Treatment and long-term outcome of mental disorders: the grim picture from a quasi-epidemiological investigation in 54,826 subjects from 40 countries

Fountoulakis, Konstantinos N, Karakatsoulis, Gregory, Abraham, Seri, Adorjan, Kristina, Ahmed, Helal Uddin, Alarcón, Renato D, Arai, Kiyomi, Auwal, Sani Salihu, Berk, Michael, Levaj, Sarah, Bobes, Julio, Bobes-Bascaran, Teresa, Bourgin-Duchesnay, Julie, Bredicean, Cristina Ana, Bukelskis, Laurynas, Burkadze, Akaki, Abud, Indira Indiana Cabrera, Castilla-Puentes, Ruby, Cetkovich, Marcelo, Colon-Rivera, Hector, Corral, Ricardo, Cortez-Vergara, Carla, Crepin, Piirika, De Berardis, Domenico, Delgado, Sergio Zamora, De Lucena, David, De Sousa, Avinash, Stefano, Ramona Di, Dodd, Seetal, Elek, Livia Priyanka, Elissa, Anna, Erdelyi-Hamza, Berta, Erzin, Gamze, Etchevers, Martin J, Falkai, Peter, Farcas, Adriana, Fedotov, Ilya, Filatova, Viktoriia, Fountoulakis, Nikolaos K, Frankova, Iryna, Franza, Francesco, Frias, Pedro, Galako, Tatiana, Garay, Cristian J, Garcia-Álvarez, Leticia, García-Portilla, Maria Paz, Gonda, Xenia, Gondek, Tomasz M, González, Daniela Morera, Gould, Hilary, Grandinetti, Paolo, Grau, Arturo, Groudeva, Violeta, Hagin, Michal, Harada, Takayuki, Hasan, Tasdik M, Razali, Salmi, Hilbig, Jan, Hossain, Sahadat, Iakimova, Rossitza, Ibrahim, Mona, Iftene, Felicia, Ignatenko, Yulia, Irarrazaval, Matias, Ismail, Zaliha, Ismayilova, Jamila, Jakobs, Asaf, Jakovljević, Miro, Jakšić, Nenad, Javed, Afzal, Kafali, Helin Yilmaz, Karia, Sagar, Kazakova, Olga, Khalifa, Doaa, Khaustova, Olena, Koh, Steve, Kopishinskaia, Svetlana, Kosenko, Korneliia, Vadon, Nikolett Beata, Lalljee, Alisha, Liewig, Justine, Majid, Abdul, Malashonkova, Evgeniia, Malik, Khamelia, Malik, Najma Iqbal, Mammadzada, Gulay, Mandalia, Bilvesh, Marazziti, Donatella, Marčinko, Darko, Martinez, Stephanie, Matiekus, Eimantas, Mejia, Gabriela, Memon, Roha Saeed, Martínez, Xarah Elenne Meza, Mickevičiūtė, Dalia, Milev, Roumen, Mohammed, Muftau, Molina-López, Alejandro, Morozov, Petr, Muhammad, Nuru Suleiman, Mustač, Filip, Naor, Mika S, Nassieb, Amira, Navickas, Alvydas, Okasha, Tarek, Pandova, Milena, Panfil, Anca-Livia, Panteleeva, Liliya, Papava, Ion, Pavlichenko, Alexey, Pejuskovic, Bojana, da Costa, Mariana Pinto, Popkov, Mikhail, Popovic, Dina, Raduan, Nor Jannah Nasution, Ramírez, Francisca Vargas, Rancans, Elmars, Hashim, Nurul Azreen, Rebok, Federico, Rewekant, Anna, Flores, Elena Ninoska Reyes, Rivera-Encinas, María Teresa, Saiz, Pilar, de Carmona, Manuel Sánchez, Martínez, David Saucedo, Saw, Jo Anne, Saygili, Görkem, Schneidereit, Patricia, Shah, Bhumika, Shirasaka, Tomohiro, Silagadze, Ketevan, Sitanggang, Satti, Skugarevsky, Oleg, Spikina, Anna, Mahalingappa, Sridevi Sira, Stoyanova, Maria, Szczegielniak, Anna, Tamasan, Simona Claudia, Tavormina, Giuseppe, Tavormina, Maurilio Giuseppe Maria, Tohen, Mauricio, Tsapakis, Eva Maria, Tukhvatullina, Dina, Ullah, Irfan, Vaidya, Ratnaraj, Vega-Dienstmaier, Johann M, Vrublevska, Jelena, Vukovic, Olivera, Vysotska, Olga, Widiasih, Natalia, Yashikhina, Anna and Smirnova, Daria (2025) Treatment and long-term outcome of mental disorders: the grim picture from a quasi-epidemiological investigation in 54,826 subjects from 40 countries. Psychiatry Research, 348. 116459. ISSN 0165-1781

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Abstract

This study registered rates of specific treatment options for mental disorders as well as their long-term outcome. The history of mental disorders was used as a proxy for diagnosis. The data came from the COMET-G study (40 countries; 54,826 subjects, 64.73 % females, 35.45±13.51 years old). The analysis included descriptive statistics, Risk Ratios, t-tests, and ANCOVA's. .14 % reported a history of any mental disorder (depression >12 %, non-affective psychosis and Bipolar disorder 1 % each, >20 % self-injury, >10 % had attempted suicide, 7.17 % illegal substance abuse). Most patients were not under any kind of treatment (59.44 %) and most were not receiving treatment as recommended (e.g. 90 % of Bipolar and 2/3 of psychotic patients). No treatment at all and psychotherapy as monotherapy were consistently related to poorer outcomes. In anxiety or depression, only antidepressant monotherapy and benzodiazepines, in Bipolar disorder only antipsychotic monotherapy in males and antidepressant monotherapy in females and in non-affective psychosis antipsychotics and psychotherapy in females only, were related to good outcomes. No treatment modality was related to a good outcome in those with a history of self-harm, suicidal attempts, or illegal substance use. Only depression and treatment with antidepressants were related to metabolic syndrome. In the community, the overwhelming majority of mental patients do not receive appropriate treatment or, even worse, no treatment at all. The outcome is unfavourable for the majority and only a few selective treatment options seem to make a difference. [Abstract copyright: Copyright © 2025. Published by Elsevier B.V.]