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. 2025 Jun:348:116459.
doi: 10.1016/j.psychres.2025.116459. Epub 2025 Mar 24.

Treatment and long-term outcome of mental disorders: The grim picture from a quasi-epidemiological investigation in 54,826 subjects from 40 countries

Konstantinos N Fountoulakis  1 , Gregory Karakatsoulis  2 , Seri Abraham  3 , Kristina Adorjan  4 , Helal Uddin Ahmed  5 , Renato D Alarcón  6 , Kiyomi Arai  7 , Sani Salihu Auwal  8 , Michael Berk  9 , Sarah Levaj  10 , Julio Bobes  11 , Teresa Bobes-Bascaran  12 , Julie Bourgin-Duchesnay  13 , Cristina Ana Bredicean  14 , Laurynas Bukelskis  15 , Akaki Burkadze  16 , Indira Indiana Cabrera Abud  17 , Ruby Castilla-Puentes  18 , Marcelo Cetkovich  19 , Hector Colon-Rivera  20 , Ricardo Corral  21 , Carla Cortez-Vergara  22 , Piirika Crepin  23 , Domenico De Berardis  24 , Sergio Zamora Delgado  25 , David De Lucena  26 , Avinash De Sousa  27 , Ramona Di Stefano  28 , Seetal Dodd  29 , Livia Priyanka Elek  30 , Anna Elissa  31 , Berta Erdelyi-Hamza  32 , Gamze Erzin  33 , Martin J Etchevers  34 , Peter Falkai  35 , Adriana Farcas  36 , Ilya Fedotov  37 , Viktoriia Filatova  38 , Nikolaos K Fountoulakis  39 , Iryna Frankova  40 , Francesco Franza  41 , Pedro Frias  42 , Tatiana Galako  43 , Cristian J Garay  44 , Leticia Garcia-Álvarez  45 , Maria Paz García-Portilla  46 , Xenia Gonda  47 , Tomasz M Gondek  48 , Daniela Morera González  49 , Hilary Gould  50 , Paolo Grandinetti  51 , Arturo Grau  52 , Violeta Groudeva  53 , Michal Hagin  54 , Takayuki Harada  55 , Tasdik M Hasan  56 , Salmi Razali  57 , Jan Hilbig  58 , Sahadat Hossain  59 , Rossitza Iakimova  60 , Mona Ibrahim  61 , Felicia Iftene  62 , Yulia Ignatenko  63 , Matias Irarrazaval  64 , Zaliha Ismail  65 , Jamila Ismayilova  66 , Asaf Jakobs  67 , Miro Jakovljević  68 , Nenad Jakšić  69 , Afzal Javed  70 , Helin Yilmaz Kafali  71 , Sagar Karia  72 , Olga Kazakova  73 , Doaa Khalifa  74 , Olena Khaustova  75 , Steve Koh  76 , Svetlana Kopishinskaia  77 , Korneliia Kosenko  78 , Nikolett Beata Vadon  79 , Alisha Lalljee  80 , Justine Liewig  81 , Abdul Majid  82 , Evgeniia Malashonkova  83 , Khamelia Malik  84 , Najma Iqbal Malik  85 , Gulay Mammadzada  86 , Bilvesh Mandalia  87 , Donatella Marazziti  88 , Darko Marčinko  89 , Stephanie Martinez  90 , Eimantas Matiekus  91 , Gabriela Mejia  92 , Roha Saeed Memon  93 , Xarah Elenne Meza Martínez  94 , Dalia Mickevičiūtė  95 , Roumen Milev  96 , Muftau Mohammed  97 , Alejandro Molina-López  98 , Petr Morozov  99 , Nuru Suleiman Muhammad  100 , Filip Mustač  101 , Mika S Naor  102 , Amira Nassieb  103 , Alvydas Navickas  104 , Tarek Okasha  105 , Milena Pandova  106 , Anca-Livia Panfil  107 , Liliya Panteleeva  108 , Ion Papava  109 , Alexey Pavlichenko  110 , Bojana Pejuskovic  111 , Mariana Pinto da Costa  112 , Mikhail Popkov  113 , Dina Popovic  114 , Nor Jannah Nasution Raduan  115 , Francisca Vargas Ramírez  116 , Elmars Rancans  117 , Nurul Azreen Hashim  118 , Federico Rebok  119 , Anna Rewekant  120 , Elena Ninoska Reyes Flores  121 , María Teresa Rivera-Encinas  122 , Pilar Saiz  123 , Manuel Sánchez de Carmona  124 , David Saucedo Martínez  125 , Jo Anne Saw  126 , Görkem Saygili  127 , Patricia Schneidereit  128 , Bhumika Shah  129 , Tomohiro Shirasaka  130 , Ketevan Silagadze  131 , Satti Sitanggang  132 , Oleg Skugarevsky  133 , Anna Spikina  134 , Sridevi Sira Mahalingappa  135 , Maria Stoyanova  136 , Anna Szczegielniak  137 , Simona Claudia Tamasan  138 , Giuseppe Tavormina  139 , Maurilio Giuseppe Maria Tavormina  140 , Mauricio Tohen  141 , Eva Maria Tsapakis  142 , Dina Tukhvatullina  143 , Irfan Ullah  144 , Ratnaraj Vaidya  145 , Johann M Vega-Dienstmaier  146 , Jelena Vrublevska  147 , Olivera Vukovic  148 , Olga Vysotska  149 , Natalia Widiasih  150 , Anna Yashikhina  151 , Daria Smirnova  152
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Free article

Treatment and long-term outcome of mental disorders: The grim picture from a quasi-epidemiological investigation in 54,826 subjects from 40 countries

Konstantinos N Fountoulakis et al. Psychiatry Res. 2025 Jun.
Free article

Abstract

Introduction: This study registered rates of specific treatment options for mental disorders as well as their long-term outcome.

Material and methods: The history of mental disorders was used as a proxy for diagnosis. The data came from the COMET-G study (40 countries; 54,826 subjects, 64.73 % females, 35.45±13.51 years old). The analysis included descriptive statistics, Risk Ratios, t-tests, and ANCOVA's.

Results: 24.14 % reported a history of any mental disorder (depression >12 %, non-affective psychosis and Bipolar disorder 1 % each, >20 % self-injury, >10 % had attempted suicide, 7.17 % illegal substance abuse). Most patients were not under any kind of treatment (59.44 %) and most were not receiving treatment as recommended (e.g. 90 % of Bipolar and 2/3 of psychotic patients). No treatment at all and psychotherapy as monotherapy were consistently related to poorer outcomes. In anxiety or depression, only antidepressant monotherapy and benzodiazepines, in Bipolar disorder only antipsychotic monotherapy in males and antidepressant monotherapy in females and in non-affective psychosis antipsychotics and psychotherapy in females only, were related to good outcomes. No treatment modality was related to a good outcome in those with a history of self-harm, suicidal attempts, or illegal substance use. Only depression and treatment with antidepressants were related to metabolic syndrome.

Discussion: In the community, the overwhelming majority of mental patients do not receive appropriate treatment or, even worse, no treatment at all. The outcome is unfavourable for the majority and only a few selective treatment options seem to make a difference.

Keywords: Disability; Epidemiology; Mental health; Metabolic syndrome; Outcomes; Psychiatry; Treatment.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.