Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries

Saris I.M., Aghajani M., van der Werff S.J., van der Wee N.J., Penninx B.W.

Adaptive social functioning is severely impeded in depressive and anxiety disorders, even after remission. However, a comprehensive overview is still lacking.Using data from the Netherlands Study of Depression and Anxiety (NESDA), behavioural (network size, social activities, social support) and affective (loneliness, affiliation, perceived social disability) indicators of social functioning were analyzed in patients with anxiety (N = 540), depressive (N = 393), comorbid anxiety and depressive disorders ('comorbid', N = 748), remitted participants (N = 621), and healthy control subjects (N = 650).Analyses revealed an increasing trend of social dysfunction among patient groups, in patients with comorbid anxiety and depressive disorders, showing the most severe impairments, followed by depressed and anxious patients (P's < 0.001 for all social functioning indicators). Affective indicators showed the largest effect sizes (Cohen's d range from 0.13 to 1.76). We also found impairments in social functioning among remitted patients. Furthermore, perceived social disability among patients was predictive of still having a depressive and/or anxiety diagnosis 2 years later (P < 0.01).Behavioural but especially affective indicators of social functioning are impaired in patients with anxiety or depressive disorders and most in patients with comorbid disorders. After remission of affective psychopathology, residual impairments tend to remain, while social dysfunction in patients seems predictive of future psychopathology.

Thornicroft G., Chatterji S., Evans-Lacko S., Gruber M., Sampson N., Aguilar-Gaxiola S., Al-Hamzawi A., Alonso J., Andrade L., Borges G., Bruffaerts R., Bunting B., de Almeida J.M., Florescu S., de Girolamo G., et. al.

BackgroundMajor depressive disorder (MDD) is a leading cause of disability worldwide.AimsTo examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards.MethodRepresentative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys.ResultsOf 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment.ConclusionsOnly a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.

Chisholm D., Sweeny K., Sheehan P., Rasmussen B., Smit F., Cuijpers P., Saxena S.

Depression and anxiety disorders are highly prevalent and disabling disorders, which result not only in an enormous amount of human misery and lost health, but also lost economic output. Here we propose a global investment case for a scaled-up response to the public health and economic burden of depression and anxiety disorders.In this global return on investment analysis, we used the mental health module of the OneHealth tool to calculate treatment costs and health outcomes in 36 countries between 2016 and 2030. We assumed a linear increase in treatment coverage. We factored in a modest improvement of 5% in both the ability to work and productivity at work as a result of treatment, subsequently mapped to the prevailing rates of labour participation and gross domestic product (GDP) per worker in each country.The net present value of investment needed over the period 2016-30 to substantially scale up effective treatment coverage for depression and anxiety disorders is estimated to be US$147 billion. The expected returns to this investment are also substantial. In terms of health impact, scaled-up treatment leads to 43 million extra years of healthy life over the scale-up period. Placing an economic value on these healthy life-years produces a net present value of $310 billion. As well as these intrinsic benefits associated with improved health, scaled-up treatment of common mental disorders also leads to large economic productivity gains (a net present value of $230 billion for scaled-up depression treatment and $169 billion for anxiety disorders). Across country income groups, resulting benefit to cost ratios amount to 2·3-3·0 to 1 when economic benefits only are considered, and 3·3-5·7 to 1 when the value of health returns is also included.Return on investment analysis of the kind reported here can contribute strongly to a balanced investment case for enhanced action to address the large and growing burden of common mental disorders worldwide.Grand Challenges Canada.

Roberge P., Normand-Lauzière F., Raymond I., Luc M., Tanguay-Bernard M., Duhoux A., Bocti C., Fournier L.

Olariu E., Forero C.G., Castro-Rodriguez J.I., Rodrigo-Calvo M.T., Álvarez P., Martín-López L.M., Sánchez-Toto A., Adroher N.D., Blasco-Cubedo M.J., Vilagut G., Fullana M.A., Alonso J.

Evidence suggests that general practitioners (GPs) fail to diagnose up to half of common mental disorder cases. Yet no previous research has systematically summarized the evidence in the case of anxiety disorders. The aim of this review was to systematically assess and meta-analyze the diagnostic accuracy of GPs' assisted (i.e., using severity scales/diagnostic instruments) and unassisted (without such tools) diagnoses of anxiety disorders.Systematic review (PROSPERO registry CRD42013006736) was conducted. Embase, Ovid Journals--Ovid SP Medline, Pubmed, PsycINFO, Scopus, Web of Science, and Science Direct were searched from January 1980 through June 2014. Seven investigators, working in pairs, evaluated studies for eligibility. The quality of included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2). The main outcome measures were sensitivity and specificity of clinical diagnoses of any anxiety disorder. We pooled sensitivity and specificity levels from included studies using bivariate meta-analyses.Twenty-four studies were included in the meta-analysis with a total sample of 34,902 patients. Pooled sensitivity and specificity were estimated at 44.5% (95% CI 33.7-55.9%) and 90.8% (95% CI 87-93.5%). GPs' sensitivity was higher when diagnoses were assisted (63.6%, 95% CI 50.3-75.1%) than when unassisted (30.5%, 95% CI 20.7-42.5%) to the expense of some specificity loss (87.9%, 95% CI 81.3-92.4% vs. 91.4%, 95% CI 86.6-94.6%, respectively). Identification rates remained constant over time (P-value = .998).The use of diagnostic tools might improve detection of anxiety disorders in "primary care."

Whiteford H.A., Ferrari A.J., Degenhardt L., Feigin V., Vos T.

Background The Global Burden of Disease Study 2010 (GBD 2010), estimated that a substantial proportion of the world’s disease burden came from mental, neurological and substance use disorders. In this paper, we used GBD 2010 data to investigate time, year, region and age specific trends in burden due to mental, neurological and substance use disorders. Method For each disorder, prevalence data were assembled from systematic literature reviews. DisMod-MR, a Bayesian meta-regression tool, was used to model prevalence by country, region, age, sex and year. Prevalence data were combined with disability weights derived from survey data to estimate years lived with disability (YLDs). Years lost to premature mortality (YLLs) were estimated by multiplying deaths occurring as a result of a given disorder by the reference standard life expectancy at the age death occurred. Disability-adjusted life years (DALYs) were computed as the sum of YLDs and YLLs. Results In 2010, mental, neurological and substance use disorders accounted for 10.4% of global DALYs, 2.3% of global YLLs and, 28.5% of global YLDs, making them the leading cause of YLDs. Mental disorders accounted for the largest proportion of DALYs (56.7%), followed by neurological disorders (28.6%) and substance use disorders (14.7%). DALYs peaked in early adulthood for mental and substance use disorders but were more consistent across age for neurological disorders. Females accounted for more DALYs in all mental and neurological disorders, except for mental disorders occurring in childhood, schizophrenia, substance use disorders, Parkinson’s disease and epilepsy where males accounted for more DALYs. Overall DALYs were highest in Eastern Europe/Central Asia and lowest in East Asia/the Pacific. Conclusion Mental, neurological and substance use disorders contribute to a significant proportion of disease burden. Health systems can respond by implementing established, cost effective interventions, or by supporting the research necessary to develop better prevention and treatment options.

Baldwin D.S., Anderson I.M., Nutt D.J., Allgulander C., Bandelow B., den Boer J.A., Christmas D.M., Davies S., Fineberg N., Lidbetter N., Malizia A., McCrone P., Nabarro D., O’Neill C., Scott J., et. al.

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.

Clement S., Schauman O., Graham T., Maggioni F., Evans-Lacko S., Bezborodovs N., Morgan C., Rüsch N., Brown J.S., Thornicroft G.

BackgroundIndividuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: (a) What is the size and direction of any association between stigma and help-seeking? (b) To what extent is stigma identified as a barrier to help-seeking? (c) What processes underlie the relationship between stigma and help-seeking? (d) Are there population groups for which stigma disproportionately deters help-seeking?MethodFive electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted.ResultsThe review identified 144 studies with 90 189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d = − 0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma.ConclusionsStigma has a small- to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.

American Psychiatric Association

Saha S., Stedman T.J., Scott J.G., McGrath J.J.

Objective: Because comorbidity between mental and physical disorders is commonly found in patients, it would be expected that this pattern would also be reflected at the family level. During a recent population-based survey of common mental disorders, respondents were asked about the presence of selected mental and physical disorders in their relatives. The aim of this research was to describe the within-family co-occurrence of selected common physical and mental disorders in a population-based sample. Methods: Subjects were drawn from the Australian National Survey of Mental Health and Wellbeing 2007. A modified version of the World Mental Health Survey Initiative of the Composite International Diagnostic Interview (WMH-CIDI 3.0, henceforth CIDI) was used to identify lifetime-ever common psychiatric disorders (anxiety disorders, depression, drug or alcohol disorders). The respondents were asked if any of their relatives had one of a list of psychiatric (anxiety, bipolar disorder, depression, drug or alcohol problem, schizophrenia) or general physical disorders (cancer, heart problems, intellectual disability, memory problems). We examined the relationship between the variables of interest using logistic regression, adjusting for potential confounding factors. Results: Compared to otherwise-well respondents, those who had a CIDI diagnosis of major depressive disorders, anxiety disorders, or drug or alcohol abuse/dependence were significantly more likely to have first-degree relatives with (a) the same diagnosis as the respondent, (b) other mental disorders not identified in the respondent, and (c) a broad range of general physical conditions. Conclusions: Individuals with common mental disorders report greater familial co-occurrence for a range of mental and physical disorders. When eliciting family histories, clinicians should remain mindful that both mental and physical disorders can co-occur within families.

Baxter A.J., Scott K.M., Vos T., Whiteford H.A.

BackgroundThe literature describing the global prevalence of anxiety disorders is highly variable. A systematic review and meta-regression were undertaken to estimate the prevalence of anxiety disorders and to identify factors that may influence these estimates. The findings will inform the new Global Burden of Disease study.MethodA systematic review identified prevalence studies of anxiety disorders published between 1980 and 2009. Electronic databases, reference lists, review articles and monographs were searched and experts then contacted to identify missing studies. Substantive and methodological factors associated with inter-study variability were identified through meta-regression analyses and the global prevalence of anxiety disorders was calculated adjusting for study methodology.ResultsThe prevalence of anxiety disorders was obtained from 87 studies across 44 countries. Estimates of current prevalence ranged between 0.9% and 28.3% and past-year prevalence between 2.4% and 29.8%. Substantive factors including gender, age, culture, conflict and economic status, and urbanicity accounted for the greatest proportion of variability. Methodological factors in the final multivariate model (prevalence period, number of disorders and diagnostic instrument) explained an additional 13% of variance between studies. The global current prevalence of anxiety disorders adjusted for methodological differences was 7.3% (4.8–10.9%) and ranged from 5.3% (3.5–8.1%) in African cultures to 10.4% (7.0–15.5%) in Euro/Anglo cultures.ConclusionsAnxiety disorders are common and the substantive and methodological factors identified here explain much of the variability in prevalence estimates. Specific attention should be paid to cultural differences in responses to survey instruments for anxiety disorders.

Koen N., Stein D.J.

Gustavsson A., Svensson M., Jacobi F., Allgulander C., Alonso J., Beghi E., Dodel R., Ekman M., Faravelli C., Fratiglioni L., Gannon B., Jones D.H., Jennum P., Jordanova A., Jönsson L., et. al.

The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people.To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country.The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010.The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US.This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges.Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.

Vøllestad J., Nielsen M.B., Nielsen G.H.

Hinton D.E., Lewis-Fernández R.

Errazuriz A., Avello-Vega D., Passi-Solar A., Torres R., Bacigalupo F., Crossley N.A., Undurraga E.A., Jones P.B.

Luo Y., Zhang Y., Zhao Y., Chen F., Li X., Liu X., Shakir M.Z., Jiang N., Shan C.

Modanlo N., Yan X., Bourgeois J.A.

Urbanos-Garrido R.M., Agúndez L.

Duty F.A., Rahman M.H., Salma N.

Smith O.R., Clark D.M., Hensing G., Layard R., Knapstad M.

Abstract Background Data from an RCT of IAPT Norway (“Prompt Mental Health Care” [PMHC]) were linked to several administrative registers up to five years following the intervention. The aims were to (1) examine the effects of PMHC compared to treatment-as-usual (TAU) on work-related outcomes and health care use, (2) estimate the cost–benefit of PMHC, and (3) examine whether clinical outcomes at six-month follow-up explained the effects of PMHC on work−/cost–benefit-related outcomes. Methods RCTs with parallel assignment were conducted at two PMHC sites (N = 738) during 2016/2017. Eligible participants were considered for admission due to anxiety and/or depression. We used Bayesian estimation with 90% credibility intervals (CI) and posterior probabilities (PP) of effects in favor of PMHC. Primary outcome years were 2018–2022. The cost–benefit analysis estimated the overall economic gain expressed in terms of a benefit–cost ratio and the differences in overall public sector spending. Results The PMHC group was more likely than the TAU group to be in regular work without receiving welfare benefits in 2019–2022 (1.27 ≤ OR ≤ 1.43). Some evidence was found that the PMHC group spent less on health care. The benefit–cost ratio in terms of economic gain relative to intervention costs was estimated at 5.26 (90%CI $ - $ 1.28, 11.8). The PP of PMHC being cost-beneficial for the economy as a whole was 85.9%. The estimated difference in public sector spending was small. PMHC effects on work participation and cost–benefit were largely explained by PMHC effects on mental health. Conclusions The results support the societal economic benefit of investing in IAPT-like services.

Uyanik H., Sengur A., Salvi M., Tan R., Tan J.H., Acharya U.R.

ABSTRACTMental and neurological disorders significantly impact global health. This systematic review examines the use of artificial intelligence (AI) techniques to automatically detect these conditions using electroencephalography (EEG) signals. Guided by Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA), we reviewed 74 carefully selected studies published between 2013 and August 2024 that used machine learning (ML), deep learning (DL), or both of these two methods to detect neurological and mental health disorders automatically using EEG signals. The most common and most prevalent neurological and mental health disorder types were sourced from major databases, including Scopus, Web of Science, Science Direct, PubMed, and IEEE Xplore. Epilepsy, depression, and Alzheimer's disease are the most studied conditions that meet our evaluation criteria, 32, 12, and 10 studies were identified on these topics, respectively. Conversely, the number of studies meeting our criteria regarding stress, schizophrenia, Parkinson's disease, and autism spectrum disorders was relatively more average: 6, 4, 3, and 3, respectively. The diseases that least met our evaluation conditions were one study each of seizure, stroke, anxiety diseases, and one study examining Alzheimer's disease and epilepsy together. Support Vector Machines (SVM) were most widely used in ML methods, while Convolutional Neural Networks (CNNs) dominated DL approaches. DL methods generally outperformed traditional ML, as they yielded higher performance using huge EEG data. We observed that the complex decision process during feature extraction from EEG signals in ML‐based models significantly impacted results, while DL‐based models handled this more efficiently. AI‐based EEG analysis shows promise for automated detection of neurological and mental health conditions. Future research should focus on multi‐disease studies, standardizing datasets, improving model interpretability, and developing clinical decision support systems to assist in the diagnosis and treatment of these disorders.

Erickson S., Irbahim A., Bowman K., Thompson S., Harrison A.

ABSTRACTBackgroundA documented underutilization of behavioural health interventions with known efficacy for treating psychological disorders exists. Thus, engagement enhancement approaches (EEAs) exist to help increase individuals' use of behavioural health interventions. EEAs target a range of barriers to treatment; therefore, a wide variety of approaches exist.MethodTo better understand what EEA approaches exist and in which contexts they are most widely implemented, this study conducted a scoping review of existing EEAs to increase treatment engagement in effective interventions for behavioural health disorders. Specifically, the purpose of this review was to characterize EEAs by type, modality, target population, and to examine the intersection of these categories. Additionally, this review examined research rigour and cultural considerations among existing EEAs.ResultsWe found that most of the identified studies targeted individual‐level barriers through psychoeducation and awareness campaigns. These primarily focused on adults with substance use disorders or major depressive disorder and occurred in person at a provider location. This review identified several limitations and gaps in the literature regarding EEAs, such a shortage of scientifically rigorous studies that assess these approaches, the lack of cultural adaptations made to EEAs to specifically support minoritized individuals, the narrow focus of targeting individual‐level barriers, and the limited scope of target groups.ConclusionsThis review offers clinicians and behavioural health researchers information regarding the selection of approaches to increase engagement in accessing behavioural health interventions, as well as suggestions for future research to address disparities and develop solutions to the systemic barriers of the EEAs.

He Y., Cai Y., Chen Y., Tang Z., Ma L., Zhou Y.

Smith O.R., Knapstad M., Aarø L.E.

Zhang J., Dai C., Wang Q., Zhao W., Shen G., Cheng J., Chen R., Zhang Y.

This study aims to investigate the relationships between living and neighborhood environmental factors and anxiety symptoms among older adults residing in urban and rural areas of Anhui Province, China. Data were collected from 5876 participants in a cross-sectional study carried out in four cities located in Anhui, China. Anxiety symptoms were evaluated via the Generalized Anxiety Disorder scale (GAD-7), and participants with scores of 5 and above were defined as having anxiety symptoms. The presence of dust and noise in the context of daily life was used to evaluate the living environment of the participants. The neighborhood environment was assessed by the availability of barrier-free facilities, proximity to facilities (supermarkets, restaurants, hospitals, and parks), and green and blue space near participants’ dwellings. Multilevel linear and logistic regression analyses were used to estimate the associations between these environmental factors and anxiety symptoms. The participants who lived in dusty environments had elevated GAD-7 scores and higher odds of anxiety (dust: β = 0.754, 95% CI: 0.337, 1.171; OR = 1.451, 95% CI: 1.164, 1.809). Having barrier-free facilities and the existence of a neighboring park decreased the GAD-7 scores and the likelihood of having anxiety symptoms (barrier-free facilities: β=-0.503, 95% CI: -0.992, -0.085; OR = 0.768, 95% CI: 0.656, 0.899; park: β=-0.478, 95% CI: -0.830, -0.125; OR = 0.599, 95% CI: 0.440, 0.816). However, participants residing in close proximity to the hospital presented an increased likelihood of experiencing anxiety symptoms (OR = 1.377, 95% CI: 1.162, 1.631). Participants who lived in dusty and noisy environments were more likely to suffer from anxiety, whereas those who lived near barrier-free facilities and parks were at lower risk. The findings emphasize the need for targeted interventions to create age-friendly communities, suggesting an integrated approach that combines environmental health strategies with mental health strategies for older adults.

Viana M.C., Kazdin A.E., Harris M.G., Stein D.J., Vigo D.V., Hwang I., Manoukian S.M., Sampson N.A., Alonso J., Andrade L.H., Borges G., Bunting B., Caldas-de-Almeida J.M., de Girolamo G., de Jonge P., et. al.

High unmet need for treatment of mental disorders exists throughout the world. An understanding of barriers to treatment is needed to develop effective programs to address this problem. Data on barriers were obtained from face-to-face interviews in 22 community surveys across 19 countries (n = 102,812 respondents aged ≥ 18 years, 57.7% female, median age [interquartile range]: 43 [31–57] years; 68.5% weighted average response rate) in the World Mental Health (WMH) surveys. We focus on the n = 5,136 respondents with 12-month DSM-IV anxiety, mood, or substance use disorders with perceived need for treatment. The n = 2,444 such respondents who did not receive treatment were asked about barriers to receiving treatment, whereas the n = 926 respondents who received treatment with a delay were asked about barriers leading to delays. Consistent with previous research, we distinguished five broad classes of barriers: low perceived disorder severity, two types of barriers in the domain of predisposing factors (beliefs/attitudes about treatment ineffectiveness and stigma) and two types in the domain of enabling factors (financial and nonfinancial). Baseline predictors of receiving treatment found in a prior report (i.e., comparing the n = 2,692 respondents who received treatment with the n = 2,444 who did not) were examined as predictors of barriers, while barriers were examined as mediators of associations between these predictors and treatment. Most respondents reported multiple barriers. Barriers among respondents who did not receive treatment included low perceived severity (52.9%), perceived treatment ineffectiveness (44.8%), nonfinancial (40.2%) and financial (32.9%) barriers in the domain of enabling factors, and stigma (20.6%). Barriers causing delays in treatment had a similar rank-order but were reported by higher proportions of respondents (X21 = 3.8–199.8, p = 0.050− < 0.001). Barriers were predicted by low education, disorder type, age, employment status, and financial obstacles. Predictors varied as a function of barrier type. A wide range of barriers to treatment exist among people with mental disorders even after a need for treatment is acknowledged. Most such individuals have multiple barriers. These results have important implications for the design of programs to decrease unmet need for treatment of mental disorders.

Yin T., Yuan J., Liu L., Wang Y., Lin Y., Ming K., Lv H.

IntroductionAnxiety disorders are prevalent mental health conditions characterized by significant impairments in daily functioning and social interactions. Despite the effectiveness of pharmacological treatments, challenges such as medication resistance, adverse side effects, and the high rate of relapse necessitate the exploration of alternative therapies. Recently, electroacupuncture (EA) has garnered attention as a promising non-pharmacological intervention for anxiety disorders; however, the mechanisms by which EA exerts its anxiolytic effects remain poorly understood. This study aims to elucidate the role of microglial cells in anxiety, specifically examining how EA modulates microglial morphology and function within the basolateral amygdala (BLA) in the context of anxiety induced by social isolation.MethodsUtilizing a mouse model of social isolation-induced anxiety, we evaluated anxiety-like behaviors through the Elevated Plus Maze (EPM) and Open Field Test (OFT). Additionally, biochemical analyses and immunofluorescence imaging were performed to assess the expression of NADPH oxidase 2 (NOX2), microglial activation markers, and levels of oxidative stress.ResultsOur findings reveal that EA treatment significantly mitigates anxiety-like behaviors in mice, correlating with a reduction in NOX2 expression within BLA microglia and decreased levels of reactive oxygen species (ROS). Furthermore, EA was observed to restore normal microglial morphology, indicating its potential role in modulating microglial activity.DiscussionThe results of this study suggest that EA exerts its anxiolytic effects through the modulation of oxidative stress and the activity of microglia in the BLA. These findings provide new insights into the cellular mechanisms underlying the therapeutic effects of EA, highlighting the potential for non-pharmacological strategies in the management of anxiety disorders and paving the way for future research aimed at improving clinical outcomes for individuals suffering from anxiety.

Dardas L.A., Habashneh R., Keyan D., Ali A., Saleh R., Aqel I.S., Abualhaija A., Bryant R.

ABSTRACTThe stepped care model is a hierarchical healthcare approach that matches treatment intensity to a patient's condition, ensuring efficient resource use while providing appropriate care. This study conducted a qualitative process evaluation to assess the feasibility, acceptability, and contextual suitability of a multicenter, parallel‐group, superiority, randomized controlled trial addressing psychological distress among adults in Jordan. The trial applied the stepped care framework using two scalable WHO interventions adapted to the Jordanian context. Qualitative data was gathered through focus group discussions and phone interviews with 44 participants, facilitators, and assessors. Two themes emerged: (1) Navigating Transformations, highlighting participants' personal growth, including improved self‐esteem, family dynamics, and coping mechanisms, alongside the benefits of group sessions and supportive relationships with facilitators; and (2) Navigating Challenges and Improvements, focusing on logistical and personal difficulties such as scheduling issues, and suggestions for improving accessibility and engagement. Findings support the feasibility of the stepped care model as a promising approach to providing accessible and effective mental health support in Jordan. The study calls for hybrid models integrating group and individual support while emphasizing the need for enhanced facilitator training and support systems.

Vigo D.V., Stein D.J., Harris M.G., Kazdin A.E., Viana M.C., Munthali R., Munro L., Hwang I., Kessler T.L., Manoukian S.M., Sampson N.A., Kessler R.C., Aguilar-Gaxiola S., Alonso J., Andrade L.H., et. al.

ImportanceAccurate baseline information about the proportion of people with mental disorders who receive effective treatment is required to assess the success of treatment quality improvement initiatives.ObjectiveTo examine the proportion of mental and substance use disorders receiving guideline-consistent treatment in multiple countries.Design, Setting, and ParticipantsIn this cross-sectional study, World Mental Health (WMH) surveys were administered to representative adult (aged 18 years and older) household samples in 21 countries. Data were collected between 2001 and 2019 and analyzed between February and July 2024. Twelve-month prevalence and treatment of 9 DSM-IV anxiety, mood, and substance use disorders were assessed with the Composite International Diagnostic Interview. Effective treatment and its components were estimated with cross-tabulations. Multilevel regression models were used to examine predictors.Main Outcomes and MeasuresThe main outcome was proportion of effective treatment received, defined at the disorder level using information about disorder severity and published treatment guidelines regarding adequate medication type, control, and adherence and adequate psychotherapy frequency. Intermediate outcomes included perceived need for treatment, treatment contact separately in the presence and absence of perceived need, and minimally adequate treatment given contact. Individual-level predictors (multivariable disorder profile, sex, age, education, family income, marital status, employment status, and health insurance) and country-level predictors (treatment resources, health care spending, human development indicators, stigma, and discrimination) were traced through intervening outcomes.ResultsAmong the 56 927 respondents (69.3% weighted average response rate), 32 829 (57.7%) were female; the median (IQR) age was 43 (31-57) years. The proportion of 12-month person-disorders receiving effective treatment was 6.9% (SE, 0.3). Low perceived need (46.5%; SE, 0.6), low treatment contact given perceived need (34.1%; SE, 1.0), and low effective treatment given minimally adequate treatment (47.0%; SE, 1.7) were the major barriers, but with substantial variation across disorders. Country-level general medical treatment resources were more important than mental health treatment resources. Other than for the multivariable disorder profile, which was associated with all intermediate outcomes, significant predictors were largely mediated by treatment contact.Conclusions and RelevanceIn addition to the gaps in treatment quality, these results highlight the importance of increasing perceived need, the largest barrier to effective treatment; the importance of training primary care treatment clinicians in recognition and treatment of mental disorders; the need to improve the continuum of care, especially from minimally adequate to effective treatment; and the importance of bridging the effective treatment gap for men and people with lower education.