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

Viana M.C.; Kazdin A.E.; Harris M.G.; Stein D.J.; Vigo D.V.; Hwang I.; Manoukian S.M.; Sampson N.A.; Alonso J.; Andrade L.H.; Borges G.; Bunting B.; Caldas-de-Almeida J.M.; de Girolamo G.; de Jonge P.; Gureje O.; Haro J.M.; Karam E.G.; Kovess-Masfety V.; Moskalewicz J.; Navarro-Mateu F.; Nishi D.; Piazza M.; Posada-Villa J.; Scott K.M.; Vladescu C.; Wojtyniak B.; Zarkov Z.; Kessler R.C.; Kessler T.; Zaslavsky A.M.; Xavier M.; Woodruff P.; Williams D.R.; Torres Y.; Have M.T.; Stagnaro J.C.; Medina-Mora M.E.; McGrath J.J.; Kiejna A.; Khaled S.; Kawakami N.; Karam G.; Karam A.N.; Jonge P.D.; Hu C.-Y.; Hinkov H.; Guzman M.L.R.E.D.; Degenhardt L.; Cía A.H.; Chardoul S.; Cardoso G.; Bruffaerts R.; Bromet E.J.; Benjet C.; Atwoli L.; Altwaijri Y.A.; Al-Hamzawi A.; Aguilar-Gaxiola S. · International Journal of Mental Health Systems (2025) · DOI: 10.1186/s13033-024-00658-2

Resumen

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 [interquartile range]: 43 [31–57] years; 68.5% weighted average response rate) 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. Consistent with previous research, we distinguished five broad classes of barriers: low perceived disorder severity, two types of barriers in the domain of predisposing factors (beliefs/attitudes about treatment ineffectiveness and stigma) and two types in the domain of enabling factors (financial and nonfinancial). Baseline predictors of receiving treatment found in a prior report (i.e., comparing the n = 2,692 respondents who received treatment with the n = 2,444 who did not) were examined as predictors of barriers, while barriers were examined as mediators of associations between these predictors and treatment. Results: Most respondents reported multiple barriers. Barriers among respondents who did not receive treatment included low perceived severity (52.9%), perceived treatment ineffectiveness (44.8%), nonfinancial (40.2%) and financial (32.9%) barriers in the domain of enabling factors, and stigma (20.6%). Barriers causing delays in treatment had a similar rank-order but were reported by higher proportions of respondents (X2 1 = 3.8–199.8, p = 0.050− < 0.001). Barriers were predicted by low education, disorder type, age, employment status, and financial obstacles. Predictors varied as a function of barrier type. Conclusions: A wide range of barriers to treatment exist among people with mental disorders even after a need for treatment is acknowledged. Most such individuals have multiple barriers. These results have important implications for the design of programs to decrease unmet need for treatment of mental disorders. © The Author(s) 2025.

Instituciones: Universidad Peruana Cayetano Heredia