Pathway to effective treatment for common mental and substance use disorders in the World Mental Health Surveys: Perceived need for treatment

Meredith G Harris^{1

2}, Alan E Kazdin³, Irving Hwang⁴, Sophie M Manoukian⁴, Nancy A Sampson⁴, Dan J Stein⁵, Maria Carmen Viana⁶, Daniel V Vigo^{7

8}, Jordi Alonso^{9

10

11}, Laura Helena Andrade¹², Ronny Bruffaerts¹³, Brendan Bunting¹⁴, José Miguel Caldas-de-Almeida¹⁵, Stephanie Chardoul¹⁶, Giovanni de Girolamo¹⁷, Oye Gureje^{18

19}, Josep Maria Haro^{20

10

21}, Elie G Karam^{22

23

24}, Viviane Kovess-Masfety²⁵, Maria Elena Medina-Mora^{26

27

28}, Fernando Navarro-Mateu^{29

30

27}, Daisuke Nishi²⁸, José Posada-Villa³¹, Charlene Rapsey³², Juan Carlos Stagnaro³³, Margreet Ten Have³⁴, Jacek Wciórka³⁵, Zahari Zarkov³⁶, Ronald C Kessler³⁷; World Mental Health Survey collaborators

Collaborators, Affiliations

Collaborators

World Mental Health Survey collaborators:
Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Jordi Alonso, Yasmin A Altwaijri, Laura Helena Andrade, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Evelyn J Bromet, Ronny Bruffaerts, Brendan Bunting, Jose Miguel Caldas-de-Almeida, Graça Cardoso, Stephanie Chardoul, Alfredo H Cía, Louisa Degenhardt, Giovanni de Girolamo, Ma Lourdes Rosanna E de Guzman, Oye Gureje, Josep Maria Haro, Meredith G Harris, Hristo Hinkov, Chi-Yi Hu, Peter de Jonge, Aimee Nasser Karam, Elie G Karam, Georges Karam, Alan E Kazdin, Norito Kawakami, Ronald C Kessler, Salma Khaled, Andrzej Kiejna, Viviane Kovess-Masfety, John J McGrath, Maria Elena Medina-Mora, Jacek Moskalewicz, Fernando Navarro-Mateu, Daisuke Nishi, Marina Piazza, José Posada-Villa, Kate M Scott, Juan Carlos Stagnaro, Dan J Stein, Margreet Ten Have, Yolanda Torres, Maria Carmen Viana, Daniel V Vigo, Cristian Vladescu, David R Williams, Bogdan Wojtyniak, Peter Woodruff, Miguel Xavier, Alan M Zaslavsky

Affiliations

¹ School of Public Health, The University of Queensland, c/o QCMHR, Locked Bag 500, Archerfield, QLD, 4108, Australia.
² Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wolston Park Rd, Wacol, QLD, 4076, Australia.
³ Department of Psychology, Yale University, 2 Hillhouse Avenue- 208205, New Haven, CT, 06520, USA.
⁴ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
⁵ Department 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.
⁶ Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Rua Dr. Euríco de Águiar, 888/705, Vitoria, ES, 2905-600, Brazil.
⁷ Department of Psychiatry, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada.
⁸ Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
⁹ IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, 08003, Barcelona, Spain.
¹⁰ CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
¹¹ Pompeu Fabra University (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain.
¹² University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica - LIM 23, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, CEP 05403-010, Brazil.
¹³ Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, UZ Herestraat 49 - Box 7003, 3000, Louvain, Belgium.
¹⁴ School of Psychology, Ulster University, Coleraine Campus, BT52 1SA, Coleraine, UK.
¹⁵ Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Rua do Instituto Bacteriológico, 5, Edifício Amarelo, 1150-190, Lisbon, Portugal.
¹⁶ Survey Research Center, Institute for Social Research, University of Michigan, 330 Packard, Room G358, Ann Arbor, MI, 48104, USA.
¹⁷ IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, Brescia, Italy.
¹⁸ Department of Psychiatry, University of Ibadan, University College Hospital, PMB 5116, Ibadan, Nigeria.
¹⁹ Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.
²⁰ Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
²¹ Departament de Medicine, Universitat de Barcelona, Barcelona, Spain.
²² Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon.
²³ Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Ashrafieh, 166378, Lebanon.
²⁴ Faculty of Medicine, Balamand University, Rond Point Saloumeh, Sin el Fil, Beirut, Lebanon.
²⁵ Institut de Psychologie, UR 4057, Université Paris Cité, 71 Avenue Édouard Vaillant, 92100, Boulogne Billancourt, Paris, France.
²⁶ National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, Col San Lorenzo Huipulco, 14370, Mexico City, CDMX, Mexico.
²⁷ Centro de Investigación Biomédica en ERed en Epidemíologia y Salud Pública (CIBERESP), 28029, Madrid, Spain.
²⁸ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-0033, Japan.
²⁹ Unidad de Docencia, Investigacion y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, Murcia Health Service, C/ Lorca, nº 58, 30120, El Palmar, Murcia, Spain.
³⁰ Instituto Murciano de Investigación Biosanitaria - Pascual Parrilla (IMIB-Pascual Parrilla), Hospital Virgen de la Arrixaca, 30120, El Palmar, Murcia, Spain.
³¹ Colombian Institute of the Nervous System, Clinica Montserrat University Hospital, Calle 134 No. 17-71, Bogotá, Colombia.
³² Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
³³ Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Ciudad Autónoma de Buenos Aires, Argentina.
³⁴ Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, Netherlands.
³⁵ Department of Psychiatry, Institute of Psychiatry and Neurology, Jana III Sobieskiego 9, 02-957, Warsaw, Poland.
³⁶ Department of Mental Health, National Center of Public Health and Analyses, 15, Acad. Ivan Geshov Blvd., 1431, Sofia, Bulgaria.
³⁷ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA. kessler@hcp.med.harvard.edu.

PMID: 40410765
PMCID: PMC12100881
DOI: 10.1186/s13033-025-00666-w

Pathway to effective treatment for common mental and substance use disorders in the World Mental Health Surveys: Perceived need for treatment

Meredith G Harris et al. Int J Ment Health Syst. 2025.

. 2025 May 23;19(1):17.

doi: 10.1186/s13033-025-00666-w.

Authors

Collaborators

World Mental Health Survey collaborators:
Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Jordi Alonso, Yasmin A Altwaijri, Laura Helena Andrade, Lukoye Atwoli, Corina Benjet, Guilherme Borges, Evelyn J Bromet, Ronny Bruffaerts, Brendan Bunting, Jose Miguel Caldas-de-Almeida, Graça Cardoso, Stephanie Chardoul, Alfredo H Cía, Louisa Degenhardt, Giovanni de Girolamo, Ma Lourdes Rosanna E de Guzman, Oye Gureje, Josep Maria Haro, Meredith G Harris, Hristo Hinkov, Chi-Yi Hu, Peter de Jonge, Aimee Nasser Karam, Elie G Karam, Georges Karam, Alan E Kazdin, Norito Kawakami, Ronald C Kessler, Salma Khaled, Andrzej Kiejna, Viviane Kovess-Masfety, John J McGrath, Maria Elena Medina-Mora, Jacek Moskalewicz, Fernando Navarro-Mateu, Daisuke Nishi, Marina Piazza, José Posada-Villa, Kate M Scott, Juan Carlos Stagnaro, Dan J Stein, Margreet Ten Have, Yolanda Torres, Maria Carmen Viana, Daniel V Vigo, Cristian Vladescu, David R Williams, Bogdan Wojtyniak, Peter Woodruff, Miguel Xavier, Alan M Zaslavsky

Affiliations

¹ School of Public Health, The University of Queensland, c/o QCMHR, Locked Bag 500, Archerfield, QLD, 4108, Australia.
² Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wolston Park Rd, Wacol, QLD, 4076, Australia.
³ Department of Psychology, Yale University, 2 Hillhouse Avenue- 208205, New Haven, CT, 06520, USA.
⁴ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
⁵ Department 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.
⁶ Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Rua Dr. Euríco de Águiar, 888/705, Vitoria, ES, 2905-600, Brazil.
⁷ Department of Psychiatry, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada.
⁸ Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
⁹ IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, 08003, Barcelona, Spain.
¹⁰ CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
¹¹ Pompeu Fabra University (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain.
¹² University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica - LIM 23, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, CEP 05403-010, Brazil.
¹³ Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, UZ Herestraat 49 - Box 7003, 3000, Louvain, Belgium.
¹⁴ School of Psychology, Ulster University, Coleraine Campus, BT52 1SA, Coleraine, UK.
¹⁵ Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Rua do Instituto Bacteriológico, 5, Edifício Amarelo, 1150-190, Lisbon, Portugal.
¹⁶ Survey Research Center, Institute for Social Research, University of Michigan, 330 Packard, Room G358, Ann Arbor, MI, 48104, USA.
¹⁷ IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, Brescia, Italy.
¹⁸ Department of Psychiatry, University of Ibadan, University College Hospital, PMB 5116, Ibadan, Nigeria.
¹⁹ Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa.
²⁰ Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
²¹ Departament de Medicine, Universitat de Barcelona, Barcelona, Spain.
²² Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon.
²³ Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Ashrafieh, 166378, Lebanon.
²⁴ Faculty of Medicine, Balamand University, Rond Point Saloumeh, Sin el Fil, Beirut, Lebanon.
²⁵ Institut de Psychologie, UR 4057, Université Paris Cité, 71 Avenue Édouard Vaillant, 92100, Boulogne Billancourt, Paris, France.
²⁶ National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, Col San Lorenzo Huipulco, 14370, Mexico City, CDMX, Mexico.
²⁷ Centro de Investigación Biomédica en ERed en Epidemíologia y Salud Pública (CIBERESP), 28029, Madrid, Spain.
²⁸ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo, Tokyo, 113-0033, Japan.
²⁹ Unidad de Docencia, Investigacion y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, Murcia Health Service, C/ Lorca, nº 58, 30120, El Palmar, Murcia, Spain.
³⁰ Instituto Murciano de Investigación Biosanitaria - Pascual Parrilla (IMIB-Pascual Parrilla), Hospital Virgen de la Arrixaca, 30120, El Palmar, Murcia, Spain.
³¹ Colombian Institute of the Nervous System, Clinica Montserrat University Hospital, Calle 134 No. 17-71, Bogotá, Colombia.
³² Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
³³ Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Ciudad Autónoma de Buenos Aires, Argentina.
³⁴ Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, Netherlands.
³⁵ Department of Psychiatry, Institute of Psychiatry and Neurology, Jana III Sobieskiego 9, 02-957, Warsaw, Poland.
³⁶ Department of Mental Health, National Center of Public Health and Analyses, 15, Acad. Ivan Geshov Blvd., 1431, Sofia, Bulgaria.
³⁷ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA. kessler@hcp.med.harvard.edu.

PMID: 40410765
PMCID: PMC12100881
DOI: 10.1186/s13033-025-00666-w

Abstract

Background: Perceived need for treatment is a first step along the pathway to effective mental health treatment. Perceived need encompasses a person's recognition that they have a problem and their belief that professional help is needed to manage the problem. These two components could have different predictors.

Methods: Respondents aged 18+ years with 12-month mental disorders from 25 representative household surveys in 21 countries in the World Mental Health Survey Initiative (n = 12,508). All surveys included questions about perceived need; 16 surveys (13 countries) included additional questions about respondents' main reason for perceived need-problem recognition or perceived inability to manage without professional help (n = 9814). Associations of three sets of predictors (disorder, socio-demographics, past treatment) with perceived need and its components were examined using Poisson regression models.

Results: Across the 16 surveys with additional questions, 42.4% of respondents with a 12-month mental disorder reported perceived need for treatment. In separate multivariable models for each predictor set: (1) Most disorder types (except alcohol use disorder, specific phobia), disorder severity, and number of disorders were associated with perceived need and both of its components; (2) Sociodemographic factors tended to differentially predict either problem recognition (females, 30-59 years, disabled/unemployed) or need for professional help (females, homemakers, disabled/unemployed, public insurance); (3) Past treatment factors (type of professional, psychotherapy, helpful or unhelpful treatment) were associated with perceived need and both components, except number of past professionals differentially predicted problem recognition. In a consolidated model: employment and insurance became non-significant; type and number of past professionals seen became more important; helpful past treatment predicted greater need for professional help while unhelpful treatment predicted lower problem recognition. Problem recognition was the more important component in determining perceived need for some groups (e.g., severe disorder, people who consulted non-mental health professionals).

Conclusions: Greater clinical need is a key determinant of perceived need for treatment. Findings suggest a need for strategies to address low perceived need (e.g., in males, older people, alcohol use disorders) and lower endorsement of professional treatment in some groups, and to improve patient's treatment experiences which are important enablers of future help-seeking.

Keywords: Health professionals; Mental disorders; Mental health services; Perceived helpfulness; Perceived need for treatment; Substance use disorders; Treatment history.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study has been performed in accordance with the Declaration of Helsinki. At all survey sites, the local ethics or institutional review committee reviewed and approved the protocol to ensure protection of human subjects, in line with appropriate international and local guidelines. Details of the ethics committees for the WMH surveys can be viewed at this link: http://www.hcp.med.harvard.edu/wmh/ftpdir/WMH_Ethics_approval.pdf Consent for publication: Not applicable. Competing interests: Dr. Dan J. Stein reports personal fees from Discovery Vitality, Johnson & Johnson, Kanna, L’Oreal, Lundbeck, Orion, Sanofi, Servier, Takeda and Vistagen. In the past 3 years, Dr. Kessler was a consultant for Cambridge Health Alliance, Canandaigua VA Medical Center, Child Mind Institute, Holmusk, Massachusetts General Hospital, Partners Healthcare, Inc., RallyPoint Networks, Inc., Sage Therapeutics and University of North Carolina. He has stock options in Cerebral Inc., Mirah, PYM (Prepare Your Mind), Roga Sciences and Verisense Health. All other authors report no conflicts of interest related to this manuscript.

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Pathway to effective treatment for common mental and substance use disorders in the World Mental Health Surveys: Perceived need for treatment

Collaborators

Affiliations

Pathway to effective treatment for common mental and substance use disorders in the World Mental Health Surveys: Perceived need for treatment

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources

Miscellaneous