Evidence map›Paper›PMID 41413555›Full record

ArticleInternational journal of mental health systems2025

Predictors and barriers to minimally adequate treatment among treated individuals with mental disorders: results from the World Mental Health Surveys.

Julia R Pozuelo, Daniel V Vigo, Alan E Kazdin, Meredith G Harris, Dan J Stein, Maria Carmen Viana, Irving Hwang, Timothy L Kessler, Sophie M Manoukian, Nancy A Sampson and 26 more

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Article in International journal of mental health systems, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

36 authors.

Julia R PozueloDepartment of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, 02115, MA, USA.
Daniel V VigoDepartment of Psychiatry & School of Population and Public Health, Faculty of Medicine, University of British Columbia, UBC Hospital - Detwiller Pavilion, UBC Vancouver Campus, Room 2813, 2255 Wesbrook Mall, Vancouver, V6T 2A1, BC, Canada.
Alan E KazdinDepartment of Psychology, Yale University, 2 Hillhouse Avenue- 208205, New Haven, 06520, CT, USA.
Meredith G HarrisSchool of Public Health, The University of Queensland, C/O QCMHR, Locked Bag 500, Archerfield, 4108, QLD, Australia.
Dan J SteinDepartment of Psychiatry & Mental Health and South African Medical Council Research Unit On Risk and Resilience in Mental Disorders, University of Cape Town, Rondebosch, Cape Town, 7925, ZA, South Africa.
Maria Carmen VianaDepartment of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Av. Marechal Campos, 1468CEP 29.043-900, Vitória, Espírito Santo (ES), Brazil.
Irving HwangDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, 02115, MA, USA.
Timothy L KesslerThe Watson Institute for International and Public Affairs, Brown University, 111 Thayer St., Providence, 02912, RI, USA.
Sophie M ManoukianDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, 02115, MA, USA.
Nancy A SampsonDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, 02115, MA, USA.
Sergio Aguilar-GaxiolaDepartment of Internal Medicine, Center for Reducing Health Disparities, UC Davis Health System, 2921 Stockton Blvd., Suite 1408, Sacramento, 95817, CA, USA.
Jordi AlonsoIMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, Barcelona, 08003, Spain.
Laura Helena AndradeUniversity of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica - LIM 23, Rua Dr., Ovidio Pires de Campos, São Paulo, 78505403-010, CEP, Brazil.
Olatunde O AyindeDepartment of Psychiatry, University of Ibadan, University College Hospital, Ibadan, 5116, PMB, Nigeria.
Ronny BruffaertsUniversitair Psychiatrisch Centrum, Katholieke Universiteit Leuven (KUL), Campus Gasthuisberg, Herestraat 49, B-3000, Louvain, Belgium.
Brendan BuntingSchool of Psychology, Ulster University, Coleraine Campus, Coleraine, BT52 1SA, UK.
José Miguel Caldas-de-AlmeidaLisbon Institute for Global Mental Health, Comprehensive Health Research Centre Nova University of Lisbon, Rua Do Instituto Bacteriológico, 5, Lisbon, 1150-190, Portugal.
Stephanie ChardoulSurvey Research Center, Institute for Social Research, University of Michigan, 330 Packard, Room G358, Ann Arbor, 48104, MI, USA.
Giovanni de GirolamoIRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni 4, Brescia, Italy.
Cristina DomenechParc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain.
Oye GurejeDepartment of Psychiatry, University of Ibadan, University College Hospital, Ibadan, 5116, PMB, Nigeria.
Elie G KaramInstitute for Development Research Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon.
Andrzej KiejnaFaculty of Applied Studies, University of Lower Silesia, Ul. Strzegomska 55, Wrocław, 53-611, Poland.
Viviane Kovess-MasfetyInstitut de Psychologie, UR 4057, Université Paris Cité, 71 avenue Édouard Vaillant, Boulogne Billancourt, 92100, Paris, France.
Maria Elena Medina-MoraNational Institute of Psychiatry Ramón de La Fuente Muñiz, Calz. Mexico-Xochimilco 101, San Lorenzo Huipulco, 14370, Ciudad de Mexico, Mexico.
Jacek MoskalewiczInstitute of Psychiatry and Neurology, Sobieskiego 9, Warsaw, 02-957, Poland.
Fernando Navarro-MateuUnidad de Docencia, Investigacion y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, Murcia Health Service, C/Lorca, nº 58. -El Palmar, Murcia, 30120, Spain.
Daisuke NishiDepartment of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
Marina PiazzaFacultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martín de Porres, 15102, Lima, Peru.
José Posada-VillaColombian Institute of the Nervous System, Clinica Montserrat University Hospital, Calle 134 No. 17-71, Bogotá, Colombia.
Kate M ScottDepartment of Psychological Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
Margreet Ten HaveTrimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Da Costakade 45 Postbus 725, Utrecht, 3500, 3521 VS, The Netherlands.
Yolanda TorresCenter for Excellence On Research in Mental Health, CES University, Medellín, Colombia.
Cristian VladescuNational Institute for Health Services Management, 31 Vaselor Str., Bucharest, 21253, Romania.
Ronald C KesslerDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, 02115, MA, USA. kessler@hcp.med.harvard.edu.
World Mental Health Survey collaborators

Funding

Risk Factors for Psychopathology in the WHO WMH SurveysR01MH070884 · NIMH · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI KESSLER, RONALD C · 2005 to 2009
$6.0M
Improving Outcomes in Depression in Primary Care in a Low Resource SettingR01MH121632 · NIMH · HARVARD MEDICAL SCHOOL · PI HOLLON, STEVEN DENNIS, PATEL, VIKRAM H · 2022 to 2025
$5.0M
Social Role Disability and Mental-Physical Co-MorbidityR01MH069864 · NIMH · KAISER FOUNDATION HEALTH PLAN OF WASHINGTON · PI VON KORFF, MICHAEL R · 2004 to 2007
$2.2M
CROSS-NATIONAL STUDIES OF DRUG INVOLVEMENT: WMH2000R01DA016558 · NIDA · MICHIGAN STATE UNIVERSITY · PI ANTHONY, JAMES CHRISTOPHER · 2003 to 2008
$1.7M
World Mental Health Consortium Annual Meeting 2003-07R13MH066849 · NIMH · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI HEERINGA, STEVEN G · 2003 to 2007
$735k
Lebanon-Epidemiology: The NCS Replication StudyR03TW006481 · FIC · HARVARD UNIVERSITY (MEDICAL SCHOOL) · PI KESSLER, RONALD C · 2004 to 2006
$142k
FIC NIH HHS R03 TW006481FIC NIH HHS R03-TW006481John D. and Catherine T. MacArthur Foundation R13-MH066849NIDA NIH HHS R01 DA016558NIMH NIH HHS 5R01MH121632-02NIMH NIH HHS R01 MH069864NIMH NIH HHS R01 MH070884NIMH NIH HHS R01 MH121632NIMH NIH HHS R13 MH066849Pfizer Foundation R01-MH069864
6 · The paper itself

Abstract

backgroundTreatments for mental disorders vary widely in type and quality, with many patients failing to receive treatments that meet even minimally adequate standards. We use data from the World Mental Health (WMH) surveys to investigate this variation by examining the prevalence and correlates of minimally adequate treatment (MAT) among patients receiving treatment for common mental disorders.

methodsData comes from 25 WMH cross-sectional surveys implemented in 21 countries (n = 1,838 respondents with n = 3,538 12-month treated disorders). MAT was defined according to widely used criteria: pharmacotherapy (≥ 1 month of medication with ≥ four visits to a healthcare provider) or counseling (≥ eight sessions with any provider). Multivariable regression analyses were used to examine associations of socio-demographic, disorder-related, and treatment-related factors with MAT.

resultsApproximately two-thirds (66.2%) of treated cases met MAT criteria. There was limited variation in MAT prevalence across disorder types, number of disorders, or years since disorder onset, but MAT prevalence was positively associated with increased disorder severity. Socio-demographic differences were nonsignificant. Relatively substantial differences in MAT prevalence were found by treatment sector (highest MAT prevalence among patients treated by mental health specialists and those treated by multiple provider types). Further analysis showed that these associations were explained by differences in premature discontinuation, completion of a full course of treatment that did not qualify as MAT, and still being in treatment at the time of interview that did not yet qualify as MAT. Low perceived disorder severity unrelated to more objective measures of severity was a central factor in accounting for premature discontinuation.

conclusionsWhile approximately two-thirds of treated cases meet MAT criteria, significant gaps remain involving both premature discontinuation and cases where respondents reported completing a 'full recommended course of treatment' that did not involve enough visits or medication duration to meet the MAT standards. Expanding access to mental health specialty providers and increasing patient education about disorder severity would be useful in increasing the proportion of treated cases that receive MAT. Future research should focus on validating MAT definitions against clinical outcomes, standardizing assessment frameworks, and exploring provider- and system-level determinants of treatment adequacy.

Indexed as

Adequacy of treatmentCross-nationalMental disorders treatmentMinimally adequate treatmentWorld mental health survey consortium

Identifiers

PMID41413555
PMCPMC12720457

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