Only seven out of 100 people worldwide receive effective treatment for their mental health or substance-use disorders

University of British Columbia

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New research estimates that globally, only 6.9 per cent of people with mental health or substance-use disorders receive effective treatment for their disorders.

Researchers from the University of British Columbia and Harvard Medical School analyzed survey data from nearly 57,000 participants in 21 countries collected over a 19-year period, to provide the clearest picture yet of where people discontinue their path to effective treatment for nine common anxiety, mood and substance-use disorders.

The biggest barrier to effective treatment is a person not recognizing that they need it, the study showed. However, even patients who contact the healthcare system often do not receive effective treatment.

“This survey data has allowed us to create the only effective treatment indicator that exists for mental health and substance use,” said lead author Dr. Daniel Vigo, associate professor at UBC's department of psychiatry and school of population and public health. “Policy decisions and allocative decisions for funding should be guided by data, and this hasn’t always been the case in the realm of mental health and substance use.”

The World Health Organization-World Mental Health Surveys Initiative collects data on the prevalence, severity and treatment of mental disorders worldwide. This study focused on survey participants who met criteria for a disorder under the Diagnostic and Statistical Manual of Mental Disorders-IV, a standardized classification system used by mental health professionals from 1994 to 2013.

The team, led by Dr. Vigo and Dr. Ronald Kessler of Harvard, was interested in how close participants got to receiving effective treatment that met evidence-based guidelines—and where they might have dropped off along the way.

They analyzed four key steps, and the percentage of people who proceeded from each step to the next:

1. Recognizes their need for treatment
2. Makes contact with the healthcare system about it
3. Receives a minimum level of adequate treatment
4. Receives effective treatment

They found:

• Only 46.5 per cent of people who met the criteria for a disorder recognized their need for treatment.
• Of those who did recognize their need, only 34.1 per cent turned to the medical system for help.
• Most who sought help (82.9 percent) received a minimum level of adequate treatment.
• About 47 per cent of people who received minimally adequate treatment ended up receiving effective treatment.

Attrition at various points along this pathway meant that only 6.9 per cent ended up receiving effective treatment.

“Understanding where the bottlenecks are for each of these disorders provides a unique and previously unavailable blueprint for decision makers to understand problems objectively and try to adjust the system,” said Dr. Vigo.

The study revealed a significant drop-off after patients contacted the healthcare system but before they received effective treatment. Since general practitioners and family doctors are typically their first point of contact with the system, it’s essential to make sure those doctors have appropriate training, said Dr. Vigo.

“Improving the ability of these general practitioners and family doctors to diagnose and treat the mild to moderate forms, and to know when to refer more severely affected folks to specialists, becomes the cornerstone of the system,” he said.

The research, published today in JAMA Psychiatry, provides decision makers with a base of evidence to guide policy and funding decisions in mental health and substance use. By highlighting gaps in service needs and outcomes for disorders ranging from bipolar disorders to addiction, it identifies where targeted investments could potentially yield the greatest impact. Armed with these insights, policymakers worldwide can prioritize interventions that result in improvements in care.

Interview languages: English, Spanish

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Journal

JAMA Psychiatry

DOI

10.1001/jamapsychiatry.2024.4378 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Effective Treatment for Mental and Substance Use Disorders in 21 Countries

Article Publication Date

5-Feb-2025

COI Statement

Please see published journal article or request a copy for details.

 

Study explores compound's potential to enhance THC for pain treatment

Researchers reveal how CBD could help ease chronic pain, anxiety, mood disorders

University of Mississippi

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Two compounds found in cannabis – CBD and THC – work in very different ways, but new research from the UM National Center for Natural Products Research could unlock the key to new medical uses for the products. A recent study published in ACS Neuroscience shows that understanding how CBD functions in the body could lead to scientists reducing the harmful side effects – such as dependence and memory loss – from THC. 

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Credit: Photo by Kevin Bain/Ole Miss Digital Imaging Services

University of Mississippi researchers have discovered how a compound found in cannabis might be used to mitigate the negative effects of THC, a psychoactive compound in the plant.

This breakthrough sets the stage for new uses of the CBD, which could help people who experience anxiety, chronic pain and a number of other illnesses.

Amar Chittiboyina, principal scientist and associate director of the National Center for Natural Products Research, and a team of investigators recently published their research in ACS Neuroscience.

"This research will open a new avenue for anyone in the field of cannabis research," Chittiboyina said. "It actually opens up new prospects or a new horizon in modulating cannabinoid receptors and harnessing THC's beneficial effects for pain management."

CBD is one of more than 200 natural cannabinoids in the cannabis plant, but unlike some of its counterparts, CBD is not psychoactive. Its popularity in the United States has grown since 2018, when the Agricultural Improvement Act decriminalized hemp.

"The 2018 Farm Bill passage effectively opened a Pandora's box of research challenges," Chittiboyina said. "CBD's use proliferated across a wide spectrum from pain management, recreational purposes to seemingly endless other applications.

"However, the fundamental question lies in understanding how CBD works on various targets and exerts its perceived effects at the molecular level."

Cannabinoid receptor type 1 is a protein found throughout the body that regulates pain, mood, appetite, metabolism and memory. Both CBD and THC bind to this protein.

When THC attaches to the receptor, the effect is like an off switch to a light bulb, effectively turning "off" the pain. But THC also has harmful side effects, including memory loss, nausea and addiction.

When CBD binds to the receptor, however, it acts more like a dimmer switch, turning up or down the function of the protein.

The researchers have discovered the locations on this protein molecule where CBD binds, meaning future research could "turn down" or minimize the side effects of THC use.

"Our primary objective is to harness the beneficial effects of THC while mitigating its undesirable side effects," said Pankaj Pandey, a research scientist in the center.

This research could help scientists develop a synthetic CBD that can alter receptor behavior more efficiently even than CBD, said Robert Laprairie, associate professor at the University of Saskatchewan and co-author of the study.

"When people talk about cannabis, they tend to focus on or think of it just as a drug, as the plant," Laprairie said. "But we have a treasure chest of drug possibilities here and what we're trying to do is pick out specific, very focused effects and refine those.

"We're trying to pull out the benefits and leave the harms behind."

One example of new research that is made possible by the recent findings is that of William Neal, a postdoctoral researcher at the Ole Miss center. Neal's upcoming research hopes to determine if CBD use would affect opioids like morphine in the body.

"In the event that CBD binds to an opioid receptor, you could have negative interplay with opiate drugs like morphine," Neal said. "If you're getting pain relief from opiates, and if CBD negatively interferes with the opioid receptor, it's going to frustrate people who are prescribed opiates.

"As a result, CBD will reduce efficacy of opiates and could enhance the drug abuse liabilities."

Neal's research into the interaction of CBD and opioids is only one of many avenues that are opened due to this research, Chittiboyina said.

"That's what I mean when I say this is a new horizon for cannabinoids research," Chittiboyina said. "Often, to mitigate pain, patients combine opiates with cannabis, kratom and other substances. Is this approach beneficial or detrimental?"

More research is needed to confirm the team's findings before they finalize their results.

"But if we can pinpoint how CBD interacts with multiple targets on molecular level, we will be in a stronger scientific position to develop solutions that are relevant to public health," he said.

This material is based on work supported by the National Institute of General Medical Sciences grant no. P30GM122733, the National Science Foundation XSEDE Bridges allocation no. CHE190092 and Mississippi State-sponsored National Center for Cannabis Research and Education.

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Journal

ACS Chemical Neuroscience

DOI

10.1021/acschemneuro.4c00343 

Article Title

Determination of the Negative Allosteric Binding Site of Cannabidiol at the CB1 Receptor: A Combined Computational and Site-Directed Mutagenesis Study

 

Rapid increase in early-onset type 2 diabetes in China highlights urgent public health challenges

Health Data Science

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Scientists from Peking University analyzed trends in early-onset T2D burden from 1990 to 2021, highlighting differences by age groups and sexes in China and globally.

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Credit: Siyan Zhan, Peking University

A new study led by researchers from Peking University, published in Health Data Science, reveals a sharp rise in the burden of early-onset type 2 diabetes (T2D) among adolescents and young adults in China from 1990 to 2021. Despite improvements in mortality rates, the incidence and disability-adjusted life years (DALYs) associated with the disease have grown alarmingly.

Using data from the Global Burden of Disease (GBD) Study 2021, the study shows that the age-standardized incidence rate nearly doubled, increasing from 140.20 per 100,000 in 1990 to 315.97 per 100,000 in 2021, with an average annual percentage change (AAPC) of 2.67%. Similarly, DALYs rose from 116.29 to 267.47 per 100,000 during the same period, marking an AAPC of 2.75%. Mortality rates, however, showed only a slight decline.

The burden of early-onset T2D disproportionately affects young males, who experience higher rates of incidence, DALYs, and mortality compared to females. The 15–19 age group witnessed the fastest rise in incidence, with an AAPC of 4.08%, indicating a critical need for age-specific interventions.

The study identifies high body mass index (BMI) as the leading contributor to early-onset T2D DALYs, accounting for 59.85% in 2021, a significant increase from 40.08% in 1990. Other key risk factors include ambient particulate matter pollution and diets high in red meat.

“Our findings underscore the urgent need for comprehensive public health strategies focused on obesity prevention, improved environmental health, and dietary interventions,” said Professor Siyan Zhan from the Department of Epidemiology and Biostatistics, School of Public Health, Peking University.

The researchers emphasize the importance of targeted interventions for males and younger age groups, integrating public awareness campaigns, policy reforms, and community-based health programs to curb the growing disease burden.

This study provides critical evidence to guide policymakers and healthcare professionals in addressing the escalating health challenge posed by early-onset type 2 diabetes in China.

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Journal

Health Data Science

DOI

10.34133/hds.0210 

Article Title

The Burden of Type 2 Diabetes in Adolescents and Young Adults in China: A Secondary Analysis from the Global Burden of Disease Study 2021

 

Fool yourself: People unknowingly cheat on tasks to feel smarter, healthier

Penn State

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UNIVERSITY PARK, Pa. — Fool me once, shame on you. Fool myself, and I may end up feeling smarter, according to a new study led by Sara Dommer, assistant professor of marketing at Penn State.

Dommer wondered why people cheat on tasks like completing crossword puzzles or Wordle and counting calories when the rewards are purely intrinsic, like feeling smarter or healthier. She found that when cheating offers the opportunity to improve self-perception, individuals engage in diagnostic self-deception — that is, they cheat yet deceive themselves by attributing their heightened performance to their innate ability instead of the cheating. She published her findings in the Journal of the Association for Consumer Research.

“I found that people do cheat when there are no extrinsic incentives like money or prizes but intrinsic rewards, like feeling better about yourself,” Dommer said. “For this to work, it has to happen via diagnostic self-deception, meaning that I have to convince myself that I am actually not cheating. Doing so allows me to feel smarter, more accomplished or healthier.”

Dommer conducted four studies to determine if people will cheat when rewards are solely intrinsic and what drives the feeling of accomplishment despite the cheating. In the first study, 288 undergraduate students received menu information about three days’ worth of meals — like three pancakes with butter — and were tasked with entering calorie information into a food-tracking app. The students were divided into two groups, with one group receiving additional calorie counts accompanying the meal descriptions.

The app listed five potential calorie options for each food entered. For example, the calorie counts for three pancakes with butter ranged from 300 to 560 calories. The group without specific calorie information could have averaged the five options to compensate for the missing information and get a better idea of the true caloric value of each meal, according to Dommer. Instead, participants in this group tended to enter fewer calories than the group that received specific calorie information, suggesting that people will cheat for intrinsic benefits, in this case feeling healthier.

The second study included 195 participants recruited on Amazon Mechanical Turk. These participants were divided into two groups — a control group and a cheat group — and asked to complete a 10-question, multiple choice IQ test. Those assigned to the cheat group were told that correct answers would be highlighted so they could keep track of their progress. After the exam, participants in the cheat group were asked to enter the number of questions they got correct, while the control group had to estimate their scores. Then the program graded both groups’ tests, and participants were asked to predict their score on an additional 10-question IQ test, this time one that did not allow for the possibility to cheat.

Dommer found that participants in the cheat group reported higher scores than those in the control group and, based on their self-reporting, overestimated their performance on the second IQ test. The results, she said, suggested that participants in the cheat group engaged in diagnostic self-deception, believing that their performance was due to their intelligence and not cheating, though their scores on the second test suggest otherwise.

The third study mirrored the second study, except this time 195 participants had to unscramble letters to find a word, like deciphering “utmost” from “motuts.” Individuals assigned to the control group had to enter their answers in an answer box, while those in the cheat group were shown the correct answer after 3 minutes and asked to self-report their scores. Then participants rated on a scale from one to seven, with one being “not at all” and seven being “very much so,” how much their intelligence and the task’s difficulty contributed to their performance. They used a similar scale to answer the question, “To what extent do you agree that unscrambling words is an accurate test of intelligence?”

Again, Dommer found that those in the cheat group reported successfully unscrambling more words than those in the control group. Compared to the control group, this group was more likely to attribute their performance to their intelligence and more likely to consider the task a legitimate test of intelligence.

“Participants in the cheat group engaged in diagnostic self-deception and attributed their performance to themselves,” Dommer said. “The thinking goes, ‘I’m performing well because I’m smart, not because the task allowed me to cheat.’”

The final study asked 231 participants to take a financial literacy test. Participants were divided into control and cheat groups, except this time the researcher had about half of each group read a statement about how most American adults cannot pass a basic financial literacy test. Dommer thought that introducing uncertainty about their own financial literacy may make individuals value accuracy over performance and reduce cheating. After taking the test, participants used a scale from one to seven to rate themselves on 15 traits related to financial literacy.

Dommer found that introducing the uncertainty statement decreased cheating as individuals sought more accurate measures of their financial literacy.

“How do we stop people from engaging in diagnostic self-deception and get a more accurate representation of who they are? One way is to draw their attention to uncertainty around the trait itself. This seems to mitigate the effect,” Dommer said.

Our society tends to think of “cheating” as a strategic, intentional act, Dommer said. This work, she explained, suggests that at times cheating happens beyond conscious awareness.

“I don’t think there’s a good cheating or a bad cheating,” she said. “I just think it’s interesting that not all cheating has to be conscious, explicit and intentional. That said, these illusory self-beliefs can still be harmful, especially when assessing your financial or physical health. When a person engages in diagnostic self-deception, they may underuse products and services designed to help them. This is why it’s important to be aware of illusory beliefs and strive to seek accurate self-assessments.”

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Journal

Journal of the Association for Consumer Research

DOI

10.1086/732915 

Article Title

Acting Immorally to Self-Enhance: The Role of Diagnostic Self-Deception

"Infant formula marketing in Ecuador: a threat to breastfeeding"

Escuela Superior Politecnica del Litoral

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Logo and brand of a breastmilk substitute.

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Credit: Luz Valencia Erazo/ESPOL

The marketing of breast milk substitutes (BMS) significantly influences infant feeding practices worldwide. In Ecuador, despite regulatory efforts aligned with the WHO’s International Code of Marketing of Breast Milk Substitutes, industry advertising strategies continue to impact the decisions of both mothers and healthcare professionals. This cross-sectional study assessed compliance with the Code in Ecuador through surveys of mothers (n=330) and healthcare professionals (n=66), observations in healthcare facilities (n=33) and retail outlets (n=44), as well as media monitoring and product labeling evaluations.

The results revealed high exposure to BMS marketing outside healthcare facilities (91.21% of mothers). Direct interactions with healthcare professionals were identified, including the distribution of free supplies (26.09%) and gifts (21.74%). In retail outlets, 95% of products featured promotions, primarily discounts. Product labeling largely failed to meet nutritional and health information criteria (39%). Television emerged as the main advertising medium, with 2,884 commercials aired over a period of 16 hours and 24 minutes, amounting to an investment of $1,876,915.50. On digital platforms, 533,845 interactions were recorded on BMS advertisements.

These findings demonstrate widespread violations of the WHO Code in Ecuador, highlighting the need for stricter regulations and educational strategies targeting healthcare professionals and the public. Despite the existence of national regulations, the industry's intensive advertising and high marketing investment expose significant enforcement gaps. To protect maternal and infant health, Ecuador must adopt and rigorously enforce all Code recommendations within its national legislation.

Key Points

• BMS advertising in Ecuador has significantly increased over the last decade, incorporating strategies in social media and digital platforms.
• Current regulations on digital BMS marketing are insufficient, underscoring the need for greater control and specific legislation.
• Systematic violations of both the International Code and national laws hinder effective regulation.
• Widespread exposure to infant formula advertising across multiple platforms reinforces the perception of these products as equivalent or superior to breastfeeding.
• To strengthen breastfeeding protection, Ecuador must improve its legislation and ensure effective enforcement.

Promotional flyer of a product. Advertisements contained wording or messages claiming health or nutrition benefits of the products

Credit

Luz Valencia Erazo/ESPOL

Infant scale with the logo of a breastmilk substitute.

Credit

Luz Valencia Erazo/ESPOL

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Journal

Maternal and Child Nutrition

DOI

10.1111/mcn.13783 

Method of Research

Observational study

Subject of Research

Not applicable

Article Title

Assessing Compliance: Violations of WHO Code in Breast Milk Substitute Marketing, Ecuador