Initiation of and adherence to treatment for mental disorders - Examination of patient advocate group members in 11 countries

OBJECTIVE. Greater understanding of the help-seeking process is needed to r educe the level of unmet need for mental health treatment. DESIGN. Cross-sectional mail survey. STUDY POPULATION. The study population consisted of 3,516 respondents to a survey of members of 14 patient advocacy groups in 11 countries. Respondent s reported whether they initiated and adhered to the treatment most recentl y recommended to them. OUTCOMES. Crude and adjusted likelihoods of initiating and adhering to reco mmended treatment were studied. RESULTS. The vast majority of respondents reported initiating the most rece nt treatment recommended to them (94%), and most of those who initiated tre atment also adhered to such treatment (83%). Predictors of initiation by th e respondents included higher levels of education, having pharmacotherapy r ecommended to the respondent, and having received explanations about the di agnosis and treatment. Predictors of adherence to therapy included male gen der, receipt of pharmacotherapy, and presence of insurance coverage. Side e ffects were an important reported reason for treatment dropout, with 44% of respondents reporting lifetime treatment dropout due to side effects. CONCLUSIONS. Successful initiation and adherence to mental health treatment s depend critically on patients' knowledge and awareness, clinicians' commu nication skills, treatment side effects, and barriers such as lack of insur ance. Further study and intervention focused on these modifiable factors ar e needed to improve the adequacy of mental health treatment.