People with self-reported poor mental health also report poorer quality of care and lower trust in health care systems, according to a study published May 5u in the open access journal PLoS Medicine by Margaret E. Kruk of Washington University in St. Louis, USA, and colleagues.
Rates of depression and anxiety have increased worldwide since the COVID-19 pandemic, and more people are seeking mental health treatment as a result. However, there is limited up-to-date data describing how these individuals seek and receive care. Detailed population-level information can help health care systems respond to the needs of this growing population.
To begin collecting this data, Kruk and her colleagues surveyed 32,419 adults in 18 high-, low-, and middle-income countries. More than 1,000 people from each country responded. Participants self-reported data through the People’s Voice Survey in 2022 and 2023.
First, survey respondents self-rated their physical and mental health (the latter including “poor,” “fair,” “good,” “very good,” and “excellent”). They then quantified their overall trust in the health care system, their own use of health care services, the typical quality of care they received, and their ability to manage their own mental health (a metric called patient activation).
Across countries, respondents who reported poor mental health were more likely to report chronic illness, poorer general health, lower patient activation, poorer quality of care, and lower trust in the health care system. Between 0.9% (Lao PDR) and 52.4% (UK) of these respondents reported receiving mental health care in the past year. Respondents in Nigeria reported the best overall mental health (4.7% of people reported the lowest rate of “poor” or “fair” mental health (4.7%), while respondents in China had the highest rate (39.6%).
The researchers hope these results can help the countries in question – and individual health care systems – better serve the needs of people with poor mental health. Although this is a descriptive study, the researchers posit patient activation as a possible goal for elevating overall health and well-being.
The authors acknowledge that big picture data do not describe specific experiences of individuals in the health care system. They suggest comparing between similar health systems and monitoring system performance over time to continuously improve health services.
The authors add, “What stands out from this study is that poor mental health does not exist in isolation. People who reported poor mental health were almost twice as likely to have a chronic illness and much less likely to feel empowered to manage their health. Health systems need to stop treating mental health in a silo and recognize that these patients present in all areas of care – and often with more complex needs.”
As a research consortium working in very different health systems, we expected to find differences, and we did, in access to treatment. But the experience gap was strikingly consistent: people with poor mental health had worse care, more unmet needs and less trust in the system, regardless of where they lived. Health systems worldwide need to rethink how they serve this growing group, not just whether they can reach them.”
Margaret E. Kruk, Washington University in St. Louis, USA
