title: Initiation of and adherence to treatment for mental disorders: examination of patient advocate group members in 11 countries.
abstract: OBJECTIVE
  Greater understanding of the help-seeking process is needed to reduce the level of unmet need for mental health treatment.
  
  
  METHODS
  Cross-sectional mail survey.
  
  
  METHODS
  The study population consisted of 3,516 respondents to a survey of members of 14 patient advocacy groups in 11 countries. Respondents reported whether they initiated and adhered to the treatment most recently recommended to them.
  
  
  RESULTS
  Crude and adjusted likelihoods of initiating and adhering to recommended treatment were studied.
  
  
  RESULTS
  The vast majority of respondents reported initiating the most recent treatment recommended to them (94%), and most of those who initiated treatment also adhered to such treatment (83%). Predictors of initiation by the respondents included higher levels of education, having pharmacotherapy recommended to the respondent, and having received explanations about the diagnosis and treatment. Predictors of adherence to therapy included male gender, receipt of pharmacotherapy, and presence of insurance coverage. Side effects 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 treatments depend critically on patients' knowledge and awareness, clinicians' communication skills, treatment side effects, and barriers such as lack of insurance. Further study and intervention focused on these modifiable factors are needed to improve the adequacy of mental health treatment.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA. wang@hcp.med.harvard.edu
authors.forename: P S
authors.initials: PS
authors.lastname: Wang
authors.forename: S E
authors.initials: SE
authors.lastname: Gilman
authors.forename: M
authors.initials: M
authors.lastname: Guardino
authors.forename: J M
authors.initials: JM
authors.lastname: Christiana
authors.forename: P L
authors.initials: PL
authors.lastname: Morselli
authors.forename: K
authors.initials: K
authors.lastname: Mickelson
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002648:Child; D003430:Cross-Sectional Studies; D019049:Developed Countries / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010344:Patient Advocacy; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014837:Voluntary Health Agencies / Q000706:statistics & numerical data
chemical_list: D014150:Antipsychotic Agents