According to a recent study, only 6.9% of patients with DSM-IV mental and substance use disorders received guideline-based treatment. Low perceived need was the primary barrier to care.

Researchers conducted a cross-sectional study analyzing mental health and substance use disorder treatment coverage across 21 countries. Using data from the World Mental Health Surveys, Daniel V. Vigo, MD, DrPH, of the Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada, and colleagues assessed the proportion of participants with DSM-IV disorders who received guideline-consistent treatment. The study, published in JAMA Psychiatry, included 56,927 respondents (69.3% weighted average response rate; 57.7% female; median age, 43 years) surveyed between 2001 and 2019.

The Composite International Diagnostic Interview was used to assess the 12-month prevalence of nine specific disorders: five anxiety disorders (generalized anxiety disorder, panic disorder, agoraphobia, specific phobia, social phobia, and posttraumatic stress disorder), two mood disorders (major depressive disorder and bipolar disorder), and two substance use disorders (alcohol use disorder and drug use disorder). Effective treatment was defined by disorder severity: mild and moderate cases required either effective pharmacotherapy or psychotherapy, while severe cases and bipolar disorder required both.

The results demonstrated that only 6.9% (standard error [SE] = 0.3) of 12-month person-disorders received effective treatment. The largest barriers included low perceived need for treatment (46.5%; SE = 0.6), low treatment contact among those with perceived need (34.1%; SE = 1.0), and low rates of effective treatment among those receiving minimally adequate treatment (47.0%; SE = 1.7). Treatment coverage varied substantially by disorder; effective treatment was more common for anxiety (7.3%; SE = 0.4) and mood (8.4%; SE = 0.4) disorders but significantly lower for substance use disorders (1.7%; SE = 0.4).

Multilevel models identified key predictors of effective treatment. Women were 50% more likely than men to receive effective treatment. Middle-aged adults (30-59 years) had a higher likelihood of receiving effective treatment compared with younger (18-29 years) and older (≥60 years) participants. Higher education and health insurance were also associated with increased treatment rates. Family income showed no significant correlation with effective treatment rates. At the country level, increased per capita health care spending and greater availability of nonpsychiatrist physicians were associated with higher treatment rates.

Full disclosures can be found in the published study.