Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys – 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) – carried out as part of the World Health Organization (WHO)’s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.

中文翻译：

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世界卫生组织世界精神卫生调查中患者报告的常见精神和物质使用障碍治疗帮助的模式和相关性

患者报告的治疗有用性是衡量以患者为中心的护理质量的重要指标。我们在家庭调查的受访者中检查了其途径和预测因素，这些受访者报告曾接受过严重抑郁症、广泛性焦虑症、社交恐惧症、特定恐惧症、创伤后应激障碍、双相情感障碍或酒精使用障碍治疗。数据来自 30 项社区流行病学调查——17 项在高收入国家 (HIC)，13 项在低收入和中等收入国家 (LMIC)——作为世界卫生组织 (WHO) 世界精神卫生 (WMH) 的一部分进行） 调查。受访者被问及每种疾病的治疗是否有帮助，如果有，在接受有帮助的治疗之前看过的专业人员数量。在所有调查和诊断类别中，26.1% 的患者（N=10，035) 报告说得到了他们看到的第一个专业人士的帮助。在第一次没有帮助的治疗后坚持到第二位专业人员使接受有帮助的治疗的累积概率达到 51.2%。如果患者坚持使用多达 8 位专业人员，累积概率上升到 90.6%。然而，估计只有 22.8% 的患者在反复接受他们认为没有帮助的治疗后会坚持去看这些专业人士。尽管与 LMICs 相比，寻求治疗的疾病患者的比例更高，并且在 HICs 中更持久，但在 HICs 和 LMICs 之间治疗病例的比例帮助没有差异。发现了广泛的感知治疗有用性的预测因子，其中一些在诊断类别中是一致的，而另一些则是特定疾病所独有的。这些结果提供了有关患者对不同诊断和不同收入水平国家治疗评估的新信息，并表明如果早期治疗没有帮助，提高精神障碍护理质量的一个关键问题应该是培养坚持寻求专业帮助的能力。