People who self-report poorer mental health also report poorer quality of care and lower trust in the health care system, according to a study published May 5 in an open access journal. PLOS medicine By Margaret E. Crook and colleagues at Washington University in St. Louis, USA.
Since the COVID-19 pandemic, rates of depression and anxiety have increased around the world, resulting in more people seeking mental health treatment. However, current data describing how these people seek and receive care are limited. Detailed population-level information can help health systems meet the needs of this growing population.
To begin collecting this data, Crook and colleagues surveyed 32,419 adults in 18 high-, low-, and middle-income countries. More than 1,000 people from all over the world 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 included “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 receive, and their ability to manage their own mental health (a measure called patient activation).
Across all countries, respondents who reported poor mental health were more likely to report chronic illness, poorer overall health, lower patient activity, poorer quality of care, and lower trust in the health system. Between 0.9% (Laos) 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%), compared to the lowest proportion (4.7%) reporting poor or fair mental health, while respondents in China had the highest proportion (39.6%).
The researchers hope that these results will help countries and individual health systems in question better meet the needs of people with poor mental health. Although this is a descriptive study, the researchers hypothesize that patient activation is a potential target for improving overall health and wellness.
The authors acknowledge that big-picture data does not describe individuals’ specific experiences within the health care system. They suggest comparing similar health systems and tracking system performance over time to continuously improve health services.
The authors add: ”What is striking about this study is that poor mental health does not exist in isolation. People who reported poor mental health were nearly twice as likely to have a chronic illness and far less likely to feel disempowered to manage their health. Health systems need to stop treating mental health in silos and recognize that these patients are present in all areas of care and often have more complex needs.. ”
As a research consortium working across very different health systems, we expected, and indeed did, to see disparities in access to treatment. But the differences in experience were strikingly consistent: people with poor mental health received worse care, more unmet needs, and less trust in institutions, regardless of where they lived. Health systems around the world need to rethink not just whether they can reach this growing group, but how they serve them. ”
Margaret E. Crook, Washington University, St. Louis, USA
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Reference magazines:
Crook, me Others. (2026) Healthcare system utilization and experiences among people with poor mental health: A cross-sectional analysis of the Voice of the People survey in 18 countries. PLoS Medicine. DOI: 10.1371/journal.pmed.1004745. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004745
