Persistence is Key in Turning Around Unhelpful Depression Treatments

Meredith G. Harris, PhD

The perceived helpfulness of depression treatment is an important metric that is a joint function of whether treatment professionals are perceived as helpful and whether patients persist in help-seeking following previous unhelpful treatments.

A team representing 19 countries, led by Meredith G. Harris, PhD, University of Queensland School of Public Health, surveyed depression patients to see if treatment becomes more helpful if they persist through early unhelpful treatment.

The researchers examined 80,332 results from a coordinated series of community epidemiologic surveys of non-institutionalized adults using the World Health Organization’s World Mental Health surveys.

A total of 17 surveys were conducted in 16 countries, with 8 surveys in high-income countries and 9 in low or middle-income countries.

The mean age for the first depression treatment was 34.8 years old.

The surveys occurred between 2002-2017 and included participants with a lifetime history of major depressive disorder.

The investigators also collected data on socioeconomic characteristics, lifetime comorbid conditions such as anxiety and substance use disorders, treatment type, treatment timing, and country income level.

The team sought main outcomes of conditional probabilities of helpful treatment after seeing between 1-5 professionals, the persistence in help-seeking after 1-4 unhelpful treatments, and ever obtaining helpful treatment regardless of the number of professionals seen.

The investigators found 68.2% of adults with a lifetime history of DSM-IV major depressive disorder (n = 2726) obtained treatment they considered helpful, while other patients stopped seeking treatment following early unhelpful treatment.

The majority of patients (93.9%) found it helpful if they persisted through 10 treatment professionals, but only 21.5% of patients were that persistent.

The survey response rates did differ based on country, ranging from 50.4% in Poland to 97.2% in Columbia. The pooled response rate was 68.3% (n = 117,616) across all surveys.

The investigators also found the probability of perceiving treatment as help increased because of a number of factors, including older age at initiating treatment (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 older age and higher educational level 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).

On the other hand, a shorter delay in initiating treatment after the first onset and the medication received from a mental health specialty 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).

“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,” the authors wrote.

The study, “Findings From World Mental Health Surveys of the Perceived Helpfulness of Treatment for Patients With Major Depressive Disorder,” was published online in JAMA Psychiatry.