In the Journals

Few patients with anxiety disorders receive suitable treatment

An international study found that among adults with anxiety disorders, just slightly more than a quarter receive treatment, and only about 10% receive acceptable treatment.

“Anxiety disorders are among the conditions that have been identified by the WHO for scaling up interventions for mental disorders. Yet a number of barriers limit the effective treatment of anxiety disorders,” Jordi Alonso, MD, PhD, from the IMIM Hospital del Mar Medical Research Institute, and colleagues wrote. “First, they are often unrecognized. Structural and health system weaknesses, including scarce mental health and human services as well as lack of awareness and costs of treatment and stigma perceived by the people who experience anxiety disorders, further limit their treatment.”

To estimate prevalence of treatment for anxiety disorders worldwide, Alonso and colleagues used data from World Mental Health surveys to estimate the proportion of individuals with a 12-month DSM-IV anxiety disorder in 21 countries who still needed treatment, received any treatment and received possibly adequate treatment.

Anxiety disorders considered in this study included agoraphobia, generalized anxiety disorder, panic disorder, PTSD, social phobia, specific phobia and adult separation anxiety disorder. The researchers asked participants whether they felt they needed professional treatment and whether they received professional help for emotional, nervous, mental health or alcohol/drug use problems in the 12 months prior. Possibly suitable treatment consisted of receiving either pharmacotherapy for at least 1 month and having visited a medical doctor at least four times in the previous 12 months for their mental health, or psychotherapy, complementary alternative medicine or nonmedical care for at least eight visits with a professional.

Researchers analyzed data from 51,547 respondents (overall weighted response rate, 71.3%). They found that that 9.8% of respondents had a 12-month DSM-IV anxiety disorder, but only 27.6% received treatment and only 9.8% of those received possibly suitable treatment. High-income and upper-middle-income countries had similar prevalence figures (10.3% and 10.6%); however, prevalence was lower in lower-income countries (7.9%). Notably, the United States had one of the highest prevalence of anxiety disorders (19%).

On average, less than half of respondents with 12-month anxiety (41.3%) perceived a need for treatment. Overall, 66.8% of those received any treatment in the previous year, a finding that declined by country income from 75% of those who used services in high-income countries compared with 46.1% in lower-middle income countries. In addition, respondents with comorbidity had significantly higher overall perception of need for care than those without (55.2% vs. 26.3; P < .001).

“A worrying finding of our study is the low proportion of possibly adequate treatment for anxiety disorders,” Alonso and colleagues wrote. “Health literacy and awareness should be promoted in countries with low perception of need, mostly among the low/lower middle-income countries. Our results suggest that it is important to encourage health providers to follow the clinical guidelines to improve treatment quality for anxiety disorders.” – by Savannah Demko

Disclosures: Alonso reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

An international study found that among adults with anxiety disorders, just slightly more than a quarter receive treatment, and only about 10% receive acceptable treatment.

“Anxiety disorders are among the conditions that have been identified by the WHO for scaling up interventions for mental disorders. Yet a number of barriers limit the effective treatment of anxiety disorders,” Jordi Alonso, MD, PhD, from the IMIM Hospital del Mar Medical Research Institute, and colleagues wrote. “First, they are often unrecognized. Structural and health system weaknesses, including scarce mental health and human services as well as lack of awareness and costs of treatment and stigma perceived by the people who experience anxiety disorders, further limit their treatment.”

To estimate prevalence of treatment for anxiety disorders worldwide, Alonso and colleagues used data from World Mental Health surveys to estimate the proportion of individuals with a 12-month DSM-IV anxiety disorder in 21 countries who still needed treatment, received any treatment and received possibly adequate treatment.

Anxiety disorders considered in this study included agoraphobia, generalized anxiety disorder, panic disorder, PTSD, social phobia, specific phobia and adult separation anxiety disorder. The researchers asked participants whether they felt they needed professional treatment and whether they received professional help for emotional, nervous, mental health or alcohol/drug use problems in the 12 months prior. Possibly suitable treatment consisted of receiving either pharmacotherapy for at least 1 month and having visited a medical doctor at least four times in the previous 12 months for their mental health, or psychotherapy, complementary alternative medicine or nonmedical care for at least eight visits with a professional.

Researchers analyzed data from 51,547 respondents (overall weighted response rate, 71.3%). They found that that 9.8% of respondents had a 12-month DSM-IV anxiety disorder, but only 27.6% received treatment and only 9.8% of those received possibly suitable treatment. High-income and upper-middle-income countries had similar prevalence figures (10.3% and 10.6%); however, prevalence was lower in lower-income countries (7.9%). Notably, the United States had one of the highest prevalence of anxiety disorders (19%).

On average, less than half of respondents with 12-month anxiety (41.3%) perceived a need for treatment. Overall, 66.8% of those received any treatment in the previous year, a finding that declined by country income from 75% of those who used services in high-income countries compared with 46.1% in lower-middle income countries. In addition, respondents with comorbidity had significantly higher overall perception of need for care than those without (55.2% vs. 26.3; P < .001).

“A worrying finding of our study is the low proportion of possibly adequate treatment for anxiety disorders,” Alonso and colleagues wrote. “Health literacy and awareness should be promoted in countries with low perception of need, mostly among the low/lower middle-income countries. Our results suggest that it is important to encourage health providers to follow the clinical guidelines to improve treatment quality for anxiety disorders.” – by Savannah Demko

Disclosures: Alonso reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.