PLoS Med
Poor mental health linked to worse care, less trust
Clinical takeaway: Negative care experiences and low trust may be part of the clinical burden in patients with poor mental health, not just a consequence. Addressing engagement, communication, and care coordination may help reduce disengagement and unmet needs.
Mental health conditions are increasingly common, yet their impact on everyday healthcare experiences is less well defined. This study examined whether people with poorer mental health perceive and navigate healthcare systems differently across diverse global settings.
Individuals reporting poor mental health consistently described worse care and less confidence in the system. Across 18 countries, they were more likely to report low-quality care, discrimination, and difficulty obtaining and affording services. They also reported lower patient activation, indicating less confidence in managing their own health, and were nearly twice as likely to have chronic illness alongside poorer overall health.
The gap in experience was notably consistent despite wide variation in access to mental health services. Use of mental health care ranged from 0.9% in Laos to 52.4% in the UK, yet poorer experiences and lower trust were reported across all settings. Country-level mental health burden also varied widely, from 4.7% reporting poor or fair mental health in Nigeria to 39.6% in China, but these differences did not explain the consistent pattern in care experience.
Lower patient activation may be a key mechanism. Patients with worse mental health were less likely to feel empowered to manage their health, which can affect follow-through, communication, and navigation of care, particularly in patients with multiple conditions.
“What stands out from this study is that poor mental health doesn’t exist in isolation,” the authors noted. “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.”
Researchers analyzed cross-sectional survey data from 32,419 adults in 18 countries using the People’s Voice Survey conducted in 2022–2023. Participants self-reported mental health status, care experiences, healthcare use, and system confidence.
The findings point to a system-level issue rather than a narrow mental health access problem. Poorer experiences and lower trust could contribute to delayed care, lower adherence, and fragmented management, especially in primary care where these patients often present with both physical and mental health needs.
“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,” said Margaret E. Kruk, MD, MPH, of Washington University in St. Louis.
Source: Kruk ME. PLoS Med. 2026 May 5. Health system use and experience among people with poor mental health: A cross-sectional analysis of the People’s Voice Survey in 18 countries