Abstract
BACKGROUND: Mental health treatment use remains low despite increasing major depressive episodes (MDE), suicidality, and substance use disorders (SUD). AIMS: To examine the associations of perceived treatment helpfulness with clinical characteristics (MDE, suicidality, and SUD) and treatment modality (medication, counseling/other treatment [COT], and both treatment [MCOT]). METHODS: We used the 2022 and 2023 U.S. National Survey on Drug Use and Health data on adult depression treatment users (N = 10,221) and multinomial and generalized ordinal logistic regression models. RESULTS: Among treatment users, 15% used medication only, 25% used COT only, and 60% used MCOT. Overall, 60% of medication users and 47% of COT users perceived their respective treatments as “a lot” or “extremely” helpful. MDE and suicidality were associated with a higher likelihood of using COT only and/or MCOT. Both MDE and suicidality were associated with lower odds of perceiving treatment as helpful among medication users (OR = 0.47, 95% CI = 0.39–0.57 for MDE; OR = 0.78, 95% CI = 0.66–0.91 for suicidality) as well as COT users (OR = 0.67, 95% CI = 0.56–0.80 for MDE; OR = 0.82, 95% CI = 0.70–0.97 for suicidality). Co-occurring alcohol and drug use disorders were also associated with lower odds of perceived helpfulness among COT users. The use of both medication and COT was associated with higher odds of perceiving either modality as helpful. These patterns did not differ meaningfully for individuals with MDE. CONCLUSIONS: The lower perceived treatment helpfulness among individuals with complex clinical presentations underscores the need for more intensive, personalized, and sustained interventions. Comparison between treatment recipients’ perceived helpfulness and objective clinical effectiveness is also needed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s44192-026-00370-2.