Background
Methods
Sample
Ethics, consent and permissions
Mental health assessment
Final diagnostic assessment
Use of mental health services and treatment received
Criteria for minimally adequate treatment
Sociodemographic, disorder-specific and comorbidity factors
Statistical analysis
Results
Participants
All | Men | Women | ||||||
---|---|---|---|---|---|---|---|---|
100.0 % |
N = 92 | 28.3 % |
N = 26 | 71.7 % |
N = 66 | |||
Variable | Category | % | N | % | N | % | N | p* |
Age | <25 years | 19.6 | 18 | 15.4 | 4 | 21.2 | 14 | |
25–29 years | 40.2 | 37 | 42.3 | 11 | 39.4 | 26 | ||
≥30 years | 40.2 | 37 | 42.3 | 11 | 39.4 | 26 | 0.818 | |
Basic education | Less than high school | 52.8 | 47 | 69.6 | 16 | 47.0 | 31 | |
High school | 47.2 | 42 | 30.4 | 7 | 53.0 | 35 | 0.062 | |
Married or cohabiting | Yes | 66.3 | 59 | 56.5 | 13 | 69.7 | 46 | |
No | 33.7 | 30 | 43.5 | 10 | 30.3 | 20 | 0.250 | |
Current employment | Employed | 56.2 | 50 | 69.6 | 16 | 51.5 | 34 | |
Studentc
| 18.0 | 16 | 21.7 | 5 | 16.7 | 11 | ||
Unemployed | 11.2 | 10 | 8.7 | 2 | 12.1 | 8 | ||
Othera
| 14.6 | 13 | 0.0 | 0 | 19.7 | 13 | 0.077** | |
Comorbid mood disorder | Yes | 58.7 | 54 | 61.5 | 16 | 57.6 | 38 | |
No | 41.3 | 38 | 38.5 | 10 | 42.4 | 28 | 0.728 | |
Comorbid personality disorder | Yes | 21.7 | 20 | 30.8 | 8 | 18.2 | 12 | |
No | 78.3 | 72 | 69.2 | 18 | 81.8 | 54 | 0.188 | |
Comorbid substance abuse or dependence (any substance) | Yes | 28.3 | 26 | 57.7 | 15 | 16.7 | 11 | |
No | 71.7 | 66 | 42.3 | 11 | 83.3 | 55 |
<0.0001
| |
Comorbid other disorderb
| Yes | 18.5 | 17 | 7.7 | 2 | 22.7 | 15 | |
No | 81.5 | 75 | 92.3 | 24 | 77.3 | 51 | 0.137 |
All (N = 92) | Men (N = 26) | Women (N = 66) | p* | ||||
---|---|---|---|---|---|---|---|
Variable | % | N | % | N | % | N | |
Panic disorder with agoraphobia | 20.7 | 19 | 23.1 | 6 | 19.7 | 13 | 0.718 |
Panic disorder without agoraphobia | 6.5 | 6 | 3.9 | 1 | 7.6 | 5 | 0.672** |
Agoraphobia without panic disorder | 7.6 | 7 | 11.5 | 3 | 6.1 | 4 | 0.399** |
Social phobia | 25.0 | 23 | 38.5 | 10 | 19.7 | 13 | 0.061 |
Obsessive-compulsive disorder | 5.4 | 5 | 3.9 | 1 | 6.1 | 4 | 1.000** |
Posttraumatic stress disorder | 6.5 | 6 | 0.0 | 0 | 9.1 | 6 | 0.179** |
Generalized anxiety disorder | 3.3 | 3 | 3.9 | 1 | 3.0 | 2 | 1.000** |
Specific phobia | 20.7 | 19 | 15.4 | 4 | 22.7 | 15 | 0.433 |
Anxiety disorder NOS | 25.0 | 23 | 23.1 | 6 | 25.8 | 17 | 0.789 |
Treatment | No treatment | |||||
---|---|---|---|---|---|---|
Variable | Category | % | N | % | N | p* |
All | 61.2 | 57 | 38.0 | 35 | ||
Gender | Men | 65.4 | 17 | 34.6 | 9 | |
Women | 60.6 | 40 | 39.4 | 26 | 0.671 | |
Panic disorder with agoraphobia | 79.0 | 15 | 21.1 | 4 | 0.087 | |
Panic disorder without agoraphobia | 66.7 | 4 | 33.3 | 2 | 1.000** | |
Agoraphobia without panic disorder | 42.9 | 3 | 57.1 | 4 | 0.421** | |
Social phobia | 65.2 | 15 | 34.8 | 8 | 0.710 | |
Obsessive-compulsive disorder | 60.0 | 3 | 40.0 | 2 | 1.000** | |
Posttraumatic stress disorder | 66.7 | 4 | 33.3 | 2 | 1.000** | |
Generalized anxiety disorder | 66.7 | 2 | 33.3 | 1 | 1.000** | |
Specific phobia | 21.1 | 4 | 79.0 | 15 |
<0.0001
| |
Anxiety disorder NOS | 91.3 | 21 | 8.7 | 2 |
0.001
|
Treatment received and treatment adequacy
Pharmacotherapy | Visits with a physician | Guideline concordant pharmacotherapyc
| Sessions of psychotherapy / a year | Minimally adequate treatmente
| Treatment dropoutf
| |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Anya
| ≥2 months | Anyb
| ≥4 times | Anyd
| ≥8 times | |||||||||||||||
Variable | Category | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | |
All | 51.3 | 40 | 43.4 | 33 | 68.8 | 53 | 36.4 | 28 | 26.6 | 21 | 57.9 | 44 | 34.2 | 26 | 41.8 | 33 | 11.0 | 8 | ||
Gender | Male | 59.1 | 13 | 54.6 | 12 | 71.4 | 15 | 42.9 | 9 | 36.4 | 8 | 71.4 | 15 | 33.3 | 7 | 45.5 | 10 | 9.5 | 2 | |
Female | 48.2 | 27 | 38.9 | 21 | 67.9 | 38 | 33.9 | 19 | 22.8 | 13 | 52.7 | 29 | 34.6 | 19 | 40.4 | 23 | 11.5 | 6 | ||
p* | 0.387 | 0.212 | 0.763 | 0.468 | 0.222 | 0.140 | 0.921 | 0.680 | 1.000 | |||||||||||
Agegroup | <25 years | 66.7 | 10 | 60.0 | 9 | 78.6 | 11 | 42.9 | 6 | 40.0 | 6 | 71.4 | 10 | 57.1 | 8 | 60.0 | 9 | 7.7 | 1 | |
25–29 years | 45.5 | 15 | 39.4 | 13 | 61.8 | 21 | 29.4 | 10 | 23.5 | 8 | 51.5 | 17 | 12.1 | 4 | 29.4 | 10 | 12.5 | 4 | ||
≥30 years | 50.0 | 15 | 39.3 | 11 | 72.4 | 21 | 41.4 | 12 | 23.3 | 7 | 58.6 | 17 | 48.3 | 14 | 46.7 | 14 | 10.7 | 3 | ||
p* | 0.389 | 0.352 | 0.453 | 0.527 | 0.426 | 0.447 |
0.002
| 0.107 | 1.000g
| |||||||||||
Basic | Less than high school | 48.7 | 18 | 36.1 | 13 | 67.6 | 25 | 35.1 | 13 | 23.7 | 9 | 61.1 | 22 | 36.1 | 13 | 44.7 | 17 | 18.2 | 6 | |
education | High school | 50.0 | 19 | 46.0 | 17 | 68.4 | 26 | 34.2 | 13 | 26.3 | 10 | 51.4 | 19 | 32.4 | 12 | 36.8 | 14 | 5.4 | 2 | |
p* | 0.907 | 0.393 | 0.937 | 0.933 | 0.791 | 0.401 | 0.741 | 0.484 | 0.136g
| |||||||||||
Current | Employed | 42.5 | 17 | 38.5 | 15 | 62.5 | 25 | 22.5 | 9 | 15.0 | 6 | 47.5 | 19 | 17.5 | 7 | 30.0 | 12 | 13.5 | 5 | |
employment | Student | 71.4 | 10 | 57.1 | 8 | 71.4 | 10 | 57.1 | 8 | 42.9 | 6 | 69.2 | 9 | 53.9 | 7 | 50.0 | 7 | 14.3 | 2 | |
Unemployed | 44.4 | 4 | 44.4 | 4 | 62.5 | 5 | 62.5 | 5 | 44.4 | 4 | 66.7 | 6 | 55.6 | 5 | 66.7 | 6 | 12.5 | 1 | ||
Other | 50.0 | 6 | 27.3 | 3 | 84.6 | 11 | 30.8 | 4 | 23.1 | 3 | 63.6 | 7 | 54.6 | 6 | 46.2 | 6 | 0.0 | 0 | ||
p* | 0.331g
| 0.491g
| 0.517g
|
0.033
g
| 0.084g
| 0.445g
|
0.008
g
| 0.167 | 0.689g
| |||||||||||
Married or | No | 63.0 | 17 | 46.2 | 12 | 80.8 | 21 | 53.9 | 14 | 33.3 | 9 | 69.2 | 18 | 46.2 | 12 | 55.6 | 15 | 12.0 | 3 | |
cohabiting | Yes | 41.7 | 20 | 38.3 | 18 | 61.2 | 30 | 24.5 | 12 | 20.4 | 10 | 48.9 | 23 | 27.7 | 13 | 32.7 | 16 | 11.1 | 5 | |
p* | 0.077 | 0.514 | 0.084 |
0.011
| 0.213 | 0.094 | 0.111 | 0.052 | 1.000g
|
Socio-demographic factors, treatment received and dropouts
Comorbid psychiatric disorders, treatment received and dropouts
Pharmacotherapy | Visits with a physician | Guideline concordant pharmacotherapyc
| Sessions of psychotherapy / a year | Minimally adequate treatmente
| Treatment dropoutf
| |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Anya
| ≥2 months | Anyb
| ≥4 times | Anyd
| ≥8 times | |||||||||||||||
Variable | Category | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | % | N | |
Comorbid | Yes | 54.2 | 26 | 45.8 | 22 | 71.7 | 33 | 41.3 | 19 | 31.3 | 15 | 58.3 | 28 | 35.4 | 17 | 45.8 | 22 | 13.6 | 6 | |
mood | No | 46.7 | 14 | 39.3 | 11 | 64.5 | 20 | 29.0 | 9 | 19.4 | 6 | 57.1 | 16 | 32.1 | 9 | 35.5 | 11 | 6.9 | 2 | |
disorders |
p* | 0.519 | 0.579 | 0.502 | 0.272 | 0.243 | 0.919 | 0.772 | 0.362 | 0.465g
| ||||||||||
Comorbid | Yes | 65.2 | 15 | 63.6 | 14 | 77.3 | 17 | 50.0 | 11 | 39.1 | 9 | 78.3 | 18 | 39.1 | 9 | 47.8 | 11 | 4.8 | 1 | |
substance use | No | 45.5 | 25 | 35.2 | 19 | 65.5 | 36 | 30.9 | 17 | 21.4 | 12 | 49.1 | 26 | 32.1 | 17 | 39.3 | 22 | 13.5 | 7 | |
disorder |
p* | 0.111 |
0.023
| 0.312 | 0.116 | 0.106 |
0.018
| 0.552 | 0.484 | 0.425g
| ||||||||||
Comorbid | Yes | 68.4 | 13 | 52.6 | 10 | 73.7 | 14 | 57.9 | 11 | 40.0 | 8 | 73.7 | 14 | 52.6 | 10 | 60.0 | 12 | 15.8 | 3 | |
personality | No | 45.8 | 27 | 40.4 | 23 | 67.2 | 39 | 29.3 | 17 | 22.0 | 13 | 52.6 | 30 | 28.1 | 16 | 35.6 | 21 | 9.3 | 5 | |
disorder |
p* | 0.086 | 0.350 | 0.599 |
0.025
| 0.116 | 0.108 | 0.051 | 0.056 | 0.421g
| ||||||||||
Comorbid other | Yes | 56.3 | 9 | 40.0 | 6 | 56.3 | 9 | 56.3 | 9 | 37.5 | 6 | 50.0 | 8 | 43.8 | 7 | 50.0 | 8 | 6.3 | 1 | |
disorderh
| No | 50.0 | 31 | 44.3 | 27 | 72.1 | 44 | 31.2 | 19 | 23.8 | 15 | 60.0 | 36 | 31.7 | 19 | 39.7 | 25 | 12.3 | 7 | |
p* | 0.656 | 0.765 | 0.239g
| 0.063 | 0.343g
| 0.472 | 0.365 | 0.455 | 0.676g
| |||||||||||
More than 1 | Yes | 46.7 | 7 | 40.0 | 6 | 64.3 | 9 | 35.7 | 5 | 25.0 | 4 | 60.0 | 9 | 40.0 | 6 | 37.5 | 6 | 0.0 | 0 | |
anxiety | No | 52.4 | 33 | 44.3 | 27 | 69.8 | 44 | 36.5 | 23 | 27.0 | 17 | 57.4 | 35 | 32.8 | 20 | 42.9 | 27 | 13.6 | 8 | |
disorder |
p* | 0.691 | 0.765 | 0.753g
| 0.956 | 1.000g
| 0.854 | 0.598 | 0.698 | 0.340g
|
Benzodiazepine | Benzodiazepine misuse | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Not prescribed | Prescribed | No | Yes | |||||||
Variable | Category | % | N | % | N | % | N | % | N | |
All | 65.4 | 51 | 34.6 | 27 | 94.9 | 75 | 5.1 | 4 | ||
Gender | Male | 50.0 | 11 | 50.0 | 11 | 95.5 | 21 | 4.6 | 1 | |
Female | 71.4 | 40 | 28.6 | 16 | 94.7 | 54 | 5.3 | 3 | ||
p* | 0.073 | 1.000a
| ||||||||
Agegroup | <25 years | 73.3 | 11 | 26.7 | 4 | 100.0 | 15 | 0.0 | 0 | |
25–29 years | 69.7 | 23 | 30.3 | 10 | 97.1 | 33 | 2.9 | 1 | ||
≥30 years | 56.7 | 17 | 43.3 | 13 | 90.0 | 27 | 10.0 | 3 | ||
p* | 0.428 | 0.402a
| ||||||||
Basic | Less than high school | 64.9 | 24 | 35.1 | 13 | 97.4 | 37 | 2.6 | 1 | |
education | High school | 71.1 | 27 | 29.0 | 11 | 94.7 | 36 | 5.3 | 2 | |
p* | 0.566 | 1.000a
| ||||||||
Current | Employed | 75.0 | 30 | 25.0 | 10 | 100.0 | 40 | 0.0 | 0 | |
employment | Student | 57.1 | 8 | 42.9 | 6 | 92.9 | 13 | 7.1 | 1 | |
Unemployed | 55.6 | 5 | 44.4 | 4 | 100.0 | 9 | 0.0 | 0 | ||
Other | 66.7 | 8 | 33.3 | 4 | 84.6 | 11 | 15.4 | 2 | ||
p* | 0.485a
| 0.061a
| ||||||||
Married or | No | 66.7 | 18 | 33.3 | 9 | 96.3 | 26 | 3.7 | 1 | |
cohabiting | Yes | 68.8 | 33 | 31.3 | 15 | 95.9 | 47 | 4.1 | 2 | |
p* | 0.853 | 1.000a
| ||||||||
Comorbid | Yes | 66.7 | 32 | 33.3 | 16 | 93.8 | 45 | 6.3 | 3 | |
mood | No | 63.3 | 19 | 36.7 | 11 | 96.8 | 30 | 3.2 | 1 | |
disorder |
p* | 0.763 | 1.000a
| |||||||
Comorbid | Yes | 43.5 | 10 | 56.5 | 13 | 87.0 | 20 | 13.0 | 3 | |
substance use | No | 74.6 | 41 | 25.5 | 14 | 98.2 | 55 | 1.8 | 1 | |
disorder |
p* |
0.009
| 0.072a
| |||||||
Comorbid | Yes | 31.6 | 6 | 68.4 | 13 | 80.0 | 16 | 20.0 | 4 | |
personality | No | 76.3 | 45 | 23.7 | 14 | 100.0 | 59 | 0.0 | 0 | |
disorder |
p* |
0.0004
|
0.003
a
| |||||||
Comorbid other | Yes | 50.0 | 8 | 50.0 | 8 | 81.3 | 13 | 18.8 | 3 | |
disorderb
| No | 69.4 | 43 | 30.7 | 19 | 98.4 | 62 | 1.6 | 1 | |
p* | 0.147 |
0.025
a
| ||||||||
More than 1 | Yes | 73.3 | 11 | 26.7 | 4 | 87.5 | 14 | 12.5 | 2 | |
anxiety | No | 63.5 | 40 | 36.5 | 23 | 96.8 | 61 | 3.2 | 2 | |
disorder |
p* | 0.472 | 0.181a
|
Factors associated with treatment in the multivariate analyses
Pharmacotherapy | Visits with a physician / a year | Guideline-concordant pharmacotherapyc
| Sessions of psychotherapy / a year | Minimally adequate treatmente
| |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Anya
| ≥2 months | Anyb
| ≥4 times | Anyd
| ≥8 times | ||||||||||||
Variable | Category | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI | OR | 95 % CI |
Gender | Male (ref.) | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - |
Female | 1.19 | 0.34–4.14 | 1.06 | 0.29–3.90 | 1.95 | 0.50–7.64 | 1.16 | 0.30–4.56 | 0.72 | 0.18–2.87 | 1.18 | 0.31–4.47 | 1.50 | 0.38–5.92 | 1.18 | 0.33–4.18 | |
Basic education | Less than high school (ref.) | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - |
High school | 1.33 | 0.42–4.18 | 3.08 | 0.86–11.04 | 1.42 | 0.41–4.97 | 0.92 | 0.25–3.35 | 1.57 | 0.40–6.09 | 1.04 | 0.31–3.45 | 1.12 | 0.32–3.94 | 0.71 | 0.22–2.30 | |
Married or | No (ref.) | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - |
cohabiting | Yes | 0.43 | 0.15–1.25 | 0.85 | 0.28–2.56 | 0.34 | 0.09–1.25 | *0.27
|
0.08–0.85
| 0.66 | 0.20–2.11 | 0.35 | 0.11–1.14 | 0.39 | 0.12–1.21 | 0.36 | 0.12–1.05 |
Comorbid | No (ref.) | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - |
mood disorder | Yes | 1.07 | 0.36–3.14 | 1.47 | 0.47–4.60 | 1.28 | 0.41–4.00 | 0.99 | 0.31–3.15 | 1.59 | 0.46–5.44 | 0.71 | 0.22–2.26 | 0.70 | 0.21–2.34 | 1.07 | 0.37–3.13 |
Comorbid substance | No (ref.) | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - |
use disorder | Yes | 1.92 | 0.54–6.86 | *4.48
|
1.11–18.08
| 2.46 | 0.59–10.30 | 1.46 | 0.39–5.48 | 1.78 | 0.46–6.95 | 3.21 | 0.81–12.75 | 1.27 | 0.33–4.82 | 0.98 | 0.28–3.42 |
Comorbid | No (ref.) | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - |
personality disorder | Yes | 1.87 | 0.49–7.20 | 1.40 | 0.34–5.84 | 1.55 | 0.38–6.35 | 2.20 | 0.55–8.70 | 1.76 | 0.41–7.51 | 2.05 | 0.49–8.48 | 4.03 | 0.97–16.83 | 2.24 | 0.61–8.26 |
Comorbid | No (ref.) | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - |
other disorderf
| Yes | 0.89 | 0.23–3.41 | 0.51 | 0.12–2.12 | 0.26 | 0.06–1.10 | 2.36 | 0.59–9.45 | 1.48 | 0.35–6.22 | 0.43 | 0.11–1.77 | 1.02 | 0.25–4.11 | 1.24 | 0.32–4.72 |
More than 1 anxiety | No (ref.) | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - | 1.00 | - |
disorder | Yes | 0.59 | 0.15–2.31 | 0.45 | 0.10–1.96 | 0.64 | 0.16–2.53 | 0.97 | 0.22–4.19 | 0.74 | 0.16–3.35 | 0.99 | 0.25–3.96 | 1.90 | 0.45–8.01 | 0.80 | 0.21–2.97 |
Benzodiazepine prescribed | |||
---|---|---|---|
Variable | Category | OR | 95 % CI |
Gender | Male (ref.) | 1.00 | - |
Female | 0.66 | 0.16–2.63 | |
Basic education | Less than high school (ref.) | 1.00 | - |
High school | 1.46 | 0.37–5.81 | |
Married or | No (ref.) | 1.00 | - |
cohabiting | Yes | 0.94 | 0.29–3.08 |
Comorbid | No (ref.) | 1.00 | - |
mood disorder | Yes | 0.66 | 0.20–2.21 |
Comorbid substance | No (ref.) | 1.00 | - |
use disorder | Yes | 2.30 | 0.57–9.26 |
Comorbid | No (ref.) | 1.00 | - |
personality disorder | Yes | *4.77
|
1.11–20.59
|
Comorbid | No (ref.) | 1.00 | - |
other disordera
| Yes | 1.72 | 0.39–7.47 |
More than 1 anxiety | No (ref.) | 1.00 | - |
disorder | Yes | 0.45 | 0.08–2.65 |