John J McGrath’s research while affiliated with Aarhus University and other places

Background Previous studies have estimated the lifetime incidence, age of onset and prevalence of mental disorders, but none have used nationwide data covering both primary and secondary care, even though mental disorders are commonly treated in primary care. We aimed to determine lifetime incidence, age-specific incidence, age of onset and service utilization for diagnosed mental disorders. Methods This register-based cohort study followed the entire population of Finland from 2000 to 2020. We estimated the cumulative incidence of diagnosed mental disorders with the Aalen–Johansen estimator, accounting for competing risks such as death and emigration. We also calculated age-specific incidence and 12-month service utilization as of 31 December 2019, providing diagnosis-, age- and gender-specific estimates. Results We followed 6.4 million individuals for 98.5 million person-years. By age 100, lifetime incidence of any diagnosed mental disorder was 76.7% (95% CI, 76.6–76.7) in women and 69.7% (69.6–69.8) in men; in psychiatric secondary care, it was 39.7% (39.6–39.8) and 31.5% (31.4–31.6). At age 75, stricter estimates for non-organic disorders (ICD-10: F10–F99) were 65.6% (65.5–65.7) for women and 60.0% (59.9–60.1). Anxiety disorders (F40–F48) had the highest cumulative incidence. Median age of onset of non-organic mental disorders was 24.1 (interquartile range, 14.8–43.3 years) in women and 20.0 (interquartile range, 7.3–42.2 years) in men. Service utilization within 12 months was 9.0% for women and 7.7% for men. Conclusions Most, though not all, individuals experience at least one type of mental disorder, often during youth. Capturing the overall occurrence of mental disorders requires including both primary and secondary care data.

Background Perceived need for treatment is a first step along the pathway to effective mental health treatment. Perceived need encompasses a person’s recognition that they have a problem and their belief that professional help is needed to manage the problem. These two components could have different predictors. Methods Respondents aged 18+ years with 12-month mental disorders from 25 representative household surveys in 21 countries in the World Mental Health Survey Initiative (n = 12,508). All surveys included questions about perceived need; 16 surveys (13 countries) included additional questions about respondents’ main reason for perceived need—problem recognition or perceived inability to manage without professional help (n = 9814). Associations of three sets of predictors (disorder, socio-demographics, past treatment) with perceived need and its components were examined using Poisson regression models. Results Across the 16 surveys with additional questions, 42.4% of respondents with a 12-month mental disorder reported perceived need for treatment. In separate multivariable models for each predictor set: (1) Most disorder types (except alcohol use disorder, specific phobia), disorder severity, and number of disorders were associated with perceived need and both of its components; (2) Sociodemographic factors tended to differentially predict either problem recognition (females, 30–59 years, disabled/unemployed) or need for professional help (females, homemakers, disabled/unemployed, public insurance); (3) Past treatment factors (type of professional, psychotherapy, helpful or unhelpful treatment) were associated with perceived need and both components, except number of past professionals differentially predicted problem recognition. In a consolidated model: employment and insurance became non-significant; type and number of past professionals seen became more important; helpful past treatment predicted greater need for professional help while unhelpful treatment predicted lower problem recognition. Problem recognition was the more important component in determining perceived need for some groups (e.g., severe disorder, people who consulted non-mental health professionals). Conclusions Greater clinical need is a key determinant of perceived need for treatment. Findings suggest a need for strategies to address low perceived need (e.g., in males, older people, alcohol use disorders) and lower endorsement of professional treatment in some groups, and to improve patient’s treatment experiences which are important enablers of future help-seeking. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-025-00666-w.

Background: Data from the World Mental Health (WMH) surveys on the coverage cascade has underscored the importance of perceived need for seeking treatment of mental disorders. However, little research has focused on treatment contact after adjusting for perceived need. We do so here in analysis of WMH data. Methods: The WMH data considered here come from 25 community surveys implemented between 2001 and 2019 across 21 countries. n = 12,508 of the n = 117,739 respondents in these surveys aged 18 and older met criteria for one or more 12-month DSM-IV anxiety, mood, or substance use disorders assessed across all these surveys. Information was obtained about 12-month treatment of each disorder. The predictors considered were disorder type, socio-demographics, and history of prior treatment. Results: Twelve-month treatment was obtained for 17.7% of the n = 18,702 12-month person-disorders in the sample, including 34.1% for the 46.5% with perceived need and 3.5% for the 54.5% without perceived need. After adjusting for perceived need, receiving treatment was most strongly associated with disorder characteristics (severity, and highest for major depressive, panic/agoraphobia, and generalized anxiety disorders; lowest for substance use disorders), health insurance, employment status (highest for students, the retired, and the unemployed/disabled), and several aspects of prior treatment. These associations were generally similar in cases with and without perceived need for treatment. 12-month treatment among cases who without perceived need and without history of prior treatment was rare (1.1%). Conclusions: Findings highlight the critical importance of perceived need for obtaining 12-month treatment in the context of other significant predictors involving complexity and severity of disorders and socio-demographic factors. The importance of prior treatment history was quite striking, as was the finding that absence of both perceived need and prior treatment history were associated with a nearly complete absence of treatment. Policy recommendations emerging from these results include the need to increase health literacy, reduce the stigmatization of mental disorder, enhance access through health insurance, and improve the quality of care given the clear evidence that prior experiences with treatment play an important role in determining the likelihood of again seeking treatment for current problems.

Background National surveys have suggested that obsessive-compulsive disorder (OCD) is a prevalent and impairing condition. However, there are few cross-national data on OCD, with data particularly scarce in low- and middle-income countries. Here we employ data from the World Mental Health surveys to characterize the onset, course, severity, and treatment of OCD across a range of countries in different geographic regions of the world. Methods Data came from general population surveys carried out in 10 countries using a consistent research protocol and interview. A total of 26,136 adults were assessed for OCD in face-to-face interviews and were included in the present analyses. We examined lifetime and 12-month prevalence as well as age of onset, persistence, severity, and treatment of DSM-IV OCD in six high-income countries (HICs) and four low- or middle-income countries (LMICs). We also investigated socio-demographic variables and temporally prior mental disorders as predictors of OCD onset, persistence, severity, and treatment. Results Across the 10 countries surveyed, OCD has a combined lifetime prevalence of 4.1%. The 12-month prevalence (3.0%) is nearly as high, suggesting a highly persistent course of illness. Age of onset is early, with more than 80% of OCD cases beginning by early adulthood. Most OCD cases in the community are mild (47.0%) or very mild (27.5%), with a smaller percentage designated as moderate (22.9%) or severe (2.7%) by the Yale-Brown Obsessive-Compulsive Scale. Only 19.8% of respondents with OCD received any mental health treatment in the past year, with treatment rates much higher in HICs (40.5%) than LMICs (7.0%). Cross-nationally, OCD commonly emerges in adolescence or early adulthood against a backdrop of earlier-occurring mental disorders. With few exceptions (e.g., marital status, prior social phobia), the socio-demographic and psychopathological risk factors for OCD onset, persistence, severity, and treatment are distinct. Conclusions These cross-national data underscore clinical lessons regarding the importance of early diagnosis of OCD and comprehensive evaluation of comorbidity; draw attention to OCD as an undertreated disorder, particularly in LMIC contexts; and emphasize the public health significance of this often-overlooked condition.

Background High unmet need for treatment of mental disorders exists throughout the world. An understanding of barriers to treatment is needed to develop effective programs to address this problem. Methods Data on barriers were obtained from face-to-face interviews in 22 community surveys across 19 countries (n = 102,812 respondents aged ≥ 18 years, 57.7% female, median age [interquartile range]: 43 [31–57] years; 68.5% weighted average response rate) in the World Mental Health (WMH) surveys. We focus on the n = 5,136 respondents with 12-month DSM-IV anxiety, mood, or substance use disorders with perceived need for treatment. The n = 2,444 such respondents who did not receive treatment were asked about barriers to receiving treatment, whereas the n = 926 respondents who received treatment with a delay were asked about barriers leading to delays. Consistent with previous research, we distinguished five broad classes of barriers: low perceived disorder severity, two types of barriers in the domain of predisposing factors (beliefs/attitudes about treatment ineffectiveness and stigma) and two types in the domain of enabling factors (financial and nonfinancial). Baseline predictors of receiving treatment found in a prior report (i.e., comparing the n = 2,692 respondents who received treatment with the n = 2,444 who did not) were examined as predictors of barriers, while barriers were examined as mediators of associations between these predictors and treatment. Results Most respondents reported multiple barriers. Barriers among respondents who did not receive treatment included low perceived severity (52.9%), perceived treatment ineffectiveness (44.8%), nonfinancial (40.2%) and financial (32.9%) barriers in the domain of enabling factors, and stigma (20.6%). Barriers causing delays in treatment had a similar rank-order but were reported by higher proportions of respondents (X²1 = 3.8–199.8, p = 0.050− < 0.001). Barriers were predicted by low education, disorder type, age, employment status, and financial obstacles. Predictors varied as a function of barrier type. Conclusions A wide range of barriers to treatment exist among people with mental disorders even after a need for treatment is acknowledged. Most such individuals have multiple barriers. These results have important implications for the design of programs to decrease unmet need for treatment of mental disorders. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-024-00658-2.

Mental disorders are associated with elevated mortality rates and reduced life expectancy. However, it is unclear whether these associations differ by socioeconomic position (SEP). The aim of this study was to explore comprehensively the role of individual‐level SEP in the associations between specific types of mental disorders and mortality (due to all causes, and to natural or external causes), presenting both relative and absolute measures. This was a cohort study including all residents in Denmark on January 1, 2000, following them up until December 31, 2020. Information on mental disorders, SEP (income percentile, categorized into low, <20%; medium, 20‐79%; and high, ≥80%), and mortality was obtained from nationwide registers. We computed the average reduction in life expectancy for those with mental disorders, relative and absolute differences in mortality rates, and proportional attributable fractions. Subgroup analyses by sex and age groups were performed. Overall, 5,316,626 individuals (2,689,749 females and 2,626,877 males) were followed up for 95.2 million person‐years. People with mental disorders had a shorter average life expectancy than the general population regardless of SEP (70.9‐77.0 vs. 77.2‐85.1 years, depending on income percentile). Among individuals with a mental disorder, the subgroup in the top 3% of the income distribution had the longest average life expectancy (77.0 years), and this estimate was lower than the shortest life expectancy in the general Danish population (77.2 years for individuals in the bottom 6% income distribution). The mortality rate differences were larger in the low‐income than the high‐income group (19.6 vs. 13.3 per 1,000 person‐years). For natural causes of death, a socioeconomic gradient for differences in life expectancy and mortality rates was observed across most diagnoses, both sexes, and all age groups. For external causes, no such gradient was observed. In the low‐SEP group, 10.1% of all deaths and 23.7% of those related to external causes were attributable to mental disorders, compared with 3.5% and 8.7% in the high‐SEP group. Thus, our data indicate that people with mental disorders have a shorter life expectancy even than people with the lowest SEP in the general population. The socioeconomic gradients in mortality rates due to natural causes highlight a greater need for coordinated care of physical diseases in people with mental disorders and low SEP.

Previous studies have estimated lifetime incidence, age-specific incidence, age of onset, and service utilization for mental disorders but none have used nationwide data from both primary and secondary care. This study used nationwide Finnish data (2000–2020), including both care settings for the first time. We followed 6.4 million individuals for 98.5 million person-years, calculating cumulative incidence while accounting for competing risks. By age 100, lifetime incidence of any diagnosed mental disorder was 76.7% (95% CI, 76.6–76.7) in women and 69.7% (69.6–69.8) in men. At age 75, stricter estimates for non-organic disorders (ICD-10: F10–F99) were 65.6% (65.5–65.7) for women and 60.0% (59.9–60.1). Anxiety disorders (F40–F48) had the highest cumulative incidence. Median age of onset of non-organic mental disorders was 24.1 (interquartile range 14.8–43.3) in women and 20.0 (7.3–42.2) in men. Service utilization within 12 months was 9.0% for women and 7.7% for men. Most, though not all, individuals experience at least one type of mental disorder, often during youth. Capturing the overall occurrence of mental disorders requires including both primary and secondary care data.

It is still unclear how changes in alcohol control policies may have contributed to changes in overall levels of alcohol-attributed harm between and within the Nordic countries. We modified and applied the Bridging the Gap (BtG)-scale to measure the restrictiveness of a set of alcohol control policies for each Nordic country and each year between 1990 and 2019. Alcohol-attributed harm was measured as total and sex-specific alcohol-attributed disease burden by age-standardized years of life losts (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) per 100 000 population from the Global Burden of Disease Study (GBD). Longitudinal crosscountry comparisons with random effects regression analysis were employed to explore associations, within and across countries, differentiated by sex and the time to first effect. Overall, alcohol-attributed YLLs, YLDs, and DALYs decreased over the study period in all countries, except in Iceland. The burden was lower in those countries with restrictive national policies, apart from Finland, and higher in Denmark which had the least restrictive policies. Changes in restrictiveness were negatively associated with DALYs for causes with a longer time to effect, although this effect was stronger for males and varied between countries. The low alcohol attributed disease burden in Sweden, Norway, and Iceland, compared to Denmark, points towards the success of upholding lower levels of harm with strict alcohol policies. However, sex, location and cause-specific associations indicate that the role of formal alcohol policies is highly context dependent and that other factors might influence harm as well.