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Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample
Abstract
The initial delay to seek treatment accounts for a significant proportion of the unmet need for treatment of common psychiatric conditions. This study aimed to examine the barriers to initial help-seeking and factors that facilitate help-seeking for anxiety and depression.
Help-seeking history was retrospectively self-reported by 233 patients at a specialist anxiety clinic, all of whom had delayed seeking professional treatment for at least one month. Data gathered included age at onset, age at help-seeking, primary reason for the delay, prompt to seek help and first professional contacted.
The most frequently endorsed reasons for the delay related to lack of knowledge about mental illness or available treatment. Increasing illness severity or disability was the primary prompt to seek help for the majority of respondents. Reason for the delay showed some relationship with length of the delay, but prompt to seek help did not. A general medical practitioner (GP) was the first professional contacted in 71 % of cases.
Lack of public 'mental health literacy' contributes to slow problem recognition. Increasing illness severity eventually facilitates problem recognition and prompts help-seeking. Structural barriers to initial help-seeking are relatively unimportant within the Australian health care system. General practitioners play an important role as gate-keepers to appropriate mental health care.
... Stress and negative life events are commonly suggested as etiological factors for depression [16,17]. However, the lack of understanding of depression and its causes has been shown to negatively impact the decision to seek professional help and influence treatment choices [15,18,19]). ...
... The reasons for not seeking help included not perceiving the episode as serious or identifying it as a disorder and thinking that they could manage the illness on their own. Numerous studies have examined the relationship between D-Lit and behavioral changes, such as help-seeking and adherence to antidepressants, among individuals with depression [14,15,18,19]. These studies support the notion that a lack of knowledge and negative attitudes toward depression contribute to the stigmatization of individuals with depression and influence their treatment choices, particularly regarding the use of antidepressants. ...
... An Arabic-validated version of the PHQ-9 was used [27], with an internal consistency reliability of 0.857, as calculated using Cronbach's alpha. A cutoff point of 10 was employed to identify depression, with further classification of depressed participants into depression (score [10][11][12][13][14], moderately severe depression (score [15][16][17][18][19], and severe depression (score ≥ 20). ...
Introduction
The prevalence of any disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is 34.2% in Saudi Arabia over the course of a person's lifetime. Young Saudis are more likely to develop major depressive disorder than older Saudis. Globally, postgraduate students are more vulnerable to developing depression compared to the general population. According to a national study carried out in Saudi Arabia, a small proportion of individuals experiencing psychiatric disorders over a period of 12 months receive any kind of treatment. This highlights the importance of community education aimed at enhancing mental health awareness.
Methods
A web-based Arabic cross-sectional survey was conducted among Saudi postgraduate students from October 2019 to August 2020. The survey included questions related to sociodemographic characteristics, sources of information, depression literacy (D-Lit), the Patient Health Questionnaire-9 (PHQ-9) for depression, and the participants’ attitudes toward depression.
Results
A total of 517 participants took part in the survey, with 46% of them screened positive for depression. The mean D-Lit score was 10.65, which was lower than that reported in studies conducted among medical students and hospital staff. No significant differences were found in D-Lit scores across all sociodemographic characteristics, except for gender and specialty ( p = 0.002 and <0.001, respectively). The Internet, awareness posters, a doctor (previously diagnosed with depression), and awareness activities related to depression showed significant differences in the mean score of D-Lit ( p < 0.001, 0.005, < 0.001, and < 0.001, respectively).
Conclusion
In Saudi Arabia, this study found that postgraduate students have a notably higher occurrence of depression compared to the general population. However, despite their higher educational level, these students lacked sufficient awareness and understanding of depression to recognize it and seek help. Consequently, it is important to initiate awareness campaigns aimed at enhancing the mental well-being of postgraduate student
... Previous research concluded that lack of knowledge about mental disease and about treatment itself substantially hinders treatment-seeking [13][14][15][16][17]. In line with this, Nuijen and colleagues [4] report that recognition of one's psychological problems facilitated treatment-seeking. ...
... Sareen [18] found attitudinal barriers to be of primary importance. Frequently reported attitudinal barriers are the wish to solve the problem oneself [14,[18][19][20][21], the idea that symptoms would remit spontaneously [14,18] and the belief that mental health care would not help [13,18,19]. A recent systematic review [22] of both quantitative and qualitative studies on stigma among participants with various mental disorders identified stigma as a barrier to access mental healthcare in general. ...
... Sareen [18] found attitudinal barriers to be of primary importance. Frequently reported attitudinal barriers are the wish to solve the problem oneself [14,[18][19][20][21], the idea that symptoms would remit spontaneously [14,18] and the belief that mental health care would not help [13,18,19]. A recent systematic review [22] of both quantitative and qualitative studies on stigma among participants with various mental disorders identified stigma as a barrier to access mental healthcare in general. ...
Background
Previous research on barriers and facilitators regarding treatment-seeking of adults with depressive and anxiety disorders has been primarily conducted in the Anglosphere. This study aims to gain insight into treatment-seeking behaviour of adults with depressive and anxiety disorders in a European healthcare system.
Methods
In-depth semi-structured interviews were conducted with 24 participants, aged ≥18 years and diagnosed with an anxiety disorder and/or depressive disorder according to DSM-IV. Participants were purposively sampled from an outpatient department for mental health care in the Netherlands. The seven steps of framework analysis were used to identify relevant themes emerging from the interviews.
Results
Data analysis suggested an interplay between individual aspects, personal social system, healthcare system and sociocultural context influences. Amongst the most relevant themes were mental health illiteracy, stigma, a negative attitude toward professional help, the influence of significant others and general practitioner, and waiting time. Financial barriers were not of relevance.
Conclusions
Even in a country with a well-developed mental health care system and in absence of financial barriers, there are many barriers to treatment-seeking in adult patients with depressive and anxiety disorders. National campaigns to increase awareness and decrease stigma in the general population, and to empower the social environment might reduce the treatment gap.
... Ceci indique des niveaux de LSM envers l'anxiété périnatale particulièrement faibles. Plusieurs études appuient par ailleurs le lien entre la LSM et les intentions et comportements de recherche d'aide de diverses populations (Fonseca et al., 2015;Rüsch et al., 2011;Thompson et al., 2004). Selon Thompson et al. (2008), une reconnaissance plus hâtive du problème, influencée par la LSM, est un prédicteur de l'écart temporel entre le développement du trouble et la recherche d'aide. ...
... De plus, le niveau de LSM prédit le niveau d'intention de consulter globale et le niveau d'ouverture psychologique à la consultation. Il ne semble pas prédire le niveau d'indifférence à la stigmatisation et de propension à l'action d'aller consulter, en présence des autres facteurs Fonseca et al. (2015) et Thompson et al. (2004) appuient le lien entre le niveau de LSM et la propension à l'action de consulter pour une détresse psychologique. La LSM est ressortie dans ces études comme une des barrières principales aux comportements de recherche d'aide. ...
Les symptômes et troubles anxieux sont prévalents en périnatalité, en plus d’être liés à des conséquences négatives pour la mère. Or, les taux de consultation dans cette période sont très faibles. Le modèle de Fonseca et Canavarro (2021) suggère des facteurs liés à la décision de consulter en périnatalité, notamment la littératie en santé mentale et l’autostigmatisation. Peu d’études appuient toutefois ces facteurs, notamment dans le contexte de la consultation pour l’anxiété périnatale, et la plupart reposent sur des devis qualitatifs. Leur apport prédictif serait par ailleurs faible, suggérant le rôle possible d’autres facteurs. Liées au doute et à la prise de décision, des vulnérabilités individuelles comme l’intolérance à l’incertitude, l’attitude face aux problèmes et l’évitement expérientiel pourraient être pertinentes à considérer. Cette étude vérifie les liens entre ces cinq facteurs et l’attitude envers la recherche d’aide et ses dimensions (p. ex., propension à l’action) auprès de femmes enceintes ou ayant accouché dans la dernière année. Les résultats confirment les liens entre la littératie, l’autostigmatisation, l’attitude négative face aux problèmes et l’évitement expérientiel et l’attitude envers la recherche d’aide, de même que l’apport prédictif de la littératie et de l’autostigmatisation sur les dimensions de la recherche d’aide. Le fait de considérer ces facteurs pourrait permettre de bonifier les modèles explicatifs des réticences à consulter chez les femmes en contexte périnatal et servir de piste pour promouvoir une attitude positive envers la consultation pour l’anxiété.
... In addition, mental health literacy can also be considered as the understanding and awareness of mental health services (Jorm, 2000). There is significant evidence to suggest that the ability to identify mental health symptoms does not always translate to help-seeking behavior (Bonabi et al., 2016;Thompson et al., 2004). The ability to connect one's experience to an appropriate service is equally as important (Bonabi et al., 2016;Thompson et al., 2004). ...
... There is significant evidence to suggest that the ability to identify mental health symptoms does not always translate to help-seeking behavior (Bonabi et al., 2016;Thompson et al., 2004). The ability to connect one's experience to an appropriate service is equally as important (Bonabi et al., 2016;Thompson et al., 2004). Research has reported this knowledge of relevant services to be lower in both men (Lynch et al., 2018;Rafal et al., 2018) and adolescents (Attygalle et al., 2017). ...
Untreated mental health problems continue from childhood and adolescence into adulthood, meaning accessible early intervention is essential to reduce long-term negative outcomes. However, there is often a reluctance to engage in mental health treatment, with considerable evidence that young men are less likely to seek help than young women. This original research study aimed to explore four areas of interest around facilitating engagement of adolescent boys to a stress workshop intervention for adolescents in U.K. schools. The areas explored were male role models, destigmatizing language, trust building, and using a transparent and collaborative approach. We also sought to understand the main barriers to engagement. To explore these areas of interest, two focus groups were run, with a total of 12 young men, over two regional sites (London and Bath). Content analysis was used to analyze the data. Participants particularly valued transparency and collaboration as strong facilitators to engagement. Building of trust was the next most popular. Use of role models and destigmatizing language were the joint third most popular methods. The main barrier to help-seeking identified was perceived threat to masculine identity (self and social stigma). Given these novel findings, the factors of transparency and collaboration and building trust as facilitators merit further research, among both adults and adolescents.
... 19 The attitude of wanting to 'do it on my own' has been cited as a common cause of delay in seeking help for mental health conditions particularly in adolescent populations but this is the first time it has been noted for caregivers. [20][21][22] In this study, caregivers saw their life challenges as normal or 'not as bad as others' and this prevented them from seeking help until they felt they could no longer cope. Self-reliance can occur with other attitudinal barriers to help seeking, such as stigma and lack of belief that professional help will be successful. ...
... In mental health, these attitudinal barriers have been found to be more important causes of delayed help seeking than structural barriers such as lack of available services or inflexible service delivery. 22 Not understanding complex health systems is a barrier for caregivers being able to access healthcare for their children resulting in caregivers feeling 'lost and confused'. 23 The importance of knowing what services are available is important for both caregivers and practitioners. ...
Objective
To explore caregivers’ experiences and challenges of accessing help for adversity across both health and social care sectors.
Design
Qualitative study design using semistructured interviews to explore how caregivers accessed services across health and social care. Interviews were audio recorded, transcribed verbatim and analysed using reflexive thematic analysis.
Setting
Families living in the city of Wyndham, Victoria, Australia.
Participants
17 caregivers of children aged 0–8 years.
Results
Five main themes emerged. (1) Emotional work of getting help. Caregivers described that getting help for life challenges was both emotionally taxing and effortful. (2) Trusting relationships are key. Engagement was related to the degree of relational practice and whether they felt judged or demeaned. (3) Wanting to manage on your own. There was a strong desire by caregivers to be independent and to only seek help when it was absolutely necessary. (4) Importance of knowing help was available and how to access it. (5) Overcoming service access barriers including long waiting times, restricted service criteria, transport issues and out-of-pocket expenses.
Conclusions
Caregivers highlighted a multitude of barriers to getting help for life challenges. Addressing these barriers will require services to become more flexible and codesign best approaches with families in ongoing partnership. Improving community knowledge of available services and building trusting relationships is the first step to overcoming these barriers.
... Although the earlier evidence suggests that the general public has poor MHL [2,[5][6][7][8], some recent studies investigated changes in mental health literacy and found improvements in the ability to recognize symptoms of mental health disorders [9,10]. Extensive research has also shown that improving MHL is beneficial for appropriate help-seeking and treatment choices [11,12]. Given the importance of improving MHL, many researchers put efforts to develop various methods to improve MHL such as community awareness campaigns [13,14], school-based interventions [15], and mental health first aid [16]. ...
... However, despite the high awareness of the PSU in the high-risk group, their general help-seeking attitudes were significantly poorer than the low-risk group. This result contradicts findings from previous studies that recognition of disorders was associated with help-seeking attitudes from professionals [11,12,49]. For example, Picco et al. (2008) conducted population-based research to investigate an association between recognition and help-seeking preferences and found that the recognition of disorders was associated with an increased preference to seek help from professionals for dementia, depression, and schizophrenia [49]. ...
The last few decades have seen an increased interest in ‘Mental Health Literacy (MHL)’ which addresses knowledge and beliefs relating to mental health problems and is likely to hinder treatment-seeking behaviors. Although MHL research to date has explored various mental disorders, far too little attention has been paid to Internet Gaming Disorder (IGD) and Problematic Smartphone use (PSU). The objective of this study is to develop an MHL questionnaire for IGD and PSU by adopting the MHL approach in the previous literature and examine MHL of IGD and PSU in Korean teenagers by focusing on their ability to recognize addictions, and perceptions and help-seeking attitudes towards a person with addictions. The current study also aimed to compare Korean teenagers’ MHL depending on low- and high-risk of IGD and PSU. A total of 169 teenagers aged 10 and 16 years were recruited from schools and children’s centers in Seoul and completed the newly developed MHL questionnaire and screening questionnaires for IGD and PSU. The MHL questionnaire for IGD and PSU was designed as a vignette-based questionnaire that depicted behavioral characteristics of a severe problem with Internet and smartphone usage. Korean teenagers had a poor ability to recognize IGD and PSU and were more prone to seek parental help than professional help. The current study also showed that teenagers had better recognition of IGD than PSU and perceived that a person with IGD has a more difficult life than a person with PSU. Furthermore, a low-risk or high-risk group of IGD or PSU showed minimal differences in MHL. The current study provided empirical evidence to support a need to develop educational programs to improve Korean teenagers’ MHL for both IGD and PSU.
... In addition to the components of the TPB, several studies have found that more severe depression affects the intention to manage depression [14][15][16]. Unlike previous related studies, this study was conducted with a focus on intentions for a healthy pregnancy. It is necessary to identify the current level of depression in college students with this new focus, including assessments of those who do not have depression; therefore, these results are expected to serve as the basis for planning programs to improve the intention of preventive depression management for a healthy pregnancy. ...
... This finding supports a previous study, according to which depression severity and perceived necessity for depression treatment were predictors of intention to seek mental healthcare [41]. A study applying the TPB model confirmed that psychological symptom severity directly increased the intention for help-seeking behavior [16]. Therefore, understanding the degree and difference between levels of depression in current college students is important for suggesting intervention strategies. ...
Background
Early adulthood is a significant period for preventive depression management for a healthy pregnancy. However, previous public health initiatives have not yet emphasized preparation for a healthy pregnancy in this population. In addition, pregnancy planning has traditionally been regarded as women’s responsibility, so intervention strategies may differ by gender. This study explored intentions of preventive depression management for a healthy pregnancy among unmarried college students, as well as factors influencing those intentions, by applying the Theory of Planned Behavior (TPB) model.
Methods
For this cross-sectional survey, 828 unmarried college students aged 18–29 were recruited from a national university in Korea from July to September 2019. The chi-square test and t-test were used to compare gender differences in general characteristics, the current level of depression, and constructs of the extended TPB. Hierarchical regression was performed to identify factors influencing the intention of preventive depression management for a healthy pregnancy.
Results
The intention to manage depression was significantly higher in men than in women (t = 2.36, p = 0.019). The factors affecting the intention of preventive depression management for a healthy pregnancy were components of TPB in both women and men, of which self-efficacy had the greatest effect (female: β = 0.34, p < 0.001, male: β = 0.30, p < 0.001). The current level of depression was a significant factor for women only (β = 0.10, p = 0.014).
Conclusions
Our study results underscore the need for nurses to perform preventive interventions and provide directions to develop interventions to improve the intention of depression management for unmarried college students. It is necessary to intervene with all the constructs of the TPB, especially self-efficacy, for both men and women. It is also important to check and address the current depression status of unmarried female college students.
... 14 At the same time, they encounter noticeable obstacles in seeking help, including lack of knowledge and negative attitudes toward mental disorders and their treatment, fear of stigmatization, and lack of knowledge of access to appropriate care. 15 The reasons for lack of help seeking are multifaceted, but a major contributor is mental health stigma. Mental health stigma in medical students is driven by perfectionism and unsustainable performance expectation that define their self-worth. ...
OBJECTIVE
Stigma surrounding mental health persists as a significant impediment to adequate support and help-seeking behaviors in Slovenia, despite advancements in psychiatric care and education. This study investigates stigma among first-year medical students at the University of Maribor, Slovenia and how the stigma changes after completing a course in mental health literacy.
PARTICIPANTS
Participants were first-year medical students at the University of Maribor in the academic year 2023/2024. A total of 116 students participated in the baseline study, with 66 students participating in the follow-up study.
STUDY METHOD
The intervention involved implementing the “Transitions” program, aimed at enhancing mental health literacy and reducing stigma. We conducted a baseline study and a follow-up study, then used Wilcoxon signed rank test for repeated measures to compare the differences in ranks before and after implementation of the program.
FINDINGS
There was a significant reduction in stigma after intervention (Wilcoxon Z = −3.06, P < .01), suggesting a positive impact of the educational program. This reduction aligns with findings from similar programs globally, suggesting the efficacy of educational interventions in mitigating mental health stigma.
CONCLUSIONS
The study emphasizes the importance of integrating mental health education into medical curricula to foster stigma reduction and enhance mental health literacy among future medical doctors.
... Anxiety disorders are amongst the most prevalent psychiatric disorders, with a prevalence rate of 10.4% in Western European, North American and Australasian populations (Baxter et al., 2012). According to research by Thompson et al. (2004Thompson et al. ( , 2008 most sufferers of anxiety do not access treatment until well into adulthood and even those who do access appropriate help typically suffer for many years before receiving that help. It is therefore important to prevent that children and youth with elevated anxiety symptoms move on to fully develop anxiety disorders. ...
Background
Anxiety and stress responses are often considered normative experiences, and children and adolescents may benefit from anxiety prevention programmes. One such programme is FRIENDS which is based on a firm theoretical model which addresses cognitive, physiological and behavioural processes. FRIENDS is manualised and can, thus, easily be integrated into school curriculums.
Objectives
What are the effects of the FRIENDS preventive programme on anxiety symptoms in children and adolescents? Do the effects differ between participant age groups, participant socio‐economic status, type of prevention, type of provider, country of implementation and/or implementation issues in relation to the booster sessions and parent sessions?
Search Methods
The database searches were carried out in September 2023, and other sources were searched in October 2023. We searched to identify both published and unpublished literature. A date restriction from 1998 and onwards was applied.
Selection Criteria
The intervention was three age‐appropriate preventive anxiety programmes: Fun FRIENDS, FRIENDS for Life, and My FRIENDS Youth. Primary outcome was anxiety symptoms and secondary outcome was self‐esteem. Studies that used a control group were eligible, whereas qualitative approaches were not.
Data Collection and Analysis
The number of potentially relevant studies was 2865. Forty‐two studies met the inclusion criteria. Twenty‐eight studies were used in the data synthesis. Four studies had a critical risk of bias. Six studies did not report data that enabled calculation of effect sizes and standard errors. Two studies had partial overlap of data to other studies used, and two were written in Persian. Meta‐analyses were conducted on each outcome separately. All analyses were inverse variance weighted using random effects statistical models.
Main Results
Studies came from 15 different countries. Intervention start varied from 2001 to 2016. The average number of participants analysed was 240, and the average number of controls was 212. Twenty‐five comparisons reported on anxiety symptoms post‐intervention. The weighted average standardised mean difference (SMD) was 0.13 (95% CI 0.04 to 0.22). There was some heterogeneity. Twelve comparisons reported on anxiety symptoms at 12 months follow‐up. The weighted average SMD was 0.31 (95% CI 0.13 to 0.49). There was a large amount of heterogeneity. Five comparisons reported on self‐esteem post‐intervention with a weighted average SMD of 0.20 (95% CI −0.20 to 0.61) and a large amount of heterogeneity. At follow‐up, we found evidence that programmes implemented by mental health providers appears to perform better than programmes implemented by teachers. The evidence was inconclusive beyond 12 months follow‐up.
Authors' Conclusions
Our results indicate that the FRIENDS intervention may reduce anxiety symptoms in children and adolescents when reported by children and adolescents themselves. The majority of trials employed a wait‐list design, implying only a few studies reported on the long‐term effects of the FRIENDS intervention. Our findings suggest that the FRIENDS intervention may increase the reduction in anxiety symptoms 12 months after the intervention. This emphasises the need for future research that apply designs that allows for long‐term follow‐up. We are uncertain about the effects on self‐esteem. The overall certainty of evidence varied from low to very low. There is a need for more rigorously conducted studies.
... The delay or avoidance of seeking professional help for mental health issues is a common phenomenon, often influenced by societal stigma and various circumstantial factors [5]. This behavior exacerbates critical situations, particularly in advanced stages of mental disorders, where individuals experience a significant decline in their ability to perform routine activities. ...
Mental health constitutes a complex and pervasive global challenge, affecting millions of lives and often leading to severe consequences. In this paper, we conduct a thorough survey to explore the intersection of data science, artificial intelligence, and mental healthcare, focusing on the recent developments of mental disorder detection through online social media (OSM). A significant portion of the population actively engages in OSM platforms, creating a vast repository of personal data that holds immense potential for mental health analytics. The paper navigates through traditional diagnostic methods, state-of-the-art data- and AI-driven research studies, and the emergence of explainable AI (XAI) models for mental healthcare. We review state-of-the-art machine learning methods, particularly those based on modern deep learning, while emphasising the need for explainability in healthcare AI models. The experimental design section provides insights into prevalent practices, including available datasets and evaluation approaches. We also identify key issues and challenges in the field and propose promising future research directions. As mental health decisions demand transparency, interpretability, and ethical considerations, this paper contributes to the ongoing discourse on advancing XAI in mental healthcare through social media. The comprehensive overview presented here aims to guide researchers, practitioners, and policymakers in developing the area of mental disorder detection.
... Obgleich es grundsätzlich als positiv zu werten ist, dass sich das öffentliche Stigma über die Inanspruchnahme von Psychotherapie über die Jahre etwas gewandelt hat (Albani et al., 2013), ist die Selbststigmatisierung wieterhin von äußerster Relevanz (Rüsch et al., 2004): Dabei begünstigen u. a. Überzeugungen wie, das Problem allein lösen zu wollen oder die Angst, um Hilfe zu bitten, eine verzögerte Inanspruchnahme professioneller Unterstützungsmöglichkeiten (Thompson et al., 2004) Ergänzend dazu liefern die Ergebnisse der Studie Hinweise darauf, dass die Suche als eine Art "Bewerbungsprozess" angesehen wird und Psychotherapie als "Privileg", welches tendenziell nur "schwer kranken" Pati-ent_innen zuteilwird. Dies könnte dazu führen, dass Menschen erst mit der Suche beginnen, wenn sie sich fühlen, als ob sie mit dem Rücken zur Wand stehen, aus Sorge, dass ihre aktuellen Symptome noch nicht therapiewürdig seien. ...
Theoretischer Hintergrund: Ein Ziel der Psychotherapiestrukturreform war unter anderem den Zugang zu ambulanter Psychotherapie zu erleichtern. Die vorliegende Studie evaluiert dabei, inwiefern dies aus Perspektive der Therapiesuchenden gelungen ist.
Fragestellung: Welche Erfahrungen machen Therapiesuchende während des Suchprozesses?
Methoden: In leitfadengestützten Interviews wurden Therapiesuchende zu ihren Erfahrungen befragt. Die Aussagen wurden transkribiert und inhaltsanalytisch ausgewertet, bevor Generalisierungen abgeleitet wurden.
Ergebnisse: 14 von 45 Therapiesuchenden konnten eine ambulante Therapie beginnen, 4 äußerten sich positiv, die Mehrheit berichtete von negativen Erfahrungen. Beklagt wurden wenig freie Plätze, lange Wartezeiten und geringe Unterstützung, ebenso wie die eingeschränkte Erreichbarkeit der Therapeut_innen. Symptom- und krankheitsspezifische Aspekte würden die Suche zusätzlich erschweren.
Schlussfolgerung: Therapiesuchende müssen diverse Hürden überwinden, um eine adäquate Versorgung zu erhalten. Diesen einschränkenden Faktoren wird im aktuellen Gesundheitssystem nicht ausreichend entgegengewirkt, weswegen weitere Maßnahmen notwendig sind, um den Zugang zu ambulanter Psychotherapie zu erleichtern.
... Anxiety disorders are amongst the most prevalent psychiatric disorders, with a prevalence rate of 10.4% in Western European, North American and Australasian populations (Baxter et al., 2012). According to research by Thompson et al. (2004Thompson et al. ( , 2008 most sufferers of anxiety do not access treatment until well into adulthood and even those who do access appropriate help typically suffer for many years before receiving that help. It is therefore important to prevent that children and youth with elevated anxiety symptoms move on to fully develop anxiety disorders. ...
This is the protocol for a Campbell systematic review. The objectives are as follows. The main objective of this review is to answer the following research question: What are the effects of the FRIENDS preventive programme on anxiety symptoms in children and adolescents? Further, the review will attempt to answer if the effects differ between participant age groups, participant socio‐economic status, type of prevention (universal, selective or indicated), type of provider (lay or mental health provider), country of implementation (Australia or other countries) and implementation issues in relation to the booster sessions and parent sessions (implemented, partly implemented or not at all).
... J. Kim et al., 2020;Smith et al., 2021). In addition, MHL is associated with the utilization of mental health care (Bonabi et al., 2016;Jorm, 2012;Thompson et al., 2004) and many positive mental health outcomes such as high psychological well-being (Bjørnsen et al., 2019). ...
Mental health literacy (MHL) predicts help-seeking attitudes. However, the relationship between components of MHL and help-seeking attitudes has not been thoroughly examined. This study aims to examine whether mental illness stigma, help-seeking efficacy, and maintenance of positive mental health mediated the relationship between recognition of mental disorders and help-seeking attitudes, using a meta-analytic structural equation modeling (MASEM) approach. A comprehensive literature search was conducted to gather relevant studies (111 articles with 118 independent samples), and their data (k = 185) were analyzed using MASEM. Reducing mental illness stigma or increasing help-seeking efficacy may be effective strategies for promoting help-seeking behaviors among individuals who recognize mental disorders, while the maintenance of positive mental health did not significantly mediate the relationship between recognition of mental disorders and help-seeking attitudes. These findings suggest that reducing stigma or increasing help-seeking efficacy may be an effective strategy for promoting help-seeking behaviors among individuals who can identify mental disorders. The use of MASEM in this study highlights the importance of integrating multiple studies to understand the complex relationship between MHL components and help-seeking attitudes.
... [46]It is worth noting that the majority of individuals with anxiety or mood disorders do not seek immediate help from a mental health professional but instead visit a general medical practitioner, which can cause a delay in treatment of at least one month. [47]Additionally, some individuals may lack empathy and compassion towards those with GAD, viewing anxiety as a weakness rather than a medical condition that requires treatment. As a result, they may feel uncomfortable or fearful around those with GAD because they do not understand the condition and its symptoms. ...
Purpose:
This abstract examines stigma and attitudes towards mental illnesses among undergraduate students at Johannian universities. The study aims to evaluate the extent of stigmatization and associated factors.
Methods:
Three online questionnaires assessed depression, generalized anxiety disorder (GAD), and schizophrenia. Demographic data were collected via a Google Form from undergraduate students. Measures included age, gender, social status, personal and perceived stigma scales, social distance preferences, sources of information about mental illness, interventions, and supporting data.
Results:
A total of 1161 responses were collected, with 384 responses for the depression survey, 382 for the schizophrenia survey, and 395 for the GAD survey. Among the respondents, 57.7% were female, 29% were first-year college students, and 57% were medical students. Notably, 40% of participants had a history of mental illness, but only 0.04% had received psychological treatment. Websites and books were the most frequently mentioned sources of knowledge about mental health (79.4% and 73.7%, respectively). Statistically significant correlations between gender and population stigma were found in the surveys on depression and GAD, as well as depression and schizophrenia. Moreover, variations in personal opinions were observed based on gender in surveys on schizophrenia and depression, and between medical and non-medical students in surveys on depression and GAD.
Conclusions:
The study reveals a significant stigma among undergraduate students at Johannian universities towards individuals with mental illnesses, leading to a desire for social distance. To mitigate this stigma, anti-stigma programs should be implemented that promote societal acceptance and provide scientific information about mental illness.
... financial cost and lack of transport); and (c) attitudinal barriers (e.g. stigma-related concerns and fears or embarrassment about revealing personal details) (Thompson, Hunt, & Issakidis, 2004). Public stigma and self-stigma also contribute to non-disclosure and poor help-seeking behaviour (Henderson, Williams, Little, & Thornicroft, 2013). ...
... Given its multidimensional structure, the relationship between each facet and help-seeking can be discussed separately. For example, there is empirical evidence of a positive association between the ability to recognize a mental illness (based on the description of symptomatology) and positive attitudes towards formal mental health help-seeking (15)(16)(17) as well as to actual use of therapeutic care (18). However, the literature holds conflicting findings in this regard as one study showed that the ability to identify a mental health problem has a negative correlation with help-seeking intentions, while knowledge of treatment efficacy is positively linked to help-seeking intentions (19). ...
Background
Because the majority of mental illnesses develop early in life, effective preventative public mental health interventions are needed. Interventions fostering mental health literacy can be used to enhance personal resources and capacities to facilitate mental health care and thus, address help-seeking barriers. A Canadian mental health literacy school curriculum was adapted, piloted, and evaluated for the use in German schools. The study presents the intervention’s effects on mental health knowledge and help-seeking efficacy among 10th grade students in Germany.
Methods
10th grade students (aged 14–17 years old) from one secondary school participated in a pre- and post-intervention control group study. Both groups completed a questionnaire at two time points assessing mental health knowledge and help-seeking efficacy. Repeated measure analysis of variance (ANOVA) was employed to evaluate the intervention’s effects.
Results
Data from 188 students was eligible for analysis. The analysis of the baseline data reveals a high comparability of the two groups in terms of demographics, and initial mental health knowledge and help-seeking efficacy scores. ANOVA results showed significant improvements for the intervention group having a large effect size for mental health knowledge (f = 0.574, p < 0.001, partial η² = 0.25) and a medium effect size for help-seeking efficacy (f = 0.311, p < 0.001, partial η² = 0.09).
Conclusion
The first-time application and evaluation of an adapted mental health literacy school curriculum shows significant increases in mental health knowledge and help-seeking efficacy, two core dimensions of mental health literacy, among 10th grade students in Germany. Further studies are needed to confirm these results as well as have a more in-depth analysis on the interrelations of the different dimensions of mental health knowledge and help-seeking practices.
... Data were collected using a semi-structured interview method. An initial interview outline was developed based on a literature review of health ecology models (9,(15)(16)(17). The initial outline was revised by consulting our psychotherapist, mental health physician, and mental health nurse specialist. ...
Background
Depression is a prevalent mental health issue among adolescents, and timely treatment can prevent it from worsening. However, many adolescent depressed patients delay seeking medical treatment. To clarify the reasons for delayed medical treatment in adolescent depressed patients and to provide reference to help adolescent depressed patients to seek medical treatment on time.
Methods
From July 2022 to March 2023, a semi-structured interview was conducted using a purposive sampling method with adolescent depressed patients attending the Mental Health Center of the First Hospital of Shanxi Medical University. Based on inclusion and exclusion criteria, 22 adolescent depression inpatients with delayed access to medical care were finally included as the study population. This study applied the phenomenological research method in qualitative research and used the Colaizzi seven-step data analysis method to analyze and refine the interview data.
Results
The study found that 22 adolescents with depression delayed medical care for 1–6 years, with a mean of 2.86 years. Six themes were identified as the reasons for delayed medical treatment: (1) inadequate levels of mental health literacy; (2) lack of disease-related knowledge and information; (3) negative emotional experiences; (4) negative attitudes toward health care; (5) inadequate medical insurance policy for psychotherapy; (6) unequal distribution of resources for mental health medical services.
Conclusion
The phenomenon of delayed medical treatment for adolescent depression patients should not be ignored. Efforts should be made to explore the trajectory of delayed illness in adolescents with depression, improve patient symptom assessment, improve poor patient experience, promote positive patient behavior, and improve the current situation of delayed medical treatment for adolescent depression patients through the joint efforts of individuals, families, schools, and society.
... (Jorm et al, 1997, p 182; see also Chapters 4,17,19 and 24,this volume) Research about MHL shows that people know less about mental illnesses than about physical illnesses, regarding, for instance, prevention or treatment opportunities (Jorm, 2012). The lack of knowledge and of treatment options is the main reason for delayed help-seeking (Thompson et al, 2004). Poor MHL is also associated with inadequate help-seeking and misunderstandings during treatment (Rickwood et al, 2004). ...
... This can be seen in an Australian study of people who sought professional help for anxiety or mood disorders. The average delay was 8.2 years, but most of this was the delay between onset and recognition (average of 6.9 years), with a much shorter delay between recognition and help-seeking (average 1.3 years) (Thompson et al, 2004). ...
... Zahlreiche Forschungsarbeiten unterstreichen die Bedeutung therapiebezogener Einstellungen für die Inanspruchnahme therapeutischer Hilfe in der Allgemeinbevölkerung (Deane & Todd, 1996 (Corrigan, 2004). Weitere einstellungsbezogene Hindernisse betreffen die Überzeugung, ein Problem selbst in den Griff zu bekommen, und den Glauben, dass ein Problem von alleine verschwinden werde (Gulliver, Griffiths & Christensen, 2010;Thompson, Hunt & Issakidis, 2004;Sareen et al., 2007). Ein Großteil dieser Forschungsarbeiten befasst sich mit der Identifizierung von Merkmalen, die mit therapiebezogenen Einstellungen zusammenhängen. ...
Zusammenfassung: Therapiemotivation von Straftäter_innen gilt gemeinhin als wichtige Voraussetzung für eine erfolgreiche Behandlung. Dennoch mangelt es derzeit an reliablen und validen Messinstrumenten. Die vorliegende Studie untersuchte eine Kurzversion des Fragebogens zur Erfassung von therapiebezogenen Einstellungen (TBE-SV) in einer männlichen Stichprobe des Straf- ( n = 215, M = 34.56 Jahre, SD = 14.07) und Maßregelvollzugs ( n = 281, M = 38.08 Jahre, SD = 11.91). Die fünf Faktoren des TBE-SV konnten mit einer konfirmatorischen Faktorenaanalyse weitestgehend repliziert werden χ²(242) = 421.46, p < .001, CFI = .92, RMSEA = .039) und eine Messinvarianzprüfung wies auf metrische Invarianz hin. Die Subskalen wiesen niedrige bis akzeptable Reliabilitätskoeffizienten auf (McDonalds ω = .51 – .87). Jüngere Probanden ( r = -.28) und jene mit niedrigerem Bildungsniveau ( r = -.17) gaben ungünstigere Theapieeinstellungen an. Schließlich unterstreichen die Korrelationen mit diversen Selbstbeurteilungsfragebögen die konvergente und diskriminante Validität des TBE-SV. Es kann geschlussfolgert werden, dass der TBE-SV, der ursprünglich für Personen im Strafvollzug konzipiert wurde, auch für die Anwendung im Maßregelvollzug geeignet ist. Ansatzpunkte zur Weiterentwicklung des Fragebogens werden abschließend kritisch diskutiert.
... 1,2 Not seeking help, or delaying help-seeking, can lead to severe mental health disorders, increase the burden of disease and hinder healthy ageing. 3,4 It is important that older adults engage mental health supports early, to protect their health and facilitate timely access to treatment. ...
Objective:
Rates of help-seeking for mental health problems among older adults are low and initiatives to increase help-seeking in older populations are limited. To our knowledge, no interventions have aimed to promote help-seeking among older adults by tapping internal motivations to seek help. In this paper, we describe the development of a theory-based intervention designed to promote mental health help-seeking among older adults in Australia, using an internal motivation paradigm.
Methods:
The intervention was co-designed through a consultative process with nine key stakeholders who represented five main groups: primary health-care providers, mental health professionals, health-care executives, community organisations and consumers. Development was an iterative process, based on best practice guidelines. Nineteen older adults (≥65 years) provided feedback on the acceptability of the intervention.
Results:
The intervention consisted of a help-seeking brochure with behaviour change messages based on the Theory of Planned Behaviour (TPB). Messages targeted older adults' attitudes towards help-seeking, subjective norms, perceived behavioural control and barriers to seeking help. Most participants (74%) responded with agree/strongly agree to 10 items measuring the acceptability of the intervention, indicating the intervention is relevant, clear, appropriate and appealing.
Conclusions:
The present intervention appears to be an acceptable way to promote help-seeking for mental health problems among older adults. A larger, robust trial is warranted to determine the effectiveness of the intervention in improving help-seeking attitudes, intentions and behaviour. The intervention has the potential to increase older adults' engagement with mental health support and improve health outcomes in this population.
... This can be seen in an Australian study of people who sought professional help for anxiety or mood disorders. The average delay was 8.2 years, but most of this was the delay between onset and recognition (average of 6.9 years), with a much shorter delay between recognition and help-seeking (average 1.3 years) (Thompson et al, 2004). ...
... This also brings to light some of the reasons identified byEigenhuis et al., (2021) as the causes of delay in helpseeking among people, for example, lack of knowledge about the outcome of events, individual functioning and wellbeing and time taken to detect illness. In addition to the barrier factorsThompson et al., (2004) also supported by arguing that public mental health illiteracy is a factor that causes more tendency for delay in seeking mental health care among younger persons. From the result therefore it is obvious that the less favourably the perceived barriers to help-seeking the more likely the people will seek help.Zola's (1973) help-seeking model as reviewed in the present study clearly presents the role of perception in symptom acknowledgment or denial and the decision to seek help which is either encouraged or delayed by social factors. ...
The study aimed at investigating the roles demographic factors, mental health literacy and delay factor play in the help-seeking attitude towards mental healthcare among young adults within the inner city of Uyo in Akwa Ibom state, Nigeria. Measures of mental health literacy, delay factor and attitude towards help-seeking for mental health help seeking as well as socio-demographic variables were administered to 385 participants aged 18 to 24 years. Participants were selected based on multistage sampling technique from the inner-city areas. Bivariate analyses and stepwise regression model were used to analyse data. It was observed that delay factor (r =-0.18; p <.01) and mental health literacy were significantly associated with attitude toward mental health (r =-0.16; p <.01) while age (r =-0.03; p >.05), sex (r =-0.06; p >.05), and income (r = 0.04; p >.05) were not significantly associated with attitude toward mental health. Further, it was observed that delay factor was a more robust predictor {β =-0.18; p <.00} of attitude toward mental health than mental health literacy {β =-0.13; p <.01}. These findings point to the important roles knowledge about mental health and reasons for delay play in understanding help-seeking attitude of youths towards mental health. The study concludes that interventions should target at removing barriers and societal stigmas in addition to better enlightenment on mental health care.
... 3,7 These students encounter significant obstacles in getting help, including a lack of understanding and negative attitudes regarding mental diseases and their treatment, fear of stigma, and limited access to adequate care. [8][9][10] Ethiopia. The enrollees of this survey were from all colleges of Dilla University, in Dilla town, Ethiopia. ...
Background
This paper investigated mental health literacy level and information seeking behavior, and mental health-related information sources in limited-resource settings, in the case of Ethiopian university students.
Methods
A cross-sectional, self-administered web-based survey was conducted among Dilla University students, from 1 January to 29 February 2022, with a total of 780 respondents. We presented descriptive statistics using mean, standard deviations, and proportions. Bivariate and multivariate logistic regression were employed to identify factors associated with mental health literacy and information seeking behavior of students. Further, path analysis was also employed.
Results
The result showed 71 (9.1%) respondents had a diagnosed history of mental illness. Overall, 397 (50.9%) respondents were identified as having adequate mental health literacy and 420 (53.8%) sought mental health information. In multivariate analysis, mental health literacy was significantly associated with: being female (AOR = 2.8; 95% CI (1.5–5.4)), higher digital health literacy (AOR=2.8; 95% CI (1.5–5.4), seeking mental health-related information (AOR=1.6; 95% CI: (1.1–2.5)), having family with mental illness, and students in health-related programs (AOR = 2.1; 95% CI (1.0–4.2)). Furthermore, health-related programs, level of mental health literacy, exposure to mental health problems in the family, and were associated with information seeking behavior regarding mental health. Further, path analysis revealed significant positive associations of information seeking behavior and digital health literacy with mental health literacy.
Conclusion
The result indicated the status of university students’ mental health literacy level and information seeking behavior were low and inadequate. This study suggests the need to improve students’ digital health competencies by designing mental health literacy programs by collaboration of different stakeholders, and mental health literacy programs need to optimize access to internet and online resources in the university settings.
... Dies wird auch bei Betrachtung von Forschungsstudien zu MHL sichtbar: Es gibt derzeit kaum zusammenfassende oder gar übergreifende Erkenntnisse darüber wie MHL, Stigmatisierung, Hilfesuche und andere für die psychische Gesundheit relevante Aspekte, wie Wohlbefinden oder Resilienz, zusammenhängen. Einzelne Studien konnten allerdings, wenn auch mit unterschiedlichen Operationalisierungen, bereits nachzeichnen, dass eine verbesserte MHL mit einer höheren Wahrscheinlichkeit professionelle Hilfe aufzusuchen zusammenhängt (Bonabi et al. 2016;Thompson et al. 2004 Ein Beispiel hierfür ist das Unterrichtsprogramm "Psychische Gesundheit und Schule", die offizielle, deutsche Version des erprobten, kanadischen Programms "The Mental Health and High School Curriculum Guide", die vom Zentrum für Prävention und Intervention im Kindes-und Jugendalter der Universität Bielefeld herausgegeben sowie betreut wird (Zentrum für Prävention im Kindes-und Jugendalter (ZPI) 2020). 3 Mit dem Programm wird zum Thema psychische Gesundheit und Erkrankung aufgeklärt und für die Problematik der Stigmatisierung sensibilisiert. ...
Psychische Belastungen und Erkrankungen sind zentrale Gesundheitsthemen im Kindes- und Jugendalter. Daher ist es bedeutsam, die psychische Gesundheit in Bestrebungen der Gesundheitsförderung und Prävention in den Blick zu nehmen und unterstützende Maßnahmen zu diskutieren. Da die Schule ein wichtiger Lebens- und Wirkort im Leben junger Menschen ist, kann hier ein wesentlicher Anknüpfungspunkt für Unterstützung verortet werden. In diesem Zusammenhang haben Lehrkräfte als Schlüsselpersonen für Schüler:innen eine besondere Position inne. Um sie bei der Adressierung und Förderung der psychischen Gesundheit ihrer Schüler:innen zu unterstützen, kann auf die mit dem Mental Health Literacy (MHL) Konzept assoziierten Kenntnisse, Fähigkeiten und Einstellungen gesetzt werden. Demzufolge werden in diesem Beitrag die Grundzüge des MHL-Verständnisses, die Relevanz und mögliche Potenziale von MHL bei und für Lehrkräfte dargestellt, sowie auf Erkenntnisse und Lücken der Forschung zu MHL bei Lehrkräften verweisen.
... Also, the most important reason for patients with mental disorders to delay receiving treatment is the lack of knowledge about available effective treatments. Therefore, having sufficient knowledge about effective treatment methods for mental disorders seems to be necessary [54]. Treatment of depression in the early stages reduces the symptoms of the disease and prevents of severe depression [55]. ...
Background
The prevalence of depression in society is increasing and there is a need for a suitable tool to assess the health literacy of people in this field. This study was conducted to evaluate the psychometric of the Iranian version of the depression literacy (D-Lit) questionnaire.
Methods
This cross-sectional study was conducted on 845 participants with a proportional stratified sampling method. First, the translation and cultural adaptation of questionnaire was performed. Then, the validity of D-Lit was assessed by face validity, content validity, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). The reliability of D-Lit was assessed by the Cronbach’s alpha coefficient and McDonald omega coefficient.
Results
Based on the results of EFA, 5 factors emerged with eigenvalues of greater than 1, which accounted for 56.30% of the variance. Based on the results of CFA, one question was deleted and the results of goodness fit indexes confirmed the model. Cronbach’s alpha coefficient and McDonald omega coefficient for D-Lit questionnaire were 0.890 and 0.891, respectively. Finally, D-Lit questionnaire with 21 questions and 5 subscales of Knowledge of the psychological symptoms (5 items), Knowledge about the effectiveness of available treatment methods (4 items), Knowledge about cognitive-behavioral symptoms (6 items), Knowledge about taking medications and their side effects (4 items), and Knowledge of the severity of the disease (2 items) were confirmed.
Conclusion
The results of this psychometric evaluation confirmed the Persian version of D-Lit questionnaire with 21 questions and 5 subscales is an appropriate tool for measuring people's literacy about depression.
... [11] Previous studies found that most young people with mental health problems prefer not to talk to anyone, including colleagues. [12][13][14] Their delay or refusal to seek help is the result of a transition from the personal domain (psychopathology) to the interpersonal domain (help-seeking intentions). [11] In addition, delay in seeking help is related to the nature of the developmental process of mental health disorders. ...
Competitive college admissions and academic pressure have continuously increased the psychopathological burden of Korean high school students. Seeking help is one of the primary means of managing mental health, and more attention is required. This study aimed to explore the psychopathological and cognitive factors related to the help-seeking intentions of Korean high school students.
This cross-sectional study was conducted between July and August 2020 using the General Help-Seeking Questionnaire, Symptom Checklist-90-R, and Mental Health Literacy Scale. Four hundred and twenty-one Korean high school students (275 males, 146 females; average age 17.44 years [standard deviation = 0.651]) completed self-report questionnaires. We performed analysis of variance, Spearman’s correlation analysis, and stepwise regression analysis to explore the factors related to help-seeking intentions.
The final model showed an explanatory power of 23.6% for the overall variance in help-seeking intentions. Somatization (β = −0.200; P = .001) and hostility (β = −0.203; P = .001) had a negative effect on help-seeking intentions. Further, knowledge of where to seek information (β = 0.230; P < .001) and attitudes promoting recognition and help-seeking behavior (β = 0.095; P = .030) had a positive effect.
Students responded to society’s negative awareness of mental illness by converting psychopathology into socially acceptable symptoms. Educational support can improve mental health literacy. This study is expected to help improve mental illness awareness and increase adolescents’ access to public services.
... Also, the most important reason for patients with mental disorders to delay receiving treatment is the lack of knowledge about available effective treatments. Therefore, having su cient knowledge about effective treatment methods for mental disorders seems to be necessary [54]. Treatment of depression in the early stages reduces the symptoms of the disease and prevents of severe depression [55]. ...
Background
The prevalence of depression in society is increasing and there is a need for a suitable tool to assess the health literacy of people in this field. This study was conducted to evaluate the psychometric of the Iranian version of the depression literacy (D-Lit) questionnaire.
Methods
This cross-sectional study was conducted on 845 participants with a proportional stratified sampling method. First, the translation and cultural adaptation of questionnaire was performed. Then, the validity of D-Lit was assessed by face validity, content validity, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). The reliability of D-Lit was assessed by the Cronbach’s alpha coefficient and McDonald omega coefficient.
Results
Based on the results of EFA, 5 factors emerged with eigenvalues of greater than 1, which accounted for 56.30% of the variance. Based on the results of CFA, one question was deleted and the results of goodness fit indexes confirmed the model. Cronbach’s alpha coefficient and McDonald omega coefficient for D-Lit questionnaire were 0.890 and 0.891, respectively. Finally, D-Lit questionnaire with 21 questions and 5 subscales of Knowledge of the psychological symptoms (5 items), Knowledge about the effectiveness of available treatment methods (4 items), Knowledge about cognitive-behavioral symptoms (6 items), Knowledge about taking medications and their side effects (4 items), and Knowledge of the severity of the disease (2 items) were confirmed.
Conclusion
The results of this psychometric evaluation confirmed the Persian version of D-Lit questionnaire with 21 questions and 5 subscales is an appropriate tool for measuring people's literacy about depression.
... High MHL has been linked to less stigma and more positive attitudes towards help-seeking (Beatie et al., 2016;Cheng et al., 2018;Thomas et al., 2014), and more help-seeking behavior (Wang et al., 2019). For example, recognizing one's symptoms and severity of the disorder (e.g., high MHL) have shown to greatly reduce the delay in seeking professional treatment (Paulus et al., 2015;Thompson et al., 2004), which likely contributes to better mental health. Indeed, a study examining suicide literacy (a component of mental health literacy focused on individuals' knowledge about suicide, such as signs and symptoms, causes, risk factors, and treatment and prevention), suicide stigma, and psychological help seeking attitudes among Arab youth found that there was a positive significant correlation between (e.g., 41.1% of U.S. college students reported moderate to severe depression in 2017-2018; Duffy et al., 2019). ...
Cybervictimization is prevalent among college students, which has negative impacts on their mental health. One factor that may buffer the effects of cybervictimization on depressive symptoms is mental health literacy (MHL). It is important to study MHL because it is associated with positive attitudes towards help-seeking and more help-seeking behavior, which may result in better mental health. However, research on MHL and mental health has shown mixed findings, and most existing research focuses on Western participants. The present study examined the effects of cybervictimization and MHL on depressive symptoms among U.S. and Chinese college students. A total of 618 college students (57.6% female, 329 U.S. students, 289 Chinese students) completed an online survey. Findings reveled that cybervictimization significantly predicted depressive symptoms for Chinese students, but not U.S. students. MHL marginally predicted more depressive symptoms for U.S. students. MHL buffered the relation between cybervictimization and depression symptoms for U.S. students, but not Chinese students. Chinese students reported lower MHL than U.S. students. High MHL may serve as a buffer for stressful life events for college students.
... However, it is seen that the application for treatment occurs when the severity of the disorder increases. At the same time, the lack of mental health literacy of the participants was listed as one of the reasons for delaying the application [16]. In the eastern Gojjam Region in the northwest of Ethiopia, a study examining the delay in receiving services found similar delays in applying for the diagnosis of tuberculosis. ...
... Distres psikologis merupakan kondisi ketidaknyamanan yang dapat disebabkan dari faktor eksternal maupun internal individu (Muzni & Wicaksono, 2015), jika kondisi tersebut tidak memperoleh suatu perbaikan, maka akan memengaruhi individu dalam menjalani kehidupannya (Saputra, 2019). Hasil penelitian ini juga selaras dengan hasil penelitian Thompson et al. (2004) yang menyatakan bahwa kemandirian merupakan salah satu prediktor yang dapat memengaruhi sikap terhadap pencarian bantuan profesional psikologis. Seseorang dikatakan memiliki kemandirian ketika mampu memutuskan dan mengerjakan suatu hal tanpa bantuan dari orang lain (Sa'diyah, 2017). ...
Tingginya angka penderita gangguan jiwa di Indonesia tidak diimbangi dengan tingginya sikap terhadap bantuan psikologis, terutama pada mahasiswa. Hasil penelitian dan studi terdahulu menunjukkan bahwa kemandirian dan tingkat distres psikologis berpengaruh terhadap sikap pencarian bantuan psikologis profesional. Subjek penelitian ini adalah 365 mahasiswa yang ditentukan dengan teknik cluster random sampling. Alat ukur yang digunakan adalah Skala Sikap terhadap Pencarian Bantuan Profesional Psikologis, skala distres psikologis menggunakan Depression Anxiety Stress Scale (DASS), dan skala kemandirian. Analisis regresi berganda yang mengukur tiga varians menunjukkan bahwa distres psikologis dan kemandirian mampu berkontribusi secara signifikan terhadap sikap pencarian bantuan profesional psikologis. Korelasi parsial pertama antara distres psikologis dengan sikap terhadap pencarian bantuan profesional psikologis menunjukkan hubungan yang positif antara keduanya. Dengan kata lain, semakin tinggi distres psikologis mahasiswa Universitas Islam Sultan Agung Semarang, maka semakin tinggi pula sikap terhadap pencarian bantuan profesional psikologis yang dimiliki. Korelasi parsial kedua antara kemandirian dengan sikap terhadap pencarian bantuan profesional psikologis menunjukkan bahwa tidak ada hubungan antara keduanya. Semakin tinggi kemandirian mahasiswa Universitas Islam Sultan Agung Semarang maka semakin tinggi pula sikap terhadap pencarian bantuan profesional psikologis yang dimiliki. Dengan demikian, hasil analisis regresi ganda yang dilakukan pada subskala DASS menunjukkan bahwa depresi dan stres tidak memprediksi sikap pencarian bantuan psikologis secara signifikan.
... However, it is seen that the application for treatment occurs when the severity of the disorder increases. At the same time, the lack of mental health literacy of the participants was listed as one of the reasons for delaying the application [16]. In the eastern Gojjam Region in the northwest of Ethiopia, a study examining the delay in receiving services found similar delays in applying for the diagnosis of tuberculosis. ...
Purpose: Maintaining a healthy life is the right of every individual. The important matter at this point is accepting early intervention without delaying healthcare demand and taking action for this intervention. Through this study, it was aimed to develop a measurement tool in order to determine the procrastination behavior for health services demand among the individuals at the age of 18 and over. Methods: In the study, a questionnaire form which consists of the demographic variables (gender, age, marital status, learning status, status of chronic diseases, number of applications to the physician, status of access to physician, and health assurance) and informed consent was employed. Healthcare Demand Procrastination Scale (HDPS) was employed as well as the Health Seeking Behavior Scale (HSBS) for the validity of criteria. The findings obtained from the study were evaluated through the programs of SPSS (Statistical Package for Social Sciences) and AMOS. Results: No significant difference was found between the scores obtained through Kendall’s test which was conducted in order to test the content validity of the scale. In order to examine the structure validation of the scale, explanatory and confirmatory factor analysis were performed and as a result of the analysis, values of goodness of fit were found normal and acceptable. Finally, HSBS was employed to ensure the criteria validity of the scale. A positive relationship was found between procrastination behavior of healthcare demand and traditional behavior of health seeking while there was a negative relationship with professional health seeking behavior. In the Pearson correlation coefficient analysis which shows the compatibility of the average test-retest scores of the draft scale, a statistically significant positive relationship was observed between two measurements. Conclusions: As a result of the research, a scale which measures the healthcare demand procrastination behavior in Turkey was obtained. In addition, the behavior of individuals with a certain disease about health procrastination behavior for health services can also be examined through the developed scale.
... Stigmatisierungsangst scheint dabei das häufigste Hindernis für die Inanspruchnahme einer Therapie zu sein (Corrigan, 2004). Weitere einstellungsbezogene Hindernisse betreffen die Überzeugung, ein Problem selbst in den Griff zu bekommen und den Glauben, dass ein Problem von alleine verschwinden werde (Gulliver et al., 2010;Thompson et al., 2004;Sareen et al., 2007). ...
Die Therapiemotivation von straffällig gewordenen Personen ist ein komplexes Konstrukt und gilt gemeinhin als wichtige Voraussetzung für eine erfolgreiche Behandlung. Dennoch man-gelt es derzeit an reliablen und validen Messinstrumenten. Die vorliegende Studie befasst sich mit der motivationalen Komponente der Therapieeinstellung und untersuchte eine Kurzver-sion des Fragebogens zur Erfassung von therapiebezogenen Einstellungen (TBE-SV) in einer männlichen Stichprobe des Straf-und Maßregelvollzugs (n = 496). Die fünf Faktoren des TBE-SV (Therapievertrauen, Misstrauen in Therapeut_innen, Therapieabwehr, Stigma-und Öffnungsängstlichkeit) konnten mit Hilfe einer konfirmatorischen Faktorenaanalyse und ei-nem explorativen Strukturgleichungsmodell weitestgehend repliziert werden. Die Subskalen Stigma-und Öffnungsängstlichkeit wiesen niedrige Reliabilitätskoeffizienten auf, die Werte für die verbleibenden Subskalen sowie den Gesamtwert waren akzeptabel. Festgestellt werden konnten bedeutsame Alters-und Bildungseffekte, wonach ältere Probanden und jene mit hö-herem Bildungsniveau positivere Theapieeinstellungen aufwiesen. Gruppenunterschiede zwi-schen den Probanden des Straf-und Maßrelvollzugs bezüglich der Werte im TBE-SV fanden sich hingegen nicht. Es kann daher geschlussfolgert werden, dass der TBE-SV, der ursprüng-lich für Personen im Strafvollzug konzipiert wurde, auch für die Anwendung im Maßregel-vollzug geeignet ist. Schließlich unterstreichen die korrelativen Analysen mit diversen Selbst-beurteilungsfragebögen die konvergente und diskriminante Validität des TBE-SV.
... These included (a) the focus on the parenting partnership in raising children; (b) involving fathers in the intake process to convey the importance of their involvement in FF and address any concerns or hesitations about what it would involve; and (c) inclusion of a male clinician to build relationships with fathers, provide opportunities to discuss men's health issues, and challenge attitudinal barriers to help-seeking commonly held by men. These findings are important given research indicating that men's help-seeking behavior and uptake of mental health interventions and support is markedly lower than women's (Thompson et al., 2004) and the need for more father-inclusive practices in child and family services to promote the engagement of fathers (Lee et al., 2018). ...
Objectives
A formative evaluation of a home‐based family intervention, Family Foundations (FF), targeting parent mental health and conflict in the perinatal period was conducted. The aims were to (a) assess parent satisfaction and recommendations for improvement, (b) identify perceived enablers and barriers to engagement, and (c) obtain preliminary outcome data related to parent mental health, conflict, and coparenting.
Methods
A mixed‐methods evaluation was conducted with 41 families at risk of or experiencing parental conflict. FF was delivered by two organizations in Australia. Qualitative interviews with parents and FF clinicians were conducted, and intervention outcomes were assessed using parent survey.
Results
Feasibility of reach and recruitment of the target population was demonstrated. Parents' indicated a high level of satisfaction with all aspects of FF and offered recommendations for improvements to resources and delivery. Service, program, clinician, and family characteristics as enablers and barriers to engagement in FF were identified. Both mothers and partners reported a decrease in their child's exposure to conflict. Mothers also reported a decrease in mental health symptoms and parenting hostility and an increase in positive coparenting behavior.
Conclusion
Feasibility and acceptability of home‐based FF in the perinatal period had been established, with preliminary evidence of positive outcomes for families.
Implications
The current findings generate evidence to inform further development of home‐based FF and wider implementation in health and social care services in Australia.
... At the same time, medical students encounter notable barriers to seeking help, including lack of knowledge and negative attitudes towards mental disorders and treatment, the fear of being stigmatized and poor access to appropriate care [9,10]. They may fear that disclosing their mental health problems might jeopardize their professional advancement or cost them their professional rights, and consequently postpone helpseeking [11]. ...
Abstract Background Medical students are prone to mental disorders, such as depression and anxiety, and their psychological burden is mainly related to their highly demanding studies. Interventions are needed to improve medical students’ mental health literacy (MHL) and wellbeing. This study assessed the digital Transitions, a MHL program for medical students that covered blended life skills and mindfulness activities. Methodology This was a one group, quasi-experimental pretest-posttest study. The study population was 374 first-year students who started attending the medical faculty at the University of Turku, Finland, in 2018-2019. Transitions was provided as an elective course and 220 students chose to attend and 182 agreed to participate in our research. Transitions included two 60-minute lectures, four weeks apart, with online self-learning material in between. The content focused on life and academic skills, stress management, positive mental health, mental health problems and disorders. It included mindfulness audiotapes. Mental health knowledge, stigma and help-seeking questionnaires were used to measure MHL. The Perceived Stress Scale and General Health Questionnaire measured the students’ stress and health, respectively. A single group design, with repeated measurements of analysis of variance, was used to analyze the differences in the mean outcome scores for the 158 students who completed all three stages: the pre-test (before the first lecture), the post-test (after the second lecture) and the two-month follow-up evaluation. Results The students’ mean scores for mental health knowledge improved (-1.6, 95% Cl -1.9 to -1.3, P
... These phases comprise suffering from symptoms, assessing the intensity and outcomes of the symptoms, examining if treatment is needed, gauging the possibility of and alternatives for treatment, and determining whether to ask for treatment (Goldberg & Huxley, 1980). The barriers to the utilization of mental health services, such as individual attitudinal factors (e.g., fear of stigmatization) and system-level structural factors (e.g., the financial cost of services) impact the journey of individuals at each phase (Crisp et al., 2000;Saldivia et al., 2004;Thompson et al., 2004;Wells et al., 1994). Consequently, individuals who are already hesitant to seek help for a mental health problem might be further hindered by the high cost of out-ofpocket payments, the costs of services, and inconvenience/transportation to postpone treatment until their needs are acute and the necessary care is even more expensive. ...
It is well documented that there is a shortage of mental health care providers, mental health literacy, and underutilization of mental health services in Pakistan. This systematic review aimed to assess the available evidence on factors hindering and/or facilitating access to care among people with mental health issues, health care providers, carers, or any other population group (e.g., students, teachers) in Pakistan. Thirteen published studies of barriers and facilitators in Pakistan were identified through nine electronic databases: Ovid MEDLINE, Ovid Embase, Ovid Emcare, CINAHL plus, Proquest Central, PsycInfo, Scopus, Pubmed, and ScienceDirect. Thematic analysis revealed that factors facilitating access to mental health services were trust in the effectiveness of mental health services and acknowledging the seriousness of the problem. However, factors hindering the access were financial issues/constraints, personal issues/other priorities, stigma, low mental health knowledge, side-effects/dissatisfaction from previous treatments, time and distance constraints, reliance on traditional/religious healers, and lack of social (i.e., family and peers) support/encouragement. Findings suggest the need for reducing barriers to and enhancing facilitators of seeking mental health services. To improve help-seeking, the focus of strategies should be on enhancing mental health literacy, lowering stigma, and increasing trust in mental health services' effectiveness.
• Implications of rehabilitation
• What is known about this topic? There is a scarcity of empirical evidence on mental health and its correlates in Pakistan-a developing country and mental health services are restricted to psychiatry departments of teaching hospitals or in privately run clinics.
• There is a scarcity of psychiatrists in rural areas having 60% population and there is a need for recognizing facilitators and reducing barriers to reasonable mental health care is crucial.
• What the paper adds: Factors facilitating access to mental health services were trust in the effectiveness of mental health services and acknowledging the seriousness of the problem.
• Factors hindering the access were financial issues/constraints, personal issues/other priorities, stigma, low mental health knowledge, side-effects/dissatisfaction from previous treatments, time and distance constraints, reliance on traditional/religious healers, and lack of social (i.e., family and peers) support/encouragement.
• This recognition can help to design adequate programs and policies for people with mental health issues.
• There is a need to raise public awareness of the importance of seeking mental health services as well as for designing, testing, and executing strategies to reduce self and social stigma related to mental health problems.
... financial cost and lack of transport); and (c) attitudinal barriers (e.g. stigma-related concerns and fears or embarrassment about revealing personal details) (Thompson, Hunt, & Issakidis, 2004). Public stigma and self-stigma also contribute to non-disclosure and poor help-seeking behaviour (Henderson, Williams, Little, & Thornicroft, 2013). ...
The purpose of this study is to examine the efficacy of a three-session free-of-charge counselling model delivered by trained master’s-level counsellors. One-hundred-and-five people who scored mild or moderate levels on the Depression Anxiety Stress Scale and had not been diagnosed or treated for any psychiatric illness in the past year participated. Data from the pre-intervention, post-intervention, and three-month follow-up questionnaires were analysed using intent-to-treat analysis. The participants exhibited a reduction in the number of symptoms of depression, anxiety, and stress and an improvement in help-seeking attitudes. These improvements persisted for at least three months. The counselling sessions removed barriers that often deter individuals from seeking professional counselling. The study limitations were its small sample size and the high dropout rates.
ZUSAMMENFASSUNG
Migration kann persönliche und seelische Belastungen sowie Auswirkungen auf das gesundheitliche Befinden mit sich bringen. Allerdings bestehen für Personen mit Migrationshintergrund Barrieren im Gesundheitssystem und die Anzahl kultursensibler Angebote ist gering. Zudem haben die wenigen kultursensiblen Angebote oftmals nur temporären Bestand und sind stark von einzelnen Protagonisten abhängig. Mit der Entwicklung des Manuals „Interkulturelle Psychoedukation für Menschen mit Migrationshintergrund“ sollte ein kultursensibles Angebot mit dem Ziel der Steigerung der Versorgungsqualität für Migranten geschaffen werden. Dabei steht die Wissensvermittlung über das tägliche Leben in Deutschland, Prävention, soziale Kontakte und Hilfsangebote, aber auch psychische Erkrankungen im Vordergrund. Zur Evaluation dieser interkulturellen Psychoedukation (iP) erfolgten Prä-/Post-Erhebungen evaluierter Fragebögen sowie selbst entwickelter Fragebögen zum Kenntnisgewinn bzw. der Pateientenzufriedenheit. Bei einer hohen Zufriedenheit mit dem Angebot, wurden die Module (Inhalt und sprachliches Verständnis) mit gut bis sehr gut bewertet. Ein signifikant verbesserter Kenntnisstand und eine signifikante Verbesserung in der Offenheit über Problem zu sprechen konnte im Prä-/Post-Vergleich identifiziert werden, während es keine signifikanten Veränderungen in der Selbstwirksamkeit und den Migrationsstressoren gab.
Den Teilnehmenden konnte im Rahmen der iP die Basis für ein Shared-Decision-Making vermittelt werden. Die Wissens- und Informationsvermittlung verbesserte das Verständnis über die psychischen Störungen, wodurch Rückfälle verhindert und stationäre Behandlungszeiten verkürzt oder vermieden werden können.
Background
As mental health problems have become more prevalent among college students, mental health services utilization needs to improve.
Objective
This study aims to explore in what state of mental health problems students start to seek professional help by registering for a mental health service and explore the types of problems that trigger their help-seeking behavior.
Methods
This study is a cross-sectional study. A total of 801 students registered as clients at the college's mental health service (649 women and 152 men) filled out the Beck Depression Inventory (BDI-II) questionnaire to measure students’ levels of depression. The severity of mental health symptoms was assessed from their level of depression. Data were analyzed using descriptive statistics, t-tests, and ANOVA tests.
Results
The findings demonstrated that most college students registering at the mental health service had moderate (31.2%) and severe (32.5%) levels of depression symptoms. The most common causes of their problems were emotional (35.8%), followed by academic (12.4%), negative thinking (11.2%), and relationship problems (10.4%). No differences were found in severity level between the male and female students [t(799)=0.841, p=0.4].
Conclusion
This study reports that college students tend to delay seeking psychological help through mental health services until they have moderate to severe mental health symptoms.
Poor sleep quality can have far reaching physical and mental health consequences (Alvaro et al., 2014; Ribeiro et al., 2012). This study explores sleep quality in older adolescents; specifically, whether insomnia constructs have unique patterns of association to depression, anxiety and stress. Data from 16–19-year olds (N=198) recruited from further education colleges were obtained. Sleep quality was assessed using the diagnostic criteria for insomnia (DSM-5), Insomnia Severity Index and self-report. The Depression Anxiety Stress Scale (DASS-21) was used to measure mental health state. A large proportion (42–52 per cent) reported sleep difficulties lasting four weeks or more, with 17 per cent short-sleepers (<7hrs.). Regression analysis indicated 12.1 per cent–17.8 per cent of variance in mental health was explained by sleep quality. Specifically, ‘non-restorative sleep’ and ‘daily impact’ consistently predicted depression, anxiety and stress levels. Interestingly, ‘maintaining sleep’ and ‘early wakings’, were associated with anxiety and stress respectively. Results indicate for a potentially large group of adolescents; sleep quality is poor. The cumulative effect of poor sleep appears particularly detrimental. Results provide preliminary indications that sleep behaviours could provide a means for early identification of mental health concerns. Findings can inform tailored interventions aimed at improving sleep quality in adolescents thereby having clear benefits in relation to both short, and longer term, health outcomes.
Background
Emerging research and early identification efforts have aimed to identify individuals at clinical high risk for psychosis (CHR). While specialized services for CHR are currently in place, there has been little examination of the subjective experience of those seeking help and accessing these services. The purpose of this article was to describe how initial mental health problems led young people at CHR to seek help, as well as their experiences with mental health care en route to a CHR service.
Methods
Eleven participants receiving care at a CHR service in Montreal, Canada were interviewed.
Results
Participants’ experiences with mental health difficulties resulted in barriers to their everyday activities, which eventually prompted them to seek out services. Long wait times and other challenges emerged when participants began their mental health care journey, while strong collaboration between services was a facilitator of rapid access to needed care.
Discussion
These experiences underscore the need for treatment planning of CHR service to be adaptable to the varied and changing experiences of young people at CHR.
Background
Early evidence suggests that the COVID-19 pandemic and associated interventions have affected mental well-being and associated health service use.
Aims
the aim of this study was to examine the effect of the COVID-19 pandemic and associated public health measures on helpline and telehealth service demand.
Methods
the study utilized a mixed methods research design. Segmented regression analyses were used first to identify changes in patterns of demand for Aotearoa/New Zealand national helplines (n = 11) from January 2020 until the end of March 2021. Thematic analysis of 23 in-depth interviews was used next to explore the reasons behind the quantitative findings from the perspective of various organizational stakeholders.
Results
the data from 1,244,293 Aotearoa/New Zealand national helplines' contacts between January 2020 and March 2021 showed a non-significant (1.4%) upward trend for the full range of observations. Throughout this period, a peak and trough pattern was observed. Significant demand increases were observed in anticipation of containment measures (12.4% increase from January to March 2020) and significant demand decreases coincided with relaxation of restrictions (6.9% decrease from April to June 2020). There were spikes in demand during public health interventions (i.e., mental health promotion, introduction of new helpline services) and regional lockdowns, but these did not result in significant changes in trends. In general, the demand for helplines stabilized at a new higher level. Most of the contacts occurred by telephone calls. Contacts by other methods (webchat, text, email) have shown higher uptake during the periods of lockdowns. Quantitative-qualitative data triangulation showed that youth and populations who were disproportionally negatively affected by unstable economic conditions and underemployment made more frequent contacts. Providers emphasized that increased demand could be viewed positively as a successful outcome of public health messaging; however, greater capacity is needed to better serve higher demand.
Conclusions
COVID-19, related interventions, and measures of control were associated with an increase in contacts to helplines. However, the extent of the demand increases was lower than observed internationally. Moreover, in Aotearoa/New Zealand the reasons for increases in demand were often beyond the COVID-19 pandemic and measures of control.
Objective
Children with a behaviorally inhibited temperament during early childhood have been shown to have an increased risk for developing anxiety disorders. This study evaluated the efficacy of an anxiety prevention program aimed at reducing the risk of anxiety in behaviorally inhibited preschool children.
Method
Participants were 86 children aged 41–57 months and their mothers. Children were selected if their mothers reported high levels of child behavioral inhibition on a screening measure. Participants were randomly allocated to a nine-session intervention or a waitlist control condition. Mothers and children both participated in the intervention. Results. At follow-up, the intervention group had significantly fewer clinician-rated child anxiety disorders and fewer mother-reported child anxiety symptoms than at baseline but this change was not significantly different to the change seen in the waitlist control group.
Conclusions
On average, across the course of the study, anxiety decreased in all children irrespective of group. A number of potential reasons for this are discussed along with implications for research and clinical practice.
Introduction:
Hidradenitis suppurativa (HS) is a debilitating skin disease with significant and often underappreciated effects on quality of life; available treatments fail to achieve consistent rates of remission. Targeting the psychosocial impact of HS has great potential to improve care for these patients. Although the literature on this topic is broad, there is a lack of specific tools that guide clinicians in this domain.
Methods:
The authors surveyed the literature to find the aspects of psychosocial functioning that most significantly impact Health-Related Quality of Life (HRQOL) for HS patients, and which may be assessed in a simple and efficient manner.
Results and discussion:
Depression and anxiety, sexuality and body image, and financial strain were identified as the most significant drivers of poor HRQOL with the greatest potential to be screened for and addressed succinctly and effectively. A practical psychosocial management guide for clinicians is presented. The guide includes a list of preexisting validated screening questions, clear guidelines for interpretation, and a suggested management algorithm all geared toward a 'real-life' medical practice.
Conclusion:
Such an approach holds a great potential for improving the care of patients with HS. Validation of this approach via controlled trials is a logical next step.
Prompt access to appropriate professional care for adolescents with self-harm thoughts and respective behaviors (suicidal behavior and non-suicidal self-injury [NSSI]) is crucial as both are associated with an increased risk of suicide in later life. The present study aimed to describe the duration from initial onset of thoughts and incidents of self-harm until first clinical presentation in children and adolescents and to identify factors affecting help-seeking duration.
Onset of self-harm thoughts and behaviors, time of first clinical presentation, and psychiatric and demographic variables were obtained from n = 672 adolescents (11-19 years) from the Germany-based AtR!Sk (Ambulanz für Risikoverhalten & Selbstschädigung) cohort-study at an outpatient clinic for risk-taking and self-harm behaviors. In 22% of overall cases, the first self-harm thoughts and behaviors occurred after contact to professional care was already established. Focusing on actual help-seeking delay only, it took between M = 0.99 years (after first suicide attempt) and M = 1.98 years (after first thoughts of NSSI) until participants sought professional help. Overall, help-seeking duration and help-seeking delay were longer for participants with more severe psychopathology (i.e., BPD, depressive symptoms, general symptom severity). The findings revealed a substantial delay of receiving appropriate professional care in adolescents with self-harm thoughts and behavior. The correlation between treatment latency and higher psychopathology may emphasize the need of prompt treatment. A better understanding of barriers and facilitators to professional help will contribute to enhance measures of tailored support for young patients in their help-seeking process.
Background
Carers who experience stigma and aversion to help-seeking could have a detrimental impact on consumers of mental health services (MHS).
Aim
This study aimed to investigate the relationship between carers’ experiences with MHS, stigma, affective state and help-seeking attitudes.
Methods
Fifty-seven carers of people with a mental illness completed an online survey including demographics about the carer and consumer, carers’ experience with MHS, Days’ mental illness stigma scale, the inventory of attitudes towards seeking mental health services and the depression–happiness scale.
Results
Carer responses evenly reflected positive and negative experiences with MHS. There were significant correlations between experiences of MHS and stigma, attitudes towards help-seeking, and affective state. Carers who reported negative experiences of MHS demonstrated reduced help-seeking attitudes. Both stigma and affective state independently reduced the association between positive experiences of MHS and more positive help-seeking attitudes. When all three variables were included in the regression model, stigma was the only significant predictor of reduced help-seeking attitudes.
Conclusions
MHS must establish positive engagement with carers, as this is associated with positive help-seeking attitudes. Negative experiences of MHS exacerbate carer stigma. Positive interactions between MHS and carers likely facilitate better access to care for consumers and improve clinical outcomes.
Objectives: To examine the effect of patients' causal attributions of common somatic symptoms on recognition by general practitioners of cases of depression and anxiety and to test the hypothesis that normalising attributions make recognition less likely.
Design: Cross sectional survey.
Setting: One general practice of eight doctors in Bristol.
Subjects: 305 general practice attenders.
Main outcome measure: The rate of detection by general practitioners of cases of depression and anxiety as defined by the general health questionnaire.
Results: Consecutive attenders completed the general health questionnaire and the symptom interpretation questionnaire, which scores style of symptom attribution along the dimensions of psychologising, somatising, and normalising. General practitioners detected depression or anxiety in 56 (36%; 95% confidence interval 28% to 44%) of the 157 patients who scored highly on the general health questionnaire. Subjects with a normalising attributional style were less likely to be detected as cases; doctors did not make any psychological diagnosis in 46 (85%; 73% to 93%) of 54 patients who had high questionnaire and high normalising scores. Those with a psychologising style were more likely to be detected; doctors did not detect 21 (38%; 25% to 52%) of 55 patients who had high questionnaire and high psychologising scores. The somatisation scale was not associated with low detection rates. This pattern of results persisted after adjustment for age, sex, general health questionnaire score, and general practitioner.
Conclusions: Normalising attributions minimise symptoms and are non-pathological in character. The normalising attributional style is predominant in general practice attenders and is an important cause of low rates of detection of depression and anxiety.
Background. This paper describes the Household Survey from the National Survey of Psychiatric Morbidity. This covered a sample drawn at random from the population of Britain, with the exception of the Highlands and Islands of Scotland.
A theoretical framework for viewing health services utilization is presented, emphasizing the importance of the (1) characteristics of the health services delivery system, (2) changes in medical technology and social norms relating to the definition and treatment of illness, and (3) individual determinants of utilization. These three factors are specified within the context of their impact on the health care system. Empirical findings are discussed which demonstrate how the framework might be employed to explain some key patterns and trends in utilization. In addition, a method is suggested for evaluating the utility of various individual determinants of health services utilization used in the framework for achieving a situation of equitable distribution of health services in the United States.
This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States.
The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview.
Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status.
The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
The authors used self-report data to study patterns and predictors of treatment contact after the first onset of DSM-III-R mood, anxiety, and addictive disorders.
Data from the National Comorbidity Survey, a general population survey of 8,098 respondents, were used. Disorders were assessed by using a modified version of the Composite International Diagnostic Interview. Age at onset and age at first treatment contact were assessed retrospectively.
There was great variation across disorders in lifetime probability of treatment contact. Most treatment contact was delayed; the median delay time was between 6 and 14 years across the disorders considered here. Probability of treatment contact was inversely related to age at onset and increased in younger cohorts. The effects of sociodemographic variables were modest and inconsistent across disorders.
The majority of people with the disorders considered here eventually make treatment contact. However, delay was pervasive. Further research is needed on the determinants of delay and on the low probability of lifetime treatment contact among people with early-onset psychiatric disorders.
To examine the effect of patients' causal attributions of common somatic symptoms on recognition by general practitioners of cases of depression and anxiety and to test the hypothesis that normalising attributions make recognition less likely.
Cross sectional survey.
One general practice of eight doctors in Bristol.
305 general practice attenders.
The rate of detection by general practitioners of cases of depression and anxiety as defined by the general health questionnaire.
Consecutive attenders completed the general health questionnaire and the symptom interpretation questionnaire, which scores style of symptom attribution along the dimensions of psychologising, somatising, and normalising. General practitioners detected depression or anxiety in 56 (36%; 95% confidence interval 28% to 44%) of the 157 patients who scored highly on the general health questionnaire. Subjects with a normalising attributional style were less likely to be detected as cases; doctors did not make any psychological diagnosis in 46 (85%; 73% to 93%) of 54 patients who had high questionnaire and high normalising scores. Those with a psychologising style were more likely to be detected; doctors did not detect 21 (38%; 25% to 52%) of 55 patients who had high questionnaire and high psychologising scores. The somatisation scale was not associated with low detection rates. This pattern of results persisted after adjustment for age, sex, general health questionnaire score, and general practitioner.
Normalising attributions minimise symptoms and are non-pathological in character. The normalising attributional style is predominant in general practice attenders and is an important cause of low rates of detection of depression and anxiety.
Why does the burden of mental disorders persist in established market economies? There are four possibilities: the burden estimates are wrong; there are no effective treatments; people do not receive treatment; or people do not receive effective treatments. Data from the Australian National Survey of Mental Health and Wellbeing about the two commonest mental disorders, generalized anxiety disorder and depression, have been used in examining these issues. The burden of mental disorders in Australia is third in importance after heart disease and cancer, and anxiety and depressive disorders account for more than half of that burden. The efficacy of treatments for both disorders has been established. However, of those surveyed, 40% with current disorders did not seek treatment in the previous year and only 45% were offered a treatment that could have been beneficial. Treatment was not predictive of disorders that remitted during the year. The burden therefore persists for two reasons: too many people do not seek treatment and, when they do, efficacious treatments are not always used effectively.
To determine whether people's attitudes towards a person who has experienced depression influence them in (i) the types of actions they take to help themselves if they experience common psychiatric symptoms, and (ii) the degree to which their symptoms improve.
A postal survey was carried out with 3,109 adults to assess attitudes and symptoms of anxiety and depression. Attitudes were assessed by questions on a depressed person's likely long-term outcome in various areas of life and whether the respondents thought the depressed person was likely to experience discrimination. A follow-up survey was carried out 6 months later with 422 persons who had a high level of symptoms at baseline. These individuals were asked about whether they had taken various actions to relieve their symptoms.
The attitude measures did not predict use of actions which involved someone else having to know that the person had psychiatric symptoms, nor use of actions which did not. The attitude measures also did not predict change in anxiety and depression symptoms.
The attitude measures did not predict patterns of help-seeking or outcome for people with common psychiatric symptoms. However, attitudes towards depression were quite benign and the situation could be different for people with severe mental disorders.
Health planning should be based on data about prevalence, disability and services used.
To determine the prevalence of ICD-10 disorders and associated comorbidity, disability and service utilisation.
We surveyed a national probability sample of Australian households using the Composite International Diagnostic Interview and other measures.
The sample size was 10 641 adults, response rate 78%. Close to 23% reported at least one disorder in the past 12 months and 14% a current disorder. Comorbidity was associated with disability and service use. Only 35% of people with a mental disorder in the 12 months prior to the survey had consulted for a mental problem during that year, and most had seen a general practitioner. Only half of those who were disabled or had multiple comorbidity had consulted and of those who had not, more than half said they did not need treatment.
The high rate of not consulting among those with disability and comorbidity is an important public health problem. As Australia has a universal health insurance scheme, the barriers to effective care must be patient knowledge and physician competence.
Treatment coverage for mental disorders is poor in most developed countries.
To explore some reasons for the poor treatment coverage for mental disorders in developed countries.
Data were taken from Australian national surveys and from the World Health Report.
Only one-third of people with a mental disorder consulted. Probability of consulting varied by diagnosis: 90% for schizophrenia, which is accounted for by external factors; 60% for depression; and 15% for substance use and personality disorders. The probability of consulting varied by gender, age, marital status and disability, from 73% among women aged 25-54 years, disabled and once married to 9% among males without these risk factors. Those who did not consult but were disabled or comorbid said that they "preferred to manage themselves". Data from five countries showed no evidence that overall health expenditure, out-of-pocket cost or responsiveness of the health system affected the overall consulting rates.
Societal, attitudinal and diagnostic variables account for the variation. Funding does not. Public education about the recognition and treatment of mental disorders and the provision of effective treatment by providers might remedy the shortfall.
Background:
This paper describes the Household Survey from the National Survey of Psychiatric Morbidity. This covered a sample drawn at random from the population of Britain, with the exception of the Highlands and Islands of Scotland.
Methods:
The Postcode Address file was used as the sampling frame. Nearly 13000 adults aged 16-65 were selected for interview, of whom 10108 (79.4%) were successfully interviewed. Eight per cent could not be contacted and 13% refused interview. Psychiatric assessment was carried out by lay interviewers using the CIS-R. Subjects were also screened for psychosis, and screen-positive individuals were examined by psychiatrists using SCAN.
Results:
Sixteen per cent of subjects scored above the standard cut-off of 12 on the CIS-R. The overall 1-week prevalence of neurotic disorder was 12.3% in males and 19.5% in females. Unmarried and post-marital groups had high rates of disorder, as did single parents and people living on their own. Respondents in Social Class I had notably lower rates of neurotic disorder than the remainder of the sample. Unemployment was strongly associated with disorder. Subjects living in urban areas had a higher overall prevalence, but there was no significant variation by region. Black respondents had higher rates of disorders that were entirely explained by their age, family type and social class. Individual neurotic disorders were all significantly commoner in women, with the exception of panic disorder. The 1-year prevalence of functional psychoses was 4 per 1000, with no sex difference. Alcohol and drug dependence was considerably more prevalent in men.
Conclusions:
For the first time, the survey provides data on the prevalence and correlates of psychiatric disorder on a nationwide sample that can be used to inform equitable and effective national psychiatric services.
Why does the burden of mental disorders persist in established market economies? There are four possibilities: the burden estimates are wrong; there are no effective treatments; people do not receive treatment; or people do not receive effective treatments. Data from the Australian National Survey of Mental Health and Wellbeing about the two commonest mental disorders, generalized anxiety disorder and depression, have been used in examining these issues. The burden of mental disorders in Australia is third in importance after heart disease and cancer, and anxiety and depressive disorders account for more than half of that burden. The efficacy of treatments for both disorders has been established. However, of those surveyed, 40% with current disorders did not seek treatment in the previous year and only 45% were offered a treatment that could have been beneficial. Treatment was not predictive of disorders that remitted during the year. The burden therefore persists for two reasons: too many people do not seek treatment and, when they do, efficacious treatments are not always used effectively.
Tavistock Press was established as a co-operative venture between the Tavistock Institute and Routledge & Kegan Paul (RKP) in the 1950s to produce a series of major contributions across the social sciences. This volume is part of a 2001 reissue of a selection of those important works which have since gone out of print, or are difficult to locate. Published by Routledge, 112 volumes in total are being brought together under the name The International Behavioural and Social Sciences Library: Classics from the Tavistock Press. Reproduced here in facsimile, this volume was originally published in 1980 and is available individually. The collection is also available in a number of themed mini-sets of between 5 and 13 volumes, or as a complete collection.
Background Health planning should be based on data about prevalence, disability and services used.
Aims To determine the prevalence of ICD-10 disorders and associated comorbidity, disability and service utilisation.
Method We surveyed a national probability sample of Australian households using the Composite International Diagnostic Interview and other measures.
Results The sample size was 10 641 adults, response rate 78%. Close to 23% reported at least one disorder in the past 12 months and 14% a current disorder. Comorbidity was associated with disability and service use. Only 35% of people with a mental disorder in the 12 months prior to the survey had consulted for a mental problem during that year, and most had seen a general practitioner. Only half of those who were disabled or had multiple comorbidity had consulted and of those who had not, more than half said they did not need treatment.
Conclusions The high rate of not consulting among those with disability and comorbidity is an important public health problem. As Australia has a universal health insurance scheme, the barriers to effective care must be patient knowledge and physician competence.
A description is presented of the key features of the Goldberg-Huxley model of the pathway to psychiatric care. There are five levels (from the community to the hospital), and four filters, the most important of which are at the primary care level. Some of the intrinsic and extrinsic problems of the model are described and discussed and some of the major implications of the model explored. In spite of reservations about its use in other cultures, most recent evidence confirms the structure and the applicability of the model. The model is sometimes misinterpreted to suggest that all the resources for treatment of mental illness should be redirected into primary care. The authors of the model do not agree with this interpretation, and this article suggests that, in mental health policy formulation and in service planning more thought needs to be given to the implications of the model, especially in respect of people with severe forms of mental illness. People with severe illnesses pass more easily through the filters to secondary professional care than do people with common mental disorders.
Effective treatments for common anxiety and mood disorders exist, yet epidemiological studies reveal that the unmet need for treatment in the community remains high. This study investigates the significance of the initial delay to first seek professional help in this unmet need for treatment in an Australian sample. Help-seeking history was retrospectively reported by 273 new referrals to a specialist anxiety treatment clinic who had a primary diagnosis of an anxiety (78%) or mood disorder (22%). Clinical, demographic and attitudinal variables were tested as potential predictors of length of the delay. Average help-seeking delay was 8.2 years (range 0–72 years). Younger age at symptom onset and slower problem recognition were associated with delayed help-seeking, and older people were more likely to report longer delays. We conclude that delays to first seek treatment are long and contribute significantly to the unmet need for treatment for anxiety and mood disorders, and that lack of problem recognition is a significant barrier to help-seeking.
Background. This paper describes the rationale and methodology of the first national psychiatric morbidity surveys to be carried out in Great Britain. The objectives of the surveys were to estimate the prevalence of psychiatric morbidity among adults aged 16-64 living in Great Britain; to identify the nature and extent of social disabilities associated with psychiatric morbidity; to describe the use of health and social services by people with psychiatric morbidity and to investigate the association between mental illness and potential environmental risk factors in a household sample. Methods. Four separate surveys were carried out in order to meet the objectives; a private household sample (N = 10108), a sample of institutions caring for the mentally ill (N = 1191), a sample of homeless people (N= 1166), and a supplementary sample of patients with psychosis living in private households (N = 350). A two-stage assessment procedure was used, in which all subjects were given the Revised Clinical Interview Schedule (CIS-R) administered by lay interviewers to assess neurotic symptoms and disorders and a psychosis screen, including the Psychosis Screening Questionnaire. Those who were positive on the psychosis screen were then interviewed by psychiatrists using the SCAN (incorporating the tenth edition of the Present State Examination). Conclusions. Large scale national surveys such as this augment the inadequate data on psychiatric morbidity that are routinely available and are, therefore, an important source of information upon which to base policy and generate aetiological hypotheses. These surveys provide a possible model for similar surveys in other countries.
This study examines the relationship between attitudes and use of mental health related services using data collected from 4838 respondents in the first wave of the Yale Epidemiological Catchment Area (ECA) project. Respondents were asked about their propensity to use mental health services, their perceptions of barriers to using services, and the potential reactions of family members to their receiving mental health treatment. Each of these measures was related to use of mental health services — but only among women meeting DIS-DSM III criteria for a recent psychiatric disorder, our indicator of need for treatment. These findings suggest that increasing the availability and accessability of mental health treatment services will not promote superfluous utilization. On the other hand, such efforts may not be sufficient to reduce unmet need for mental health treatment among men with psychiatric disorders. These findings also contribute to our understanding of the disproportional use of mental health related services by women.
This study focuses on predisposing, enabling, and need factors affecting contact with health professionals for the treatment of psychiatric and emotional problems during a 6-month period. Data are from the first wave of the Yale Epidemiologic Catchment Area (ECA) Project. The study confirms the important relationship of psychopathology to both the likelihood of using mental health related services and the quantity of service contacts. Sex, age, race, education, marital status, usual source of medical care, and attitudes toward mental health services were found to exert independent effects on the likelihood of contact with a health professional after controlling for clinical status. Factors affecting the quality of service contacts among utilizers were psychiatric status, usual source of care, and attitudes.
It is argued that two major symptom dimensions underlie common mental disorders. These are depression related symptoms on the one hand, and anxious symptoms on the other. Each of these symptom dimensions is relate to a set of social variables, but an individual patient may have social factors present that are associated with each symptom dimension, thus producing an overlapping of symptoms. Another reason why the symptom dimensions overlap is that depression and anxiety relate to reward and punishment systems respectively, and these systems are necessarily reciprocally related to one another. Finally, each of these systems is related to abnormal activities in both nor-adrenergic and 5-hydroxytryptaminergic neurones. It is argued that in order to produce a useful model for common disorders one should distinguish between three groups of factors: those producing vulnerability to anxious or depressive symptoms, those factors releasing symptoms at a particular time, and those factors which determine how long illness lasts. These three groups of factors are respectively called vulnerability, destabilisation and restitution.
This paper examines perceived barriers to mental health care reported in two very similar community surveys in two cities that are not only on opposite sides of the world but that differ substantially in their health care systems, their size, and their mix of ethnic groups, namely, St. Louis in the United States and Christchurch in New Zealand. Respondents were asked about mental health care ever received, any failure to seek care when required, and symptoms of 14 psychiatric disorders according to DSM-III. The frequency with which respondents reported not seeking care and the popularity of specific reasons for not seeking care were almost identical in the two sites. A common reason offered for not seeking care was doubt about the need for professional help; this appeared to be particularly common for people with alcohol disorder. Respondents who said that they had failed to seek care when needed gave reasons that were mainly attitudinal, such as believing they should be strong enough to cope without professional help. Structural characteristics of services such as cost, times open, and travel distance were given less often. Sociodemographic factors had small or negligible effect on care seeking.
The stigma of depression is a major factor hindering effective treatment. In 1992, the Royal College of Psychiatrists and the Royal College of General Practitioners launched a 'defeat depression' campaign. This aimed to reduce the stigma associated with depression by improving public awareness of the condition and by improving health professionals' knowledge of the illness. The mental health team and general practitioners can work together to encourage people to seek help to alleviate this distressing illness.
To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy").
A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia.
A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette.
Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%). When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so. Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%). Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems). Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics.
If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised. Further, public understanding of psychiatric treatments can be considerably improved.
Two peer-led anxiety disorder support groups were surveyed to ascertain characteristics of individuals seeking the services of these groups. Both groups had received information and consultation from the Anxiety Disorders Association of America. One hundred and eighty-four individuals were interviewed for diagnosis by structured clinical interview; demographics and treatment-seeking behaviors were ascertained by self-report questionnaires. Both groups surveyed were composed of more females than males and were predominantly Caucasian. Treatment was most frequently sought from psychiatrists, psychologists, and family doctors. One fourth of the sample had sought help for anxiety in a hospital emergency room. Eighty-eight subjects (94%) at the Dallas site and 57 subjects (61%) at the Durham site met criteria for at least one current anxiety or affective disorder. More than half of those who met criteria for current panic disorder with agoraphobia also met criteria for at least one other anxiety disorder, or for major depression. Approximately one third of each support group met criteria for current social phobia. Severity of social phobia symptoms was assessed by four scales. An increased risk of substance abuse was noted for individuals with a diagnosis of social phobia, as compared with diagnoses of other anxiety disorders.
Self-report data obtained from members of advocate groups for patients with anxiety or mood disorders in 11 countries were used to study time to initial professional help-seeking after incident episodes.
Data were taken from 3516 self-administered questionnaires completed by members of GAMIAN, an international consortium of mental health patient advocate groups. Reports about age at onset and age at first seeking treatment were obtained retrospectively.
Approximately 40% of respondents reported that they sought treatment in the same year as the first onset of their disorder. The median delay in help-seeking was 8 years for the remainder of respondents. Synthetic cohort analysis suggests that delays have decreased in recent cohorts. However, time to initial help-seeking in all cohorts and all countries was found to be inversely related to age at onset.
Although caution is needed in generalizing the results beyond members of patient advocate groups, the key patterns found here were also found in previous analyses of general population surveys carried out in the US and Canada. The critical and consistent finding in all these studies is that presumably curable adolescents with early-onset disorders are, in effect, ignored by the treatment system in these countries. Aggressive outreach and intervention among early-onset cases might prove to be a cost-effective approach both to prevent the onset of secondary disorders and to improve success in treating primary disorders.
Previous research has shown that the public have different beliefs to mental health professionals about the helpfulness of interventions for mental disorders. However, it is not known whether the public's beliefs actually influence their behaviour when they develop psychiatric symptoms.
A postal survey of 3,109 Australian adults was used to assess beliefs about the helpfulness of a broad range of interventions for depression, as well as respondents' current level of anxiety and depression symptoms and any history of treated depression. A follow-up survey of 422 persons who had a high level of symptoms at baseline was conducted 6 months later. These people were asked which interventions they had used to reduce their symptoms. An analysis was carried out to see whether beliefs and other factors at baseline predicted subsequent use of interventions.
There were some major discrepancies between the ranking of interventions as likely to be helpful and the ranking of how frequently they were actually used. Interventions involving mental health professionals were often rated as likely to be helpful, but were rarely used in practice. Other simple, cheap and readily available interventions were used the most frequently, but were not the most likely to be rated as helpful. The most consistent predictors across all interventions used were gender, history of treatment, current symptoms and belief in a particular intervention. Of particular interest was the finding that beliefs in the helpfulness of antidepressants predicted their use. However, beliefs were not predictors of use for all interventions.
Beliefs about the helpfulness of an intervention did not always predict actual use of that intervention, although beliefs did predict use of antidepressants. Therefore, campaigns that change public beliefs about effective treatments may also influence actual use of treatments. Interventions preferred by professionals are not frequently used at present. Most people with anxiety and depression symptoms rely primarily on simple self-help interventions, the effectiveness of which has been little researched.
To determine the variation in prevalence of common mental disorders and general practitioner (GP) responses across Australian general practices, and to identify practice characteristics that predict these rates.
Cross-sectional national audit of general practices throughout Australia in 1998-1999.
46515 ambulatory care patients attending 386 GPs.
Practice-based prevalence of mental disorders (based on patient-reported symptoms) and GP-reported rates of psychological diagnoses and treatment (median and range, excluding the upper and lower 10% of practices); practice characteristics (patient, doctor and organisational) that predict prevalences and rates, determined by multiple regression analysis.
Even after omitting the upper and lower 10% of practices, there were large variations between practices in prevalence of common mental disorders (range, 39% to 59% of patients; median, 48%), and substance misuse (range, 3%-13%; median, 7%). There were also large variations between practices in rates at which GPs made psychological diagnoses in each practice (range, 12%-51%; median, 27%), judged patients to be at risk to self or others (range, 6%-54%; median, 23%), provided psychological treatments (range, 8%-41%; median, 22%) and referred patients to specialist services (range, 1%-10%; median, 4%). Practice-based rates of disorders and GP responses were predicted not only by sociodemographic characteristics of patients in each practice (eg, mean age or proportion of unemployed people), but also by doctor characteristics (eg, age and sex) and practice organisation characteristics (eg, urban versus regional or rural location).
We identified patient, GP and practice characteristics that predict rates of mental disorder and treatments provided. These could be used to guide mental health service reform in general practice and assist with targeting relevant education and practice support programs.
To determine the rate and predictors of unmet need for recognition of common mental disorders in Australian general practice.
Cross-sectional national audit of general practices throughout Australia in 1998-1999.
46 515 ambulatory care patients attending 386 GPs. SCREENING TOOLS: Prevalence of common mental disorders--12 items from the 34-item SPHERE self-report questionnaire and associated classification system; prevalence of recognition of mental disorders by GPs--GPs reporting whether patients had depression, anxiety, mixed depression/anxiety, somatoform, or other psychological disorder; predictors of unmet need for recognition of mental disorders--self-report questions about demography for patients and GPs, and about practice organisation for GPs.
Reported recognition of psychological disorders by GPs; actual prevalence of disorders; and patient, GP and practice characteristics predicting the failure to recognise disorders.
GPs did not recognise mental disorder in 56% (11922/21210) of patients. These comprised 46% (5134/11060) of patients in the higher level of mental disorders, and (in the second level of disorders) 58% (2906/5036) of patients with predominantly psychological symptoms, and 76% (3882/5114) of those with predominantly somatic symptoms. Patients more likely to have their need for psychological assessment met had the following characteristics: middle-aged (odds ratio [OR], 1.76; 95% CI, 1.59-1.96), female (OR, 1.19; 95% CI, 1.12-1.27), Australian-born (OR, 1.16; 95% CI, 1.08-1.24), unemployed (OR, 1.75; 95% CI, 1.64-1.89), single (OR, 1.52; 95% CI, 1.41-1.61), presenting with mainly psychological symptoms (OR, 3.54; 95% CI, 3.28-3.81), and presenting for psychological reasons (OR, 4.20; 95% CI, 3.02-5.82). Characteristics of doctors associated with meeting patients' need for assessment were being aged over 35 years (OR, 1.51; 95% CI, 1.09-2.08), having an interest in mental health (OR, 1.27; 95% CI, 1.15-1.41), having had previous mental health training (OR, 1.29; 95% CI, 1.15-1.45), being in part-time practice (OR, 1.23; 95% CI, 1.09-1.39), seeing fewer than 100 patients per week (OR, 1.29; 95% CI, 1.13-1.47), working in practices with fewer than 2000 patients (OR, 1.28; 95% CI, 1.13-1.45) and working in regional centres (OR, 1.16; 95% CI, 1.05-1.28).
Unmet need for recognition of common mental disorders remains high. Predictors of unmet need include a somatic symptom profile and practitioner and organisational characteristics which impede the provision of high quality mental health services.