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Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys

Abstract

Purpose

To investigate the prevalence and predictors of perceived helpfulness of treatment in persons with a history of DSM-IV social anxiety disorder (SAD), using a worldwide population-based sample.

Methods

The World Health Organization World Mental Health Surveys is a coordinated series of community epidemiological surveys of non-institutionalized adults; 27 surveys in 24 countries (16 in high-income; 11 in low/middle-income countries; N = 117,856) included people with a lifetime history of treated SAD.

Results

In respondents with lifetime SAD, approximately one in five ever obtained treatment. Among these (n = 1322), cumulative probability of receiving treatment they regarded as helpful after seeing up to seven professionals was 92.2%. However, only 30.2% persisted this long, resulting in 65.1% ever receiving treatment perceived as helpful. Perceiving treatment as helpful was more common in female respondents, those currently married, more highly educated, and treated in non-formal health-care settings. Persistence in seeking treatment for SAD was higher among those with shorter delays in seeking treatment, in those receiving medication from a mental health specialist, and those with more than two lifetime anxiety disorders.

Conclusions

The vast majority of individuals with SAD do not receive any treatment. Among those who do, the probability that people treated for SAD obtain treatment they consider helpful increases considerably if they persisted in help-seeking after earlier unhelpful treatments.

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Data availability

Access to the cross-national World Mental Health (WMH) data is governed by the organizations funding and responsible for survey data collection in each country. These organizations made data available to the WMH consortium through restricted data sharing agreements that do not allow us to release the data to third parties. The exception is that the U.S. data are available for secondary analysis via the Inter-University Consortium for Political and Social Research (ICPSR), http://www.icpsr.umich.edu/icpsrweb/ICPSR/series/00527.

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Acknowledgements

The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the United States National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the United States Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical Inc., GlaxoSmithKline, and Bristol-Myers Squibb. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. None of the funders had any role in the design, analysis, interpretation of results, or preparation of this paper. The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of the World Health Organization, other sponsoring organizations, agencies, or governments.

The WHO World Mental Health Survey collaborators are Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Mohammed Salih Al-Kaisy, Yasmine A Altwaijri, Jordi Alonso, Laura Helena Andrade, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Evelyn J. Bromet, Ronny Bruffaerts, Brendan Bunting, Jose Miguel Caldas-de-Almeida, Graça Cardoso, Somnath Chatterji, Alfredo H. Cia, Louisa Degenhardt, Koen Demyttenaere, Silvia Florescu, Giovanni de Girolamo, Oye Gureje, Josep Maria Haro, Meredith G. Harris, Hristo Hinkov, Chi-yi Hu, Peter de Jonge, Aimee Nasser Karam, Elie G. Karam, Norito Kawakami, Ronald C. Kessler, Andrzej Kiejna, Viviane Kovess-Masfety, Sing Lee, Jean-Pierre Lepine, John J McGrath, Maria Elena Medina-Mora, Zeina Mneimneh, Jacek Moskalewicz, Fernando Navarro-Mateu, Marina Piazza, Jose Posada-Villa, Kate M. Scott, Tim Slade, Juan Carlos Stagnaro, Dan J. Stein, Margreet ten Have, Yolanda Torres, Maria Carmen Viana, Daniel V. Vigo, Harvey Whiteford, David R. Williams, Bogdan Wojtyniak.

A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.

Funding

The Argentina survey—Estudio Argentino de Epidemiología en Salud Mental (EASM)—was supported by a grant from the Argentinian Ministry of Health (Ministerio de Salud de la Nación)—(Grant number 2002-17270/13-5). The 2007 Australian National Survey of Mental Health and Wellbeing is funded by the Australian Government Department of Health and Ageing. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The Bulgarian Epidemiological Study of common mental disorders EPIBUL is supported by the Ministry of Health and the National Center for Public Health Protection. EPIBUL 2, conducted in 2016-17, is supported by the Ministry of Health and European Economic Area Grants. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The Mental Health Study Medellín—Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123, and EAHC 20081308), (the Piedmont Region (Italy)), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Generalitat de Catalunya (2017 SGR 452; 2014 SGR 748), Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. Implementation of the Iraq Mental Health Survey (IMHS) and data entry were carried out by the staff of the Iraqi MOH and MOP with direct support from the Iraqi IMHS team with funding from both the Japanese and European Funds through United Nations Development Group Iraq Trust Fund (UNDG ITF). The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013, H25-SEISHIN-IPPAN-006) from the Japan Ministry of Health, Labour and Welfare. The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health/Fogarty International Center (R03 TW006481-01), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from, Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, Glaxo Smith Kline, Lundbeck, Novartis, OmniPharma, Pfizer, Phenicia, Servier, UPO. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H), with supplemental support from the Pan American Health Organization (PAHO). Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and the Health Research Council. The Northern Ireland Study of Mental Health was funded by the Health & Social Care Research & Development Division of the Public Health Agency. The Peruvian World Mental Health Study was funded by the National Institute of Health of the Ministry of Health of Peru. The Polish project Epidemiology of Mental Health and Access to Care—EZOP Project (PL 0256) was carried out by the Institute of Psychiatry and Neurology in Warsaw in consortium with Department of Psychiatry—Medical University in Wroclaw and National Institute of Public Health-National Institute of Hygiene in Warsaw and in partnership with Psykiatrist Institut Vinderen–Universitet, Oslo. The project was funded by the European Economic Area Financial Mechanism and the Norwegian Financial Mechanism. EZOP project was co-financed by the Polish Ministry of Health. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology (FCT) and Ministry of Health. The Romania WMH study projects “Policies in Mental Health Area” and “National Study regarding Mental Health and Services Use” were carried out by National School of Public Health & Health Services Management (former National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics-National Centre for Training in Statistics, SC Cheyenne Services SRL, Statistics Netherlands and were funded by Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The Saudi National Mental Health Survey (SNMHS) is conducted by the King Salman Center for Disability Research. It is funded by Saudi Basic Industries Corporation (SABIC), King Abdulaziz City for Science and Technology (KACST), Ministry of Health (Saudi Arabia), and King Saud University. Funding in-kind was provided by King Faisal Specialist Hospital and Research Center, and the Ministry of Economy and Planning, General Authority for Statistics. The Shenzhen Mental Health Survey is supported by the Shenzhen Bureau of Health and the Shenzhen Bureau of Science, Technology, and Information. The Psychiatric Enquiry to General Population in Southeast Spain—Murcia (PEGASUS-Murcia) Project has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias (FFIS) of Murcia. The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust. Dr. Jordi Alonso reports grants from the EU Commission, ISCIII/FEDER, and Generalitat de Catalunya, during the conduct of the study. Dr. Laura Helena Andrade is supported by the Brazilian Council for Scientific and Technological Development (CNPq Grant # 307933/2019-9). Dr. Corina Benjet reports grants from Consejo Nacional de Ciencia y Tecnología, during the conduct of the study.

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Contributions

RCK had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: RB and RCK. Acquisition, analysis, and interpretation of data: all the authors. Drafting of the manuscript: RB, NAS, RCK, and AEK. Critical revision of the manuscript for important intellectual content: all the authors. Statistical analysis: WTC and NAS. Obtained funding: AA-H, JA, YAA, LA, GC, AHC, SF, OG, CH, ANK, FN-M, SO, KMS, YT, BW, and RCK. Administrative, technical, or material support: NAS. Supervision: NAS and RCK.

Corresponding author

Correspondence to Ronald C. Kessler.

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Conflict of interest

In the past 3 years, Dr. Kessler was a consultant for Datastat, Inc., Holmusk, RallyPoint Networks, Inc., and Sage Therapeutics. He has stock options in Mirah, PYM, and Roga Sciences. Dr. Navarro-Mateu reports non-financial support from Otsuka, outside the submitted work.

Ethics approval

All the procedures performed in studies involving human participants were approved by local Institutional Review Boards. The study is performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

The interview schedule was developed in English and translated into other languages using a standardized WHO translation, team translation, and harmonization protocol. Interviews were administered face-to-face in respondents’ homes after obtaining informed consent using procedures approved by local Institutional Review Boards.

Appendix

Appendix

See Tables

Table 5 WMH sample characteristics by World Bank income categoriesa

5 and

Table 6 Interaction between main effects and historical time to predictor of helpful treatment and persistence (pooled across professionals seen), and perceived helpfulness of treatment (person level), among people with lifetime DSM-IV social anxiety disorder (SAD) who obtained treatment

6.

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Bruffaerts, R., Harris, M.G., Kazdin, A.E. et al. Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys. Soc Psychiatry Psychiatr Epidemiol (2022). https://doi.org/10.1007/s00127-022-02249-3

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Keywords

  • Perceived helpfulness
  • Treatment
  • Social anxiety disorder