Health system use and experience among people with poor mental health: A cross-sectional analysis of the People’s Voice Survey in 18 countries

Journal article

Background: Across the globe, rates of depression and anxiety have risen substantially since the COVID pandemic. Consequently, poor mental health is now a top health policy priority in many countries and more people than ever are seeking treatment. While the segment of people with poor mental health is large and growing, there is a dearth of data about their demographics and health needs and their use of and experience in the health system. Health systems require this information to effectively organize and provide services. Methods and findings: We investigated population prevalence of fair or poor mental health and compared health system experience and quality of care among adults with poor versus good mental health in 18 high-, middle-, and low-income countries using data from the People’s Voice Survey (n = 32,419). Data were collected in 2022 and 2023 through a combination of nationally representative telephone, online, and in-person surveys. Prevalence of self-reported poor mental health ranged from 4.7% in Nigeria to 39.6% in China and was unrelated to national income per capita. More women than men reported poor mental health in most countries. Across all countries, people with poor mental health had worse self-rated overall health and more chronic illness. Between 0.9% (Lao PDR) and 52.4% (UK) of those with poor mental health had received mental healthcare in the past year. People with poor mental health reported lower patient activation, worse care quality, and lower confidence in the health system. A study limitation is that results are based on self-reported mental health rather than clinical diagnoses. Conclusions: People with poor mental health have markedly different health profiles and health system experience. These findings should prompt health systems to re-assess their services to better serve this growing patient group. Comparison of user experience and quality over time and across countries with similar health systems may assist in benchmarking performance.

Authors: Kruk, ME; Kapoor, NR; Arsenault, C; Carai, S; Daray, FM

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Public Library of Science
• Journal: PLoS Medicine
• Volume: 23
• Issue: 5
• Pages: e1004745
• Article number: e1004745
• Publication date: 2026-05-05
• Acceptance date: 2026-03-27
• DOI: 10.1371/journal.pmed.1004745
• EISSN: 1549-1676
• ISSN: 1549-1277
• Language: English