings From World Mental Health Surveys of the Perceived Helpfulness of Treatment for Patients With Major Depressive Disorder
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DOI：
10.1001/jamapsychiatry.2020.1107
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发表时间：
2020-08-01
期刊：
影响因子：
25.8
通讯作者：
Kessler, Ronald C.
中科院分区：
文献类型：
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作者：
Harris, Meredith G.;Kazdin, Alan E.;Kessler, Ronald C.
关键点：抑郁症患者认为治疗有帮助的比例是多少？FindingsThis研究的80332名受访者在16个国家进行了调查，发现68.2%的成年人与DSM-IV的终身病史的重度抑郁症（n=2726）获得治疗，他们认为有帮助的;其他患者停止寻求治疗后，早期无益的治疗。大多数患者（93.9%）如果坚持通过10名治疗专业人员，则会得到帮助，但只有21.5%的患者会坚持。MeaningMany more patients with major depression disorder might get helpful treatment if they perform after early unhelpful treatment.ImportanceThe perceived helpfulness of treatment是一个重要的以患者为中心的衡量标准，它是一个联合函数，衡量治疗专业人员是否被认为是有帮助的，以及患者是否在以前的无益治疗后坚持寻求帮助。目的探讨有抑郁症（MDD）终生史的抑郁症患者的治疗帮助感的两个主要组成部分的患病率及其相关因素。设计，设置，和propantsThis研究探讨了一个协调的一系列社区流行病学调查的结果，非制度化的成年人使用世界卫生组织世界精神卫生调查。在16个国家进行了17次调查（8次在高收入国家，9次在中低收入国家）。数据收集日期从2002年至2003年（黎巴嫩）到2016年至2017年（保加利亚）。参与者包括有MDD治疗终身史的患者。数据分析于二零一九年四月至二零二零年一月进行。收集了有关社会经济特征、终生共病（如焦虑和物质使用障碍）、治疗类型、治疗时机和国家收入水平的数据。主要结果和测量：在看了1到5个专业人员后，有帮助的治疗的条件概率;在1到4个无用的治疗后，寻求帮助的坚持;无论看了多少专业人员，都能获得有帮助的治疗。结果调查应答率范围从50.4%（波兰）到97.2%（麦德林，哥伦比亚），所有调查的汇总应答率为68.3%（n=117616）。首次抑郁症治疗时的平均（SE）年龄为34.8（0.3）岁，69.4%为女性。在2726名有MDD终生治疗史的患者中，在接受多达10名专业人员的帮助治疗后，所有受访者在不同国家汇总的累积概率（SE）为93.9%（1.2%），但只有21.5%（3.2%）的患者持续了这么长时间（即超过9种无效治疗），导致68.2%（1.1%）的患者接受过他们认为有帮助的治疗。认为治疗有帮助的可能性增加与4个因素有关：开始治疗时年龄较大（校正比值比[AOR]，1.02; 95% CI，1.01-1.03），较高教育水平（低：AOR，0.48; 95% CI，0.33-0.70;低平均：AOR，0.62; 95% CI，0.44-0.89;高平均：AOR，0.67; 95% CI，0.49-0.91 vs高教育水平），首次发作后开始治疗的延迟时间较短（AOR，0.98; 95% CI，0.97-0.99），以及从精神健康专家处接受的药物治疗（AOR，2.91; 95% CI，2.04-4.15）。分解分析显示，这4个因素中的前2个因素仅与个人治疗专业人员被视为有帮助的条件概率相关（首次抑郁症治疗时的年龄：AOR，1.02; 95% CI，1.01-1.02;教育水平：低：AOR，0.48; 95% CI，0.33-0.70;低平均：AOR，0.62; 95% CI，0.44-0.89;高平均值：AOR，0.67; 95% CI，0.49-0.91 vs高教育水平），而后2个因素仅与持续性相关（治疗延迟：AOR，0.98; 95% CI，0.97-0.99;治疗类型：AOR，3.43; 95% CI，2.51-4.70）。结论和相关性MDD患者获得他们认为有帮助的治疗的可能性可能会增加，也许是显着的，这项研究分析了在16个国家进行的调查，以评估有终身抑郁症病史的受访者认为治疗专业人员是有帮助的，并且坚持帮助的比例。寻求以前无用的治疗。
Key PointsQuestionWhat proportion of patients with depression perceive treatment as helpful? FindingsThis study of 80332 respondents surveyed in 16 countries found that 68.2% of adults with a lifetime history of DSM-IV major depressive disorder (n=2726) obtained treatment that they considered helpful; other patients stopped seeking treatment after early unhelpful treatment. Most patients (93.9%) were helped if they persisted through 10 treatment professionals, but only 21.5% of patients were that persistent. MeaningMany more patients with major depressive disorder might obtain helpful treatment if they persist after early unhelpful treatment.ImportanceThe perceived helpfulness of treatment is an important patient-centered measure that is a joint function of whether treatment professionals are perceived as helpful and whether patients persist in help-seeking after previous unhelpful treatments. ObjectiveTo examine the prevalence and factors associated with the 2 main components of perceived helpfulness of treatment in a representative sample of individuals with a lifetime history of DSM-IV major depressive disorder (MDD). Design, Setting, and ParticipantsThis study examined the results of a coordinated series of community epidemiologic surveys of noninstitutionalized adults using the World Health Organization World Mental Health surveys. Seventeen surveys were conducted in 16 countries (8 surveys in high-income countries and 9 in low- and middle-income countries). The dates of data collection ranged from 2002 to 2003 (Lebanon) to 2016 to 2017 (Bulgaria). Participants included those with a lifetime history of treated MDD. Data analyses were conducted from April 2019 to January 2020. Data on socioeconomic characteristics, lifetime comorbid conditions (eg, anxiety and substance use disorders), treatment type, treatment timing, and country income level were collected. Main Outcomes and MeasuresConditional probabilities of helpful treatment after seeing between 1 and 5 professionals; persistence in help-seeking after between 1 and 4 unhelpful treatments; and ever obtaining helpful treatment regardless of number of professionals seen. ResultsSurvey response rates ranged from 50.4% (Poland) to 97.2% (Medellin, Columbia), with a pooled response rate of 68.3% (n=117616) across surveys. Mean (SE) age at first depression treatment was 34.8 (0.3) years, and 69.4% were female. Of 2726 people with a lifetime history of treatment of MDD, the cumulative probability (SE) of all respondents pooled across countries of helpful treatment after seeing up to 10 professionals was 93.9% (1.2%), but only 21.5% (3.2%) of patients persisted that long (ie, beyond 9 unhelpful treatments), resulting in 68.2% (1.1%) of patients ever receiving treatment that they perceived as helpful. The probability of perceiving treatment as helpful increased in association with 4 factors: older age at initiating treatment (adjusted odds ratio [AOR], 1.02; 95% CI, 1.01-1.03), higher educational level (low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), shorter delay in initiating treatment after first onset (AOR, 0.98; 95% CI, 0.97-0.99), and medication received from a mental health specialist (AOR, 2.91; 95% CI, 2.04-4.15). Decomposition analysis showed that the first 2 of these 4 factors were associated with only the conditional probability of an individual treatment professional being perceived as helpful (age at first depression treatment: AOR, 1.02; 95% CI, 1.01-1.02; educational level: low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high-average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), whereas the latter 2 factors were associated with only persistence (treatment delay: AOR, 0.98; 95% CI, 0.97-0.99; treatment type: AOR, 3.43; 95% CI, 2.51-4.70). Conclusions and RelevanceThe probability that patients with MDD obtain treatment that they consider helpful might increase, perhaps markedly, if they persisted in help-seeking after unhelpful treatments with up to 9 prior professionals.This study analyzes surveys conducted in 16 countries to evaluate the proportion of respondents with a lifetime history of major depressive disorder who perceive treatment professionals as helpful and who persist in help-seeking after previous unhelpful treatments.