Barriers to 12-month treatment of common anxiety, mood, and substance use disorders in the World Mental Health (WMH) surveys

Background High unmet need for treatment of mental disorders exists throughout the world. An understanding of barriers to treatment is needed to develop effective programs to address this problem. Methods Data on barriers were obtained from face-to-face interviews in 22 community surveys across 19 countries (n=102,812 respondents aged ≥18 years; 57.7% female; median age [IQR] 43 [31–57]); weighted average response rate 68.5%) in the World Mental Health (WMH) surveys. We focus on the n=5,136 respondents with 12-month DSM-IV anxiety, mood, or substance use disorders with perceived need for treatment. The n=2,444 such respondents who did not receive treatment were asked about barriers to receiving treatment, whereas the n=926 respondents who received treatment with a delay were asked about barriers leading to delays. Five barrier classes were distinguished: low perceived disorder severity; predisposing factors (perceived treatment ineffectiveness; stigma); and enabling factors (financial; nonfinancial). Baseline predictors of receiving treatment found previously were examined as predictors of barriers, while barriers were examined as mediators of associations between predictors and treatment. Results Most respondents reported multiple barriers. Among those who did not receive treatment, barriers included low perceived severity (52.9%), perceived treatment ineffectiveness (44.8%), nonfinancial enabling barriers (40.2%), financial barriers (32.9%), and stigma (20.6%). Barriers causing delays showed similar rank-order but higher proportions (χ²=3.8–199.8, p=0.050–<0.001). Barriers were predicted by lower education, disorder type, age, employment status, and financial obstacles, with predictors varying by barrier type.

Maria Carmen Viana, Alan E. Kazdin, Meredith G. Harris, Dan J. Stein, Daniel V. Vigo, Irving Hwang, Sophie M. Manoukian, Nancy A. Sampson, Jordi Alonso, Laura Helena Andrade, Guilherme Borges, Brendan Bunting, José Miguel Caldas-de-Almeida, Giovanni de Girolamo, Peter de Jonge, Oye Gureje, Josep Maria Haro, Elie G. Karam, Viviane Kovess-Masfety, Jacek Moskalewicz, Fernando Navarro-Mateu, Daisuke Nishi, Marina Piazza, José Posada-Villa, Kate M. Scott, Cristian Vladescu, Bogdan Wojtyniak, Zahari Zarkov, Ronald C. Kessler, Timothy Kessler, World Mental Health Survey collaborators