Table 3.
Statistically significant pooled within-country and country-level predictors of 12-month treatment mediated through barriersa
| Total | Low perceived severity | Financial | Other enabling | Low perceived treatment effectiveness | Perceived stigma | |
|---|---|---|---|---|---|---|
| RR (95% CI) | RR (95% CI) | RR (95% CI) | RR (95% CI) | RR (95% CI) | RR (95% CI) | |
| I. Socio-demographics | ||||||
| Education not high | 0.9* (0.8–1.0) | 0.9* (0.9–1.0) | 0.9* (0.8–1.0) | 0.9 (0.9–1.0) | 1.0 (0.9–1.0) | 0.9* (0.8–1.0) |
| X21 | 8.7* | 5.1* | 4.7* | 3.6 | 1.2 | 5.7* |
| Health insurance | 1.5* (1.2–1.8) | 1.3* (1.1–1.6) | 1.1 (0.9–1.3) | 1.3* (1.1–1.5) | 1.4* (1.1–1.7) | 1.4* (1.2–1.7) |
| X21 | 13.9* | 12.6* | 1.3 | 10.1* | 11.1* | 14.0* |
| Group X22 | 28.7* | 19.5* | 6.3* | 14.8* | 13.6* | 22.8* |
| II. 12-month DSM-IV/CIDI disorders | ||||||
| GAD | 1.1* (1.0–1.2) | 1.0 (1.0–1.1) | 1.1* (1.0–1.2) | 1.1* (1.0–1.2) | 1.0 (1.0–1.1) | 1.1 (1.0–1.2) |
| X21 | 4.6* | 0.8 | 5.7* | 5.1* | 1.2 | 2.9 |
| Panic/Ago | 1.2* (1.1–1.3) | 1.2* (1.1–1.3) | 1.2* (1.1–1.3) | 1.2* (1.1–1.3) | 1.2* (1.1–1.3) | 1.2* (1.1–1.3) |
| X21 | 19.9* | 20.0* | 22.4* | 23.5* | 23.7* | 22.1* |
| PTSD | 1.1* (1.0–1.2) | 1.1* (1.0–1.2) | 1.1* (1.0–1.2) | 1.1* (1.0–1.2) | 1.1* (1.0–1.2) | 1.2* (1.1–1.3) |
| X21 | 3.9* | 5.3* | 5.5* | 6.4* | 7.1* | 11.7* |
| MDD | 1.4* (1.3–1.6) | 1.3* (1.2–1.5) | 1.4* (1.3–1.6) | 1.4* (1.2–1.5) | 1.3* (1.2–1.4) | 1.4* (1.2–1.5) |
| X21 | 48.2* | 51.2* | 51.0* | 43.0* | 36.8* | 43.2* |
| BD | 1.2* (1.0–1.3) | 1.2* (1.1–1.3) | 1.1 (1.0–1.3) | 1.1 (1.0–1.3) | 1.0 (0.9–1.2) | 1.1 (1.0–1.3) |
| X21 | 4.3* | 8.0* | 3.1 | 3.3 | 0.3 | 3.6 |
| Group X25 | 82.1* | 80.8* | 89.9* | 84.4* | 82.3* | 85.5* |
| Disorder severity (compared to mild) | ||||||
| Severe | 1.3* (1.1–1.5) | 1.2* (1.0–1.3) | 1.4* (1.2–1.6) | 1.3* (1.1–1.5) | 1.3* (1.1–1.4) | 1.3* (1.1–1.5) |
| Moderate |
1.2 (1.0–1.4) |
1.1 (1.0–1.3) | 1.2* (1.0–1.4) | 1.2* (1.0–1.4) | 1.1 (1.0–1.3) | 1.2 (1.0–1.4) |
| X22 | 12.7* | 7.3* | 17.8* | 15.4* | 16.8* | 17.2* |
| III. History of prior treatment | ||||||
| Types of providers | ||||||
| Psychiatrist | 0.6* (0.5–0.8) | 0.7* (0.6–0.9) | 0.6* (0.5–0.8) | 0.7* (0.5–0.9) | 0.7* (0.5–0.8) | 0.6* (0.5–0.8) |
| Other mental health | 0.5* (0.4–0.7) | 0.7* (0.5–0.8) | 0.6* (0.5–0.8) | 0.6* (0.5–0.8) | 0.6* (0.5–0.8) | 0.5* (0.4–0.7) |
| General medical | 0.6* (0.4–0.7) | 0.7* (0.5–0.9) | 0.6* (0.5–0.7) | 0.6* (0.5–0.8) | 0.6* (0.5–0.8) | 0.6* (0.4–0.7) |
| Human services | 0.6* (0.5–0.8) | 0.8 (0.6–1.0) | 0.6* (0.5–0.8) | 0.7* (0.5–0.9) | 0.7* (0.5–0.9) | 0.6* (0.5–0.8) |
| CAM | 0.5* (0.4–0.6) | 0.6* (0.5–0.8) | 0.5* (0.4–0.7) | 0.6* (0.4–0.7) | 0.5* (0.4–0.7) | 0.5* (0.4–0.6) |
| X25 | 45.8* | 20.1* | 29.8* | 24.7* | 38.2* | 42.9* |
| Number of provider types | ||||||
| 2 | 2.3* (1.7–3.1) | 1.7* (1.3–2.3) | 2.0* (1.6–2.6) | 1.9* (1.5–2.6) | 2.0* (1.5–2.6) | 2.2* (1.7–3.0) |
| 3 | 4.4* (2.6–7.4) | 2.6* (1.6–4.2) | 3.5* (2.2–5.7) | 3.1* (1.9–5.1) | 3.3* (2.0–5.4) | 4.2* (2.5–7.1) |
| 4 | 7.9* (3.7–17.0) | 3.6* (1.8–7.3) | 6.1* (3.0–12.4) | 5.0* (2.4–10.4) | 5.6* (2.8–11.4) | 7.4* (3.4–16.2) |
| 5 | 15.9* (5.6–44.5) | 5.5* (2.1–14.4) | 10.9* (4.2–28.7) | 8.2* (3.0–22.2) | 9.6* (3.7–24.6) | 14.4* (5.0–41.5) |
| X24 | 32.7* | 19.2* | 28.6* | 24.2* | 25.4* | 30.3* |
| Helpfulness of prior treatment | ||||||
| Helpful tx for any 12-mo dx | 3.1* (2.5–4.0) | 2.2* (1.7–2.7) | 2.9* (2.3–3.6) | 2.6* (2.1–3.3) | 2.5* (2.1–3.2) | 2.9* (2.3–3.7) |
| Unhelpful tx for any 12-mo dx | 1.9* (1.5–2.5) | 1.6* (1.3–2.0) | 1.9* (1.5–2.4) | 1.8* (1.4–2.3) | 2.1* (1.6–2.6) | 2.0* (1.5–2.5) |
| X22 | 153.1* | 85.4* | 156.7* | 121.1* | 92.8* | 133.2* |
| IV. Country-level variablesb | ||||||
| Non-psychiatrist MDs/population | 1.1 (1.1–1.2) | 1.1* (1.1–1.2) | 1.1* (1.0–1.1) | 1.1* (1.0–1.1) | 1.1* (1.1–1.2) | 1.1* (1.0–1.1) |
| X21 | 26.3* | 18.7* | 7.5* | 5.0* | 26.8* | 9.8* |
| (n) | (4039) | (2721) | (3219) | (3006) | (2930) | (3521) |
Total all respondents with 12-month DSM-IV/CIDI disorders and perceived need excluding those missing reasons (n = 1,097), Low perceived severity excluding those who did not obtain any 12-month treatment and reported low perceived severity, Financial excluding those who did not obtain any 12-month treatment and reported financial reasons for not doing so, Other enabling excluding those who did not obtain any 12-month treatment and reported nonfinancial barriers in the domain of enabling factors, Low perceived treatment effectiveness excluding those who did not obtain any 12-month treatment and reported low perceived treatment effectiveness, Stigma excluding those who did not obtain any 12-month treatment and reported perceived stigma, RR risk-ratio predicting 12-month treatment using a Poisson link function for pooled within-country associations of the predictors with the outcome, 95% CI design-based 95% confidence interval of RR taking into consideration the weighting and geographic clustering of the WMH data, See footnotes to earlier tables for abbreviations of predictors; n, the 4,039 respondents with 12-month disorders, perceived need, and asked about reasons for not seeking treatment. The smaller numbers in the remaining columns reflect the exclusion of respondents who did not obtain any 12-month treatment and reported the reasons indicated by the column heading
aBased on multivariable Poisson regression models to predict 12-month treatment across all WMH surveys, with surveys weighted by sample size rather than by country population size with dummy variables for country included as controls, allowing coefficients to be interpreted as pooled weighted within-country coefficients. Respondents with none of the five barriers are kept in the sample for the regression models and coded to 0
bResults are from a separate model controlling for the same predictors but including the country-level variables as an additional predictor
*Significant at the 0.05 level, two-sided design-based test