Browsing by Author "Chiu, W. T."

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Findings from world mental health surveys of the perceived helpfulness of treatment for patients with major depressive disorder
(American Medical Association, 2020-05) Harris, M. G.; Kazdin, A. E.; Chiu, W. T.; Sampson, N. A.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Alonso, J.; Altwaijri, Y.; Andrade, L. H.; Cardoso, G.; Cía A.; Florescu, S.; Gureje, O.; Hu, C.; Karam, E. G.; Karam, G.; Mneimneh, Z.; Navarro-Mateu, F.; Oladeji, B. D.; O'Neill, S.; Scott, K.; Slade, T.; Torres, Y.; Vigo, D.; Wojtyniak, B.; Zarkov, Z.; Ziv, Y.; Kessler, R. C.; WHO World Mental Health Survey Collaborators
IMPORTANCE The perceived helpfulness of treatment is an important patient-centered measure that is a joint function of whether treatment professionals are perceived as helpful and whether patients persist in help-seeking after previous unhelpful treatments. OBJECTIVE To examine the prevalence and factors associated with the 2 main components of perceived helpfulness of treatment in a representative sample of individuals with a lifetime history of DSM-IV major depressive disorder (MDD). DESIGN, SETTING, AND PARTICIPANTS This study examined the results of a coordinated series of community epidemiologic surveys of noninstitutionalized adults using theWorld Health OrganizationWorld Mental Health surveys. Seventeen surveys were conducted in 16 countries (8 surveys in high-income countries and 9 in low- and middle-income countries). The dates of data collection ranged from 2002 to 2003 (Lebanon) to 2016 to 2017 (Bulgaria). Participants included those with a lifetime history of treated MDD. Data analyses were conducted from April 2019 to January 2020. Data on socioeconomic characteristics, lifetime comorbid conditions (eg, anxiety and substance use disorders), treatment type, treatment timing, and country income level were collected. MAIN OUTCOMES AND MEASURES Conditional probabilities of helpful treatment after seeing between 1 and 5 professionals; persistence in help-seeking after between 1 and 4 unhelpful treatments; and ever obtaining helpful treatment regardless of number of professionals seen. RESULTS Survey response rates ranged from 50.4%(Poland) to 97.2%(Medellín, Columbia), with a pooled response rate of 68.3%(n = 117 616) across surveys. Mean (SE) age at first depression treatment was 34.8 (0.3) years, and 69.4%were female. Of 2726 people with a lifetime history of treatment of MDD, the cumulative probability (SE) of all respondents pooled across countries of helpful treatment after seeing up to 10 professionals was 93.9% (1.2%), but only 21.5%(3.2%) of patients persisted that long (ie, beyond 9 unhelpful treatments), resulting in 68.2%(1.1%) of patients ever receiving treatment that they perceived as helpful. The probability of perceiving treatment as helpful increased in association with 4 factors: older age at initiating treatment (adjusted odds ratio [AOR], 1.02; 95%CI, 1.01-1.03), higher educational level (low: AOR, 0.48; 95%CI, 0.33-0.70; low-average: AOR, 0.62; 95%CI, 0.44-0.89; high average: AOR, 0.67; 95%CI, 0.49-0.91 vs high educational level), shorter delay in initiating treatment after first onset (AOR, 0.98; 95%CI, 0.97-0.99), and medication received from a mental health specialist (AOR, 2.91; 95%CI, 2.04-4.15). Decomposition analysis showed that the first 2 of these 4 factors were associated with only the conditional probability of an individual treatment professional being perceived as helpful (age at first depression treatment: AOR, 1.02; 95%CI, 1.01-1.02; educational level: low: AOR, 0.48; 95%CI, 0.33-0.70; low-average: AOR, 0.62; 95%CI, 0.44-0.89; high-average: AOR, 0.67; 95%CI, 0.49-0.91 vs high educational level), whereas the latter 2 factors were associated with only persistence (treatment delay: AOR, 0.98; 95%CI, 0.97-0.99; treatment type: AOR, 3.43; 95%CI, 2.51-4.70). CONCLUSIONS AND RELEVANCE The probability that patients with MDD obtain treatment that they consider helpful might increase, perhaps markedly, if they persisted in help-seeking after unhelpful treatments with up to 9 prior professionals.
Parental psychopathology and the risk of suicidal behavior in their offspring: results from the world mental health surveys
(Macmillan Publishers Limited, 2011) Gureje, O.; Oladeji, B.; Hwang, I.; Chiu, W. T.; Kessler, R. C.; Sampson, N. A.; Alonso, J.; Andrade, L. H.; Beautrais, A.; Borges, G.; Bromet, E.; Bruffaerts, R.; de Girolamo, G.; de Graaf, R.; Gal, G.; He, Y.; Hu, C.; Iwata, N.; Karam, E. G.; Kovess-Masféty, V.; Matschinger, H.; Moldovan, M. V.; Posada-Villa, J.; Sagar, R.; Scocco, P.; Seedat, S.; Tomov, T.; Nock, M. K.
Previous research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive aggression (for example, antisocial personality) and anxiety/agitation (for example, panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N= 55 299; age 18þ) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (that is, time since most recent episode controlling for age of onset and time since onset) of subsequent suicidal behavior (suicide ideation, plans and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental antisocial personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt was also found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of intergenerational transmission of suicidal behavior.
Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys
(Elsevier Srl, 2022) Kessler, R. C.; Kazdin, A. E.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Alonso, J.; Altwaijri, Y. A.; Andrade, L. H.; Benjet, C.; Bharat, C.; Borges, G.; Bruffaerts, R.; Bunting, B.; Caldas de Almeida, J. M.; Cardoso, G.; Chiu, W. T.; Cía, A.; Ciutan, M.; Degenhardt, L.; de Girolamo, G.; de Jonge, P.; de Vries, Y. A.; Florescu, S.; Gureje, O.; Haro, J. M.; Harris, M. G.,; Hu, C.; Karam, A. N.; Karam, E. G.; Karam, G.; Kawakami, N.; Kiejna, A.; Kovess-Masfety, V.; Lee, S.; Makanjuola, V.; McGrath, J. J.; Medina-Mora, M. E.; Moskalewicz, J.; Navarro-Mateu, F.; Nierenberg, A. A.; Nishi, D.; Ojagbemi, A.; Oladeji, B. D.; O’Neill, S.; Posada-Villa, J.; Puac-Polanco, V.; Rapsey, C.; Ruscio, A. M.; Sampson, N. A.; Scott, K. M.; Slade, T.; Stagnaro, J. C.; Stein, D. J.; Tachimori, H.; ten Have, M.; Torres, Y.; Viana, M. C.; Vigo, D. V.; Williams, D. R.; Wojtyniak, B.; Xavier, M.; Zarkov, Z.; Ziobrowski, H. N.; WHO WMH survey collaborators
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.
Pre-marital predictors of marital violence in the WHO World mental health (WMH) surveys
(Springer, 2019) Stokes, C. M.; Alonso, J.; Andrade, L. H.; Atwoli, L.; Cardoso, G.; Chiu, W. T.; Dinolova, R. V.; Gureje, O.; Karam, A. M.; Karam, G.; Kessler, R. C.; Chatterji, S.; King, A.; Lee, S.; Mneimneh, Z.; Oladeji, B. D.; Petukhova, M.; Rapsey, C.; Sampson, N. A.; Scott, K.; Street, A.; Viana, M. C.; Williams, M. A.; Bossarte, R. M.
Purpose Intimate partner violence (IPV) is a pervasive public health problem. Existing research has focused on reports from victims and few studies have considered pre-marital factors. The main objective of this study was to identify pre-marital predictors of IPV in the current marriage using information obtained from husbands and wives. Methods Data from were obtained from married heterosexual couples in six countries. Potential predictors included demographic and relationship characteristics, adverse childhood experiences, dating violence, and psychiatric disorders. Reports of IPV and other characteristics from husbands and wives were considered independently and in relation to spousal reports. Results Overall, 14.4% of women were victims of IPV in the current marriage. Analyses identified ten significant variables including age at first marriage (husband), education, relative number of previous marriages (wife), history of one or more categories of childhood adversity (husband or wife), history of dating violence (husband or wife), early initiation of sexual intercourse (husband or wife), and four combinations of internalizing and externalizing disorders. The final model was moderately predictive of marital violence, with the 5% of women accounting for 18.6% of all cases of marital IPV. Conclusions Results from this study advance understanding of pre-marital predictors of IPV within current marriages, including the importance of considering differences in the experiences of partners prior to marriage and may provide a foundation for more targeted primary prevention efforts.