Tag: psychiatric diagnosis

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People with Poor Mental Health Experience Healthcare Differently, Survey Reports

On By ModernMedia

Poorer mental health was associated with worse reported care and less trust in the healthcare system

Photo by Alex Green on Pexels

People with self-reported poorer mental health also report worse quality of care and lower confidence in healthcare systems, according to a study published May 5th in the open-access journal PLOS Medicine by Margaret E. Kruk from Washington University in St. Louis, U.S., and colleagues.

Rates of depression and anxiety have increased worldwide since the COVID-19 pandemic, and more people are pursuing mental health treatment as a result. However, there is limited up-to-date data describing how these individuals seek out and receive care. Detailed, population-level information can help healthcare systems meet this growing population’s needs.

To make a start on gathering this data, Kruk and her colleagues surveyed 32 419 adults in 18 high-, low-, and medium-income countries. More than 1000 people from each country responded. Participants self-reported data via the People’s Voice Survey in 2022 and 2023.

First, survey respondents self-assessed their physical and mental health (the latter including “poor,” “fair,” “good,” “very good,” and “excellent”). Then, they quantified their overall confidence in the healthcare system, their own use of healthcare services, the typical quality of care received, and their ability to manage their own mental health (a metric called patient activation).

Mental healthcare receipt among people with poor mental health. Infographic displaying the weighted distribution of mental health status and care receipt. Each figure icon represents 2% of the population. Dark orange = respondents with poor/fair mental health who received mental healthcare in the past 12 months; light orange = those with poor/fair mental health who did not receive care; blue = those with good/very good/excellent mental health.

Image credit: Kruk ME, et al., 2026, PLOS Medicine, CC-BY 4.0 (https://creativecommons.org/licenses/by/4.0/)

Across all countries, respondents reporting poor mental health were more likely to report chronic illness, poorer overall health, lower patient activation, worse care quality and lower confidence in the healthcare system. Between 0.9% (Lao PDR) and 52.4% (UK) of these respondents reported receiving mental health care in the last year. Respondents in Nigeria reported the best overall mental health (4.7% people reported the lowest proportion of “poor” or “fair” mental health (4.7%), while respondents in China had the highest proportion (39.6%).

The researchers hope these results can help the countries in question – and individual healthcare systems – better serve the needs of those with poor mental health. While this is a descriptive study, the researchers posit patient activation as a potential target for elevating overall health and wellness.

The authors acknowledge that big-picture data doesn’t describe individuals’ specific experiences within the healthcare system. They suggest comparison across similar health systems and tracking system performance over time to continuously improve health services.

The authors add, “What stands out from this study is that poor mental health doesn’t exist in isolation. People reporting poor mental health were nearly twice as likely to have a chronic illness and far less likely to feel empowered to manage their own health. Health systems need to stop treating mental health in a silo and recognise that these patients are showing up across all areas of care – and often with more complex needs.”

Kruk adds, “As a research consortium working across very different health systems, we expected to find variation, and we did, in treatment access. But the experience gap was remarkably 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 globally need to rethink how they serve this growing group, not just whether they can reach them.”

Provided by PLOS

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Is It Really ADHD? Serious Flaws in Trials With Adult ADHD Patients

On By ModernMedia
Photo by Alex Green on Pexels

Millions of adults around the world are diagnosed with ADHD every year, and there is a great need for research in the field. Yet much clinical research on adult ADHD suffers from serious methodological shortcomings that make it difficult to use the results in practice, researchers from the University of Copenhagen and the University of Sao Paulo show in a new study.

Originally developed for children, the diagnosis of ADHD is often difficult to make in adults. This is partly because the diagnostic criteria are based on behaviour in children. When diagnosing adults, however, these criteria are often based on adults’ subjective experiences, eg, of having difficulty concentrating or being very impulsive.

“The rising number of adults diagnosed with ADHD raises important questions about diagnostic validity – especially since many were never identified in childhood and are now seeking help, sometimes prompted by ADHD content on social media. That made us curious: how have randomised controlled trials on ADHD dealt with this diagnostic challenge?” explains Dr Igor Studart, who is first author of the study published in European Psychiatry.

Moreover, ADHD shares its symptoms with a number of other mental disorders such as depression, schizophrenia, and bipolar disorder, making it crucial to exclude these disorders when diagnosing ADHD. This requires a thorough diagnostic assessment by an experienced psychologist or psychiatrist.

But it is not always the case that such a thorough assessment is made. The study now shows that even psychiatric research into ADHD often neglects this fundamental work.

“We have examined how 292 of the most credible studies in evidence-based medicine – the so-called randomised controlled trials – diagnosed their adult subjects,” says Professor of Psychiatry and Consultant Psychiatrist Julie Nordgaard, who conducted the study together with Associate Professor and Senior Researcher Mads Gram Henriksen and Dr Igor Studart.

She continues:

“We conclude that half of the studies did not ensure a broad and thorough diagnostic assessment of the patients before the trial to rule out other disorders. This means that they can’t actually know, if their subjects have other mental disorders such as depression or schizophrenia. And that’s not all. More than half of the studies included subjects, who have also been diagnosed with other mental disorders, making the diagnosis even more difficult to allocate”, Julie Nordgaard explains.

According to the researchers, these methodological shortcomings are problematic, because they imply that it is impossible to know which disorders and symptoms the treatment investigated in these trials potentially had an effect on.

“This makes the research results from many of these clinical trials difficult to utilise. Yet, the results of randomised controlled trials are considered particularly trustworthy, and they may inform the guidelines we use to treat adult ADHD patients, even though the results from many of these trials should be assessed very carefully,” says Mads Gram Henriksen.

A need for consistent and robust diagnoses

According to the researchers, one of the problems with the diagnostic assessment in many of the clinical trials is that it seems to have been carried out by people who are not trained to do so. And often with methods that are not thorough enough.

“In 61% of the studies, they do not state who diagnosed the subjects. In only 35% of the studies, it is stated that a psychiatrist or psychologist made the diagnosis. But diagnostic assessment should always be performed by an experienced professional with the necessary training to ensure that the diagnosis is made correctly, and this should be stated in the studies’ method section,” explains Mads Gram Henriksen.

In some cases, the assessment and thus the diagnosis was made by the subject themselves, and in one particularly egregious case, it was done with the help of a computer, the researchers explain.

“In psychiatry, we really need that all diagnoses, not just ADHD, are made with the same uniform criteria and by trained professionals. Otherwise, we cannot rely on the results or compare them across studies,” says Julie Nordgaard and concludes:

“Especially in a situation where a diagnosis such as ADHD in adults is increasing, we need to be very thorough and have a solid foundation. Otherwise, we risk too many people getting a wrong diagnosis and not being able to give them the most effective treatment. Or they risk receiving unnecessary treatment that causes side-effects.”

Source: University of Copenhagen