Alan E. Kazdin

The majority of people with mental disorders in low-, middle-, and high-income countries do not receive any intervention for their symptoms, despite enormous advances in developing evidence-based psychosocial treatments and medications. The perspective and viewpoint article discusses and illustrates digital and technology-based interventions and activities in everyday life that have been shown to reduce symptoms of mental disorders. The article begins with background on the treatment gap and a discussion of why treatments do not reach people in need. Digital and technology-based interventions and everyday activities are presented to complement current treatments with the goal of scaling interventions to serve more people in need and to circumvent many of the usual barriers that preclude people from seeking or receiving traditional mental health services. Interventions in each of the categories are illustrated. The challenge is to integrate such interventions in mental health practices, to better promote these at the population level, and to monitor their impact.

Mental disorders are highly prevalent worldwide. Unfortunately, most people with these disorders do not receive any treatment. This is due in part to a large set of barriers (e.g., no access to therapists or clinics, lack of insurance, stigma) that impede seeking and obtaining mental health services. Many lifestyle interventions that are not part of traditional mental health services have indirect effects on reducing symptoms of mental disorders. These are interventions that target a direct focus (e.g., physical health, socialization, general well-being) but also have indirect and significant impact on reducing mental disorders. This article discusses indirect interventions as an additional way of reaching people in need of help with mental health problems. Interventions such as physical activity and exercise, diet, addressing sleep problems, yoga, tai chi, qigong, and volunteering have indirect beneficial effects. This article highlights the scope of mental illness as a background, introduces indirect interventions, and details three illustrations with evidence that targeting one focus with indirect effects on improving mental disorders. The interventions point to a category of interventions are not systematically used in the care of mental health problems. Among their many advantages is the prospect of their use at the levels of individuals and populations. Indirect interventions do not replace any of the current advances in treatment but add to ways of reaching people in need.

Coifman and Gunstad (2024) raise cogent points about childhood and adolescence as a place to begin to help close the mental health treatment gap, note the potential of applications (apps) as a modality of intervention given the pervasiveness of smartphones, and highlight a large-scale intervention study to convey that treatments can be scaled in outcome research. I expand the range of interventions we might consider, pose a best-buy approach to decide how and where to begin to address the treatment gap, and underscore that mental health problems in children, adolescents, and adults are on the rise. We still have no evidence that we can close the treatment gap and that to do so will require a marriage of multiple disciplines, interventions, and agencies to effect change.

The high prevalence rates of mental disorders worldwide and the paucity of services constitute a mental health crisis. The vast majority of people in low-, middle-, and high-income countries do not receive any intervention for their symptoms of mental disorders, despite enormous advances in developing evidence-based psychosocial treatments and medications. The article proposes greater utilization of interventions in everyday life as an addition to the more traditional and commonly used mental-health interventions. The article delineates criteria to help identify what such interventions ought to include to permit accessibility, scalability, and reach to special populations. Physical activity, contact with nature, and yoga are examples to illustrate the class of everyday interventions that have evidence attesting to their impact on mental health and symptoms of psychopathology. The challenge is to integrate such interventions in mental health practices to better promote these at the population level and to monitor the impact. Many components of what is needed are in place but are not coordinated in an effective way to have widespread impact on mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Previous global and regional studies indicate that adolescents and young adults (i.e., youth) are affected by various mental disorders with lifelong consequences. However, there are no national estimates of mental disorders prevalent among Saudi youth. Using data from the Saudi National Mental Health Survey (SNMHS), we examined the lifetime prevalence, treatment, and socio-demographic correlates of mental disorders among Saudi youth (aged 15–30). A total of 4004 interviews were conducted using the adapted Composite International Diagnostic Interview (CIDI 3.0). Cross tabulations and logistic regression were used to generate estimates for the SNMHS youth sample (n = 1881). The prevalence of a mental disorder among Saudi youth was 40.10%, where anxiety disorders affected 26.84% of the sample, followed by disruptive behavior disorders (15.44%), mood disorders (9.67%), substance use disorders (4%) and eating disorders (7.06%). Sex, education, parental education, income, marital status, region, and family history of disorders were significant correlates of various classes of mental disorders. Only 14.47% of Saudi youth with any mental disorder received treatment for a lifetime disorder. Age, parental education, and family history of disorders emerged as significant correlates of mental health treatment. Lifetime mental disorders are highly prevalent among Saudi youth. There is an unmet need for culturally sensitive and age-appropriate treatment of lifetime mental disorders among youth in Saudi Arabia.

What is the public health significance of this article? The focus is on the treatment gap, namely, the large discrepancy between the prevalence of mental disorders and the proportion of individuals who receive care. The vast majority of individuals in need of services receive no care at all. This article underscores the importance of developing treatments that can be scaled as well as reach those individuals least likely to receive services. Novel interventions and models of delivery are proposed to redirect intervention research and narrow the treatment gap. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

El presente artículo se centra en la brecha de tratamiento, que se refiere a la discrepancia entre la proporción de la población que necesita servicios y la que los recibe. Actualmente, en México, pero también en el mundo, la mayoría de las personas que necesitan servicios de salud mental no reciben tratamiento. Los autores se centran en el tratamiento de los trastornos mentales en niños y adolescentes porque en su mayoría tales trastornos surgen durante estos periodos de vida. Se discuten las barreras para recibir y prestar servicios de las personas que lo necesitan, y se subraya la importancia de proporcionar tratamientos que sean escalables (o sea, que puedan llegar a un gran número de personas) y que tengan alcance (es decir, que puedan extenderse a los grupos que a menudo se descuidan en la atención de la salud mental). Se identifican múltiples modelos de prestación de tratamiento y se ilustran tres de ellos en detalle: el cambio de tareas, el entretenimiento educativo y las intervenciones de mejor-compra. Estos y otros modelos permiten que los servicios de salud mental lleguen a más personas que los necesitan, y reducir así la brecha de tratamiento en México.

Randomized control trials (RCTs) have played a critical role in psychotherapy research. This article discusses RCTs in the context of the criteria for drawing causal inferences in psychotherapy and...