Perceived Need for Mental Health Care and Service Use Among Adults in Western Europe: Results of the ESEMeD Project
ABSTRACT This study assessed prevalence and correlates of perceived need for mental health care and its role in help seeking.
Data were from general population surveys conducted for the European Study of the Epidemiology of Mental Disorders. The sample consisted of adults who screened positive for specific mood and anxiety symptoms in surveys conducted in Belgium, France, Germany, Italy, The Netherlands, and Spain (N=8,796). These individuals were further assessed for mental disorders with the Composite International Diagnostic Interview 3.0. Respondents who reported voluntary use of health services to address concerns with their "emotions or mental health" or who reported a need for services for mental health reasons were considered to have perceived need.
Nine percent of the total sample perceived some need for mental health care in the past 12 months. Among those who had a mental disorder in the past 12 months, 33% had perceived need. Psychiatric morbidity was the major determinant of perceived need. Among those with perceived need, older age, nonurban residence, and residence in Germany were positively associated with use of services.
Only a third of those with a 12-month mental disorder perceived need for mental health care. Psychiatric morbidity was the main determinant of perceived need; however, other factors (being female and being older) were associated with use of health services among those with perceived need. Among those with perceived need, it is important to increase access to care for the youngest and those living in urban areas.
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ABSTRACT: To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders. Method Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 636 78) and analyzed at different levels of clinical severity. Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.Psychological Medicine 08/2013; DOI:10.1017/S0033291713001943 · 5.43 Impact Factor
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ABSTRACT: Aims. To examine stigma- and knowledge-related barriers to help-seeking among members of the general population. Methods. In a representative survey of young to middle-aged Swiss adults (n = 8875), shame about a potential own mental illness, perceived knowledge about and satisfaction with one's mental health, psychiatric symptoms and attitudes towards help-seeking were assessed. Results. A latent profile analysis of all participants yielded two groups with different attitudes towards help-seeking. Relative to the majority, a one-in-four subgroup endorsed more negative attitudes towards seeking professional help, including psychiatric medication, and was characterized by more shame, less perceived knowledge, higher satisfaction with their mental health, younger age, male gender and lower education. Among participants with high symptom levels (n = 855), a third subgroup was reluctant to seek help in their private environment and characterized by high symptoms as well as low satisfaction with their mental health. Conclusions. Shame as an emotional proxy of self-stigma as well as poor subjective mental health literacy may be independent barriers to help-seeking. Interventions to increase mental health service use could focus on both variables and on those individuals with more negative views about professional help, in the general public as well as among people with a current mental illness.Epidemiology and Psychiatric Sciences 07/2013; 23(3):1-11. DOI:10.1017/S204579601300036X · 3.36 Impact Factor