Barriers to mental health treatment: results from the WHO World Mental Health surveys
Open accessAbstract
Background: To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders. Method: Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample ( n = 636 78) and analyzed at different levels of clinical severity. Results: Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). Conclusions: Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.
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Disorder characteristics are known to predict treatment.
“these disorder characteristics are known to predict treatment (Andrade et al. 2014)”
From Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: Results from the WHO World Mental Health (WMH) surveys (2018) · cites this paper as Andrade et al. 2014
The Results (page not supplied) show that disorder severity is associated with perceived need for treatment and with reported barriers to seeking it. The paper does not establish that disorder characteristics predict whether someone actually receives treatment; its regression models examine barriers rather than treatment receipt. (LLM, conf=0.83)
Experimental — accuracy not yet measuredBarriers for the dissemination of MBIs are similar to those facing other evidence-based psychotherapies (eg, lack of available providers, cost, logistical challenges).
“Barriers for the dissemination of MBIs are similar to those facing other evidence-based psychotherapies (eg, lack of available providers, cost, logistical challenges) [23-25].”
From Testing the efficacy of a multicomponent, self-guided, smartphone-based meditation app: Three-armed randomized controlled trial (2020) · cites this paper as [23]
The Results (Barriers to seeking treatment; page unavailable) identify financial barriers and lack of availability, while the Introduction describes inconvenient locations and difficulty obtaining appointments. The paper studies mental health treatment broadly; it does not establish that these barriers are similar for MBIs and other evidence-based psychotherapies. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA digital therapeutic tool has the potential to increase accessibility and availability of treatment for GAD by reducing barriers such as waiting times, perceived stigma, geographical distance, financial costs, and lack of time.
“A digital therapeutic tool has the potential to increase accessibility and availability of treatment for those suffering with GAD by reducing barriers such as waiting times before treatment [7], perceived stigma [8,9], geographical distance, financial costs, and lack of time due to, for example, work commitments or caring responsibilities [10].”
From Development and feasibility of a digital acceptance and commitment therapy⇓based intervention for generalized anxiety disorder: Pilot acceptability study (2021) · cites this paper as [10]
The Discussion (page unavailable) identifies geographic distance, financial problems, and time barriers to seeking mental health treatment, supporting the barriers attached to citation [10]. The paper groups mental disorders rather than assessing GAD-specific barriers, and the passages do not establish work or caring responsibilities as reasons for the time barrier. Waiting times and stigma are attached to other citations in the sentence; this paper does not test whether a digital tool reduces any of these barriers. (LLM, conf=0.84)
Experimental — accuracy not yet measuredLack of access to services and limited mobility are reasons older people do not receive adequate care.
“This is due to the lack of access to those services (Andrade et al . 2014; Gamm et al . 2010) and limited mobility (Wetherell et al . 2004).”
From Effectiveness of a training programme based on acceptance and commitment therapy aimed at older adults – no moderating role of cognitive functioning (2021) · cites this paper as Andrade et al . 2014
The Discussion (page unavailable) identifies service availability and accessibility as barriers to mental health treatment, supporting the lack-of-access portion attributed to Andrade et al. The Results report that structural barriers were more common among the youngest than the oldest respondents, so the paper does not establish lack of access specifically as a reason older people miss care. Limited mobility is attributed to Wetherell et al. in the citing sentence, not to Andrade et al. (LLM, conf=0.84)
Experimental — accuracy not yet measuredTraditional face-to-face psychotherapies, including DBT, usually carry high economic costs and personal barriers that may prevent youth from accessing them.
“Traditional face-to-face psychotherapies, including DBT, usually carry high economic costs and personal barriers that may prevent youth from accessing them [20].”
From A mobile health intervention (LifeBuoy App) to help young people manage suicidal thoughts: protocol for a mixed-methods randomized controlled trial (2020) · cites this paper as [20]
The Results (Correlates of barriers to treatment; page not provided) report that younger respondents were more likely to encounter structural barriers. The Discussion (page not provided) identifies possible financial and time barriers for younger respondents. The paper addresses mental-health treatment generally, not the costs of face-to-face psychotherapy or DBT specifically, and its younger respondents are not identified as youth. (LLM, conf=0.88)
Experimental — accuracy not yet measured
There is an exigency to implement quick and effective preventive procedures in primary care facilities followed by referral to self-help evidence-based treatment interventions due to prevalence of undiagnosed mental disorders, sub-threshold manifestations, and obstacles to comprehensive therapies.
“Due to thepreva lence of undiagnosed mental disorders and the vast number of severe but sub-threshold manifestations ofproblematic symptomatology and obstacles to reach ing comprehensive therapies [35], there is anexigency to implement quick and effective preventive procedures in primary care facilities, followed by referral to self-help evidence-based treatment interventions.”
From The effectiveness of acceptance and commitment therapy-based intervention in therapy for mental health disorders - case study (2020) · cites this paper as [35]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredWeb-based interventions can overcome many structural and attitudinal barriers of face-to-face treatment, such as therapist worker shortages, geographical distance, wait-lists, social stigma, financial cost, and work commitments.
“These interventions can overcome many of the structural and attitudinal barriers of face-to-face treatment such as therapist worker shortages, geographical distance, wait-lists, social stigma, financial cost, and work commitments [22], which are especially pronounced in rural areas [23].”
From Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. (2019) · cites this paper as [22]
The Introduction identifies stigma, inconvenient location, difficulty obtaining appointments, and financial cost as barriers; the Discussion also mentions time barriers and limited availability of services. But the paper does not assess web-based interventions or establish that they overcome these barriers, so the sentence’s central claim is unsupported by this source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredArtificial agents could be a means to help increase access to mental health services, given that barriers such as perceived public stigma, finance, and lack of service often prevent individuals from seeking out and obtaining needed mental health care.
“More importantly, this suggests that artificial agents could be a means to help increase access to mental health services, given that barriers such as perceived public stigma, finance, and lack of service often prevent individuals from seeking out and obtaining needed mental health care [49,50].”
From User Experiences of Social Support From Companion Chatbots in Everyday Contexts: Thematic Analysis (2020) · cites this paper as [49]
Experimental — accuracy not yet measuredResearch has identified differences across countries regarding attitudes and perceived barriers to treatment seeking across mental health disorders.
“research has previously identified differences across countries regarding attitudes and perceived barriers to treatment seeking across mental health disorders”
From Treatment histories, barriers, and preferences for individuals with symptoms of generalized anxiety disorder (2024) · cites this paper as Andrade et al., 2014
Lack of a perceived need for mental health treatment is a widely documented barrier to seeking mental health services, particularly among people with mild to moderate symptoms.
“Lack of a perceived need for mental health treatment is a widely documented barrier to seeking mental health services, particularly among people with mild to moderate symptoms (48).”
From Improving Acceptability and Uptake Behavior for Internet-Based Cognitive-Behavioral Therapy (2021) · cites this paper as [48]
Reasons for non-access include low mental health literacy and not recognizing a need for treatment, high cost of treatment, low availability, and attitudinal barriers such as perceived stigma.
“this is because they have low mental health literacy and do not recognize a need for treatment [7], but also because of the high cost of treatment, low availability, or attitudinal barriers, such as perceived stigma [8,9].”
Access to mental health services for affected individuals is impeded by both structural and attitudinal barriers.
“Access to mental health services for affected individuals is impeded by both structural (eg, lack of availability) and attitudinal (eg, fear of stigma) barriers.13”
Other WMH research on treatment seeking for mental disorders has shown that the most important barrier is failure to recognize that the symptoms of the disorder constitute evidence of an 'illness' that could profit from treatment.
“Other WMH research on treatment seeking for mental disorders has shown that the most important barrier is failure to recognize that the symptoms of the disorder constitute evidence of an “illness” that could profit from treatment”
From The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental health surveys (2017) · cites this paper as Andrade et al. 2014
The core ACT processes of values and committed action are consistent with the WHO definition of healthy ageing.
“The core ACT processes of values and committed action are consistent with the recommendations included in the definition of healthy ageing proposed by the WHO (Andrade et al . 2014), which describes it as the process of developing and preserving the functional capabilities which facilitate wellbeing in older age.”
From Effectiveness of a training programme based on acceptance and commitment therapy aimed at older adults – no moderating role of cognitive functioning (2021) · cites this paper as Andrade et al . 2014
The Discussion (page unavailable) addresses perceived need for mental-health treatment and barriers among age groups, not healthy ageing. Searches for the WHO healthy-ageing definition and for ACT values and committed action found no passage addressing either point or their proposed consistency. (LLM, conf=0.77)
Experimental — accuracy not yet measuredBarriers such as lack of perceived need for treatment, negative attitudes and stigma, and structural barriers can preclude access.
“This can be due to barriers, such as a lack of perceived need for treatment, negative attitudes and stigma around mental health, as well as structural barriers [Andrade et al., 2014, Thornicroft et al., 2022].”
From Closing the accessibility gap to mental health treatment with a personalized self-referral chatbot (2024) · cites this paper as Andrade et al., 2014
Among people who recognize their need for mental health treatment, 64% are resistant to reaching out to another person for assistance and 23% have financial, transportation, or time-related barriers to seeking care.
“Among people who recognize their need for mental health treatment, 64% are resistant to reaching out to another person for assistance and 23% have financial, transportation, or time-related barriers to seeking care [13,14].”
From A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study (2022) · cites this paper as [13]
Reasons for undertreatment of anxiety disorders include stigmatisation, lack of trained therapists and the costs of therapy.
“Reasons for undertreatment include stigmatisation, lack of trained therapists and the costs of therapy [8].”
Low perceived need for treatment is a major treatment barrier for other severe mental disorders.
“This may reflect a low perceived need for treatment that was already found as a major treatment barrier for other severe mental disorders in the worldwide WHO World Mental Health Surveys [47].”
From Treatment utilization and treatment barriers in individuals with body dysmorphic disorder (2020) · cites this paper as [47]
This uncertainty may reflect a low perceived need for treatment that was already found as a major treatment barrier for other severe mental disorders in the worldwide WHO World Mental Health Surveys.
“This may reflect a low perceived need for treatment that was already found as a major treatment barrier for other severe mental disorders in the worldwide WHO World Mental Health Surveys [47].”
From Treatment utilization and treatment barriers in individuals with body dysmorphic disorder (2020) · cites this paper as [47]
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Self-citationHay, S. I., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulkader, R. S., Abdulle, A. M., Abebo, T. A., Abera, S. F., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)32130-x · Cited by 2,083 · see citing works
Undertreatment of people with major depressive disorder in 21 countries
Thornicroft, G., Chatterji, S., Evans-Lacko, S., Gruber, M., Sampson, N., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L., Borges, G., et al. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.188078 · Cited by 1,121 · see citing works
Self-citationInkster, B., Sarda, S., & Subramanian, V. (2018) · doi:10.2196/preprints.12106 · Cited by 1,063 · see citing works
Collaborators, O. B. O. T. W. W. M. H. S., Fayyad, J., Sampson, N. A., Hwang, I., Adamowski, T., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H. S. G., Borges, G., de Girolamo, G., et al. (2017) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-016-0208-3 · Cited by 824 · see citing works
Self-citationEvans-Lacko, S., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bruffaerts, R., Chiu, W. T., Florescu, S., de Girolamo, G., Gureje, O., et al. (2018) · Psychological Medicine · doi:10.1017/s0033291717003336 · Cited by 781 · see citing works
Self-citationSchnyder, N., Panczak, R., Groth, N., & Schultze-Lutter, F. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.189464 · Cited by 716 · see citing works
Kazdin, A. E. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.06.004 · Cited by 554 · see citing works
An overview of and recommendations for more accessible digital mental health services
Lattie, E. G., Stiles-Shields, C., & Graham, A. K. (2022) · Nature Reviews Psychology · doi:10.1038/s44159-021-00003-1 · Cited by 446 · see citing works
Serious Games and Gamification for Mental Health: Current Status and Promising Directions
Fleming, T. M., Bavin, L., Stasiak, K., Hermansson-Webb, E., Merry, S. N., Cheek, C., Lucassen, M., Lau, H. M., Pollmuller, B., & Hetrick, S. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00215 · Cited by 582 · see citing works
Ebert, D. D., Van Daele, T., Nordgreen, T., Karekla, M., Compare, A., Zarbo, C., Brugnera, A., Øverland, S., Trebbi, G., Jensen, K. L., et al. (2018) · European Psychologist · doi:10.1027/1016-9040/a000318 · Cited by 437 · see citing works
User Experiences of Social Support From Companion Chatbots in Everyday Contexts: Thematic Analysis
Ta, V., Griffith, C., Boatfield, C., Wang, X., Civitello, M., Bader, H., DeCero, E., & Loggarakis, A. (2020) · Journal of Medical Internet Research · doi:10.2196/16235 · Cited by 461 · see citing works
“More importantly, this suggests that artificial agents could be a means to help increase access to mental health services, given that barriers such as perceived public stigma, finance, and lack of service often prevent individuals from seeking out and obtaining needed mental health care [49,50].”
BackgroundEbert, D. D., Mortier, P., Kaehlke, F., Bruffaerts, R., Baumeister, H., Auerbach, R. P., Alonso, J., Vilagut, G., Martínez, K. U., Lochner, C., et al. (2019) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1782 · Cited by 407 · see citing works
Self-citationAddressing critical gaps in the treatment of eating disorders
Kazdin, A. E., Fitzsimmons‐Craft, E. E., & Wilfley, D. E. (2017) · International Journal of Eating Disorders · doi:10.1002/eat.22670 · Cited by 389 · see citing works
Walker, E. R., Cummings, J. R., Hockenberry, J. M., & Druss, B. G. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201400248 · Cited by 392 · see citing works
Josephine, K., Josefine, L., Philipp, D., David, E., & Harald, B. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.07.021 · Cited by 341 · see citing works
Patel, V., Xiao, S., Chen, H., Hanna, F., Jotheeswaran, A. T., Luo, D., Parikh, R., Sharma, E., Usmani, S., Yu, Y., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00160-4 · Cited by 342 · see citing works
Is clinical virtual reality ready for primetime?
Rizzo, A. “., & Koenig, S. T. (2017) · Neuropsychology · doi:10.1037/neu0000405 · Cited by 372 · see citing works
Factors associated with health service utilisation for common mental disorders: a systematic review
Roberts, T., Esponda, G. M., Krupchanka, D., Shidhaye, R. R., Patel, V., & Rathod, S. D. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1837-1 · Cited by 355 · see citing works
Byrow, Y., Pajak, R., Specker, P., & Nickerson, A. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2019.101812 · Cited by 345 · see citing works
Karyotaki, E., Ebert, D. D., Donkin, L., Riper, H., Twisk, J., Burger, S., Rozental, A., Lange, A., Williams, A. D., Zarski, A. C., et al. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.06.007 · Cited by 303 · see citing works
Stein, D. J., Shoptaw, S. J., Vigo, D. V., Lund, C., Cuijpers, P., Bantjes, J., Sartorius, N., & Maj, M. (2022) · World Psychiatry · doi:10.1002/wps.20998 · Cited by 331 · see citing works
Self-citationSalaheddin, K., & Mason, B. (2016) · British Journal of General Practice · doi:10.3399/bjgp16x687313 · Cited by 329 · see citing works
Haugen, P. T., McCrillis, A. M., Smid, G. E., & Nijdam, M. J. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.08.001 · Cited by 339 · see citing works
Liu, H., Peng, H., Song, X., Xu, C., & Zhang, M. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100495 · Cited by 296 · see citing works
“…therapy for students, many students refuse to seek help when they are suffering from mental health issues due to the reason of low perceived need (Andrade et al., 2014), attitude barriers (Andrade et al., 2014; Neathery et al., 2020), and the lack of mental health education (Neathery et al., 2020).”
BackgroundKazdin, A. E. (2019) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12937 · Cited by 274 · see citing works
Cognitive–behavioral therapy for Internet gaming disorder: A systematic review and meta‐analysis
Stevens, M. W. R., King, D. L., Dorstyn, D., & Delfabbro, P. H. (2019) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2341 · Cited by 295 · see citing works
Ebert, D. D., Berking, M., Cuijpers, P., Lehr, D., Pörtner, M., & Baumeister, H. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.01.056 · Cited by 268 · see citing works
Use of Social Robots in Mental Health and Well-Being Research: Systematic Review
Scoglio, A. A. J., Reilly, E. D., Gorman, J. A., & Drebing, C. E. (2019) · Journal of Medical Internet Research · doi:10.2196/13322 · Cited by 290 · see citing works
Epidemiology of anxiety disorders: from surveys to nosology and back.
Stein, D. J., Scott, K. M., de Jonge, P., & Kessler, R. C. (2017) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2017.19.2/dstein · Cited by 283 · see citing works
Xu, Z., Huang, F., Kösters, M., Staiger, T., Becker, T., Thornicroft, G., & Rüsch, N. (2018) · Psychological Medicine · doi:10.1017/s0033291718001265 · Cited by 252 · see citing works
Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD
Rizzo, A. ‘., & Shilling, R. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1414560 · Cited by 241 · see citing works
Domhardt, M., Geßlein, H., von Rezori, R. E., & Baumeister, H. (2019) · Depression and Anxiety · doi:10.1002/da.22860 · Cited by 218 · see citing works
The cross-national epidemiology of specific phobia in the World Mental Health Surveys
Wardenaar, K. J., Lim, C. C. W., Al-Hamzawi, A. O., Alonso, J., Andrade, L. H., Benjet, C., Bunting, B., de Girolamo, G., Demyttenaere, K., Florescu, S. E., et al. (2017) · Psychological Medicine · doi:10.1017/s0033291717000174 · Cited by 227 · see citing works
“…due to differences in the availability of care and financial resources (Saxena et al. 2007; McBain et al. 2012), the perceived need for treatment (Andrade et al. 2014), knowledge Specific phobia in the World Mental Health surveys 1755 about mental healthcare (Palazzo et al. 2014) and prejudices…”
Self-citationHarrer, M., Adam, S. H., Fleischmann, R. J., Baumeister, H., Auerbach, R., Bruffaerts, R., Cuijpers, P., Kessler, R. C., Berking, M., Lehr, D., et al. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9293 · Cited by 216 · see citing works
Self-citationPedersen, E. R., & Paves, A. P. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.05.017 · Cited by 226 · see citing works
Maximizing the Impact of e-Therapy and Serious Gaming: Time for a Paradigm Shift
Fleming, T. M., de Beurs, D., Khazaal, Y., Gaggioli, A., Riva, G., Botella, C., Baños, R. M., Aschieri, F., Bavin, L. M., Kleiboer, A., et al. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00065 · Cited by 212 · see citing works
Bendig, E., Erb, B., Schulze-Thuesing, L., & Baumeister, H. (2022) · Verhaltenstherapie · doi:10.1159/000501812 · Cited by 214 · see citing works
Philippi, P., Baumeister, H., Apolinário-Hagen, J., Ebert, D. D., Hennemann, S., Kott, L., Lin, J., Messner, E.-M., & Terhorst, Y. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100459 · Cited by 200 · see citing works
“Furthermore, IMI offer a low-threshold option for treatment, which may reduce or even eliminate the fear of stigmatization, discrimination, or embarrassment (Andrade et al., 2014; Baumeister et al., 2017).”
BackgroundSchomerus, G., Stolzenburg, S., Freitag, S., Speerforck, S., Janowitz, D., Evans-Lacko, S., Muehlan, H., & Schmidt, S. (2019) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-018-0896-0 · Cited by 214 · see citing works
Jennings, K. S., Cheung, J. H., Britt, T. W., Goguen, K. N., Jeffirs, S. M., Peasley, A. L., & Lee, A. C. (2015) · Psychiatric Rehabilitation Journal · doi:10.1037/prj0000138 · Cited by 207 · see citing works
Chatbots and mental health: Insights into the safety of generative <scp>AI</scp>
De Freitas, J., Uğuralp, A. K., Oğuz‐Uğuralp, Z., & Puntoni, S. (2024) · Journal of Consumer Psychology · doi:10.1002/jcpy.1393 · Cited by 211 · see citing works
Ma, K. K. Y., Anderson, J., & Burn, A. (2022) · Child and Adolescent Mental Health · doi:10.1111/camh.12543 · Cited by 201 · see citing works
Gronholm, P. C., Thornicroft, G., Laurens, K. R., & Evans-Lacko, S. (2017) · Psychological Medicine · doi:10.1017/s0033291717000344 · Cited by 181 · see citing works
Barriers to Professional Mental Health Help-Seeking Among Chinese Adults: A Systematic Review
Shi, W., Shen, Z., Wang, S., & Hall, B. J. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00442 · Cited by 196 · see citing works
Public mental health: required actions to address implementation failure in the context of COVID-19
Campion, J., Javed, A., Lund, C., Sartorius, N., Saxena, S., Marmot, M., Allan, J., & Udomratn, P. (2022) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00199-1 · Cited by 177 · see citing works
Why do oncology outpatients who report emotional distress decline help?
Clover, K. A., Mitchell, A. J., Britton, B., & Carter, G. (2015) · Psycho-Oncology · doi:10.1002/pon.3729 · Cited by 180 · see citing works
Arvind, B. A., Gururaj, G., Loganathan, S., Amudhan, S., Varghese, M., Benegal, V., Rao, G. N., Kokane, A. M., Chavan, B. S., Dalal, P., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-027250 · Cited by 174 · see citing works
Thompson, E. M., Destree, L., Albertella, L., & Fontenelle, L. F. (2021) · Behavior Therapy · doi:10.1016/j.beth.2020.07.002 · Cited by 168 · see citing works
Wasil, A. R., Venturo-Conerly, K. E., Shingleton, R. M., & Weisz, J. R. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.103498 · Cited by 160 · see citing works
Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs?
Iliakis, E. A., Sonley, A. K. I., Ilagan, G. S., & Choi-Kain, L. W. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201900073 · Cited by 161 · see citing works
Monitoring Changes in Depression Severity Using Wearable and Mobile Sensors
Pedrelli, P., Fedor, S., Ghandeharioun, A., Howe, E., Ionescu, D. F., Bhathena, D., Fisher, L. B., Cusin, C., Nyer, M., Yeung, A., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.584711 · Cited by 158 · see citing works
Stress management interventions for college students: A systematic review and meta-analysis.
Amanvermez, Y., Rahmadiana, M., Karyotaki, E., de Wit, L. D., Ebert, D., Kessler, R., & Cuijpers, P. (2020) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12342 · Cited by 163 · see citing works
Self-citationPotential Applications of Social Robots in Robot-Assisted Interventions for Social Anxiety
Rasouli, S., Gupta, G., Nilsen, E. S., & Dautenhahn, K. (2022) · International Journal of Social Robotics · doi:10.1007/s12369-021-00851-0 · Cited by 151 · see citing works
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Racism and Poverty are Barriers to the Treatment of Youth Mental Health Concerns
Castro‐Ramirez, F., Al‐Suwaidi, M., García, P., Rankin, O., Ricard, J. R., & Nock, M. K. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2021.1941058 · Cited by 147 · see citing works
Sagar, R., Pattanayak, R., Chandrasekaran, R., Chaudhury, P., Deswal, B., Singh, R. L., Malhotra, S., Nizamie, S., Panchal, B. N., Sudhakar, T., et al. (2017) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_333_16 · Cited by 140 · see citing works
Self-citationService Use and Unmet Needs for Substance Use and Mental Disorders in Canada
Urbanoski, K. A., Inglis, D., & Veldhuizen, S. (2017) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717714467 · Cited by 134 · see citing works
Gabrielli, S., Rizzi, S., Bassi, G., Carbone, S., Maimone, R., Marchesoni, M., & Forti, S. (2021) · JMIR mHealth and uHealth · doi:10.2196/27965 · Cited by 125 · see citing works
“However, about three-quarters of college students who are in need of clinical services do not access them [6]; this is because they have low mental health literacy and do not recognize a need for treatment [7], but also because of the high cost of treatment, low availability, or attitudinal barriers, such as perceived…”
BackgroundClosing the accessibility gap to mental health treatment with a personalized self-referral chatbot
Habicht, J., Viswanathan, S., Carrington, B., Hauser, T. U., Harper, R., & Rollwage, M. (2024) · Nature Medicine · doi:10.1038/s41591-023-02766-x · Cited by 132 · see citing works
Brief Unstructured Interaction with a Dog Reduces Distress
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Folker, A. P., Mathiasen, K., Lauridsen, S. M., Stenderup, E., Dozeman, E., & Folker, M. P. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.02.001 · Cited by 116 · see citing works
Public attitudes toward guided internet-based therapies: web-based survey study
Apolinário-Hagen, J., Harrer, M., Kählke, F., Fritsche, L., Salewski, C., & Ebert, D. D. (2018) · JMIR Mental Health · doi:10.2196/10735 · Cited by 123 · see citing works
Faregh, N., Lencucha, R., Ventevogel, P., Dubale, B. W., & Kirmayer, L. J. (2019) · International Journal of Mental Health Systems · doi:10.1186/s13033-019-0312-9 · Cited by 120 · see citing works
Preferences for Exercise as a Treatment for Depression
Busch, A. M., Ciccolo, J. T., Puspitasari, A. J., Nosrat, S., Whitworth, J. W., & Stults-Kolehmainen, M. A. (2016) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2015.12.004 · Cited by 119 · see citing works
Microdosing psychedelics: Motivations, subjective effects and harm reduction
Lea, T., Amada, N. M., Jungaberle, H., Schecke, H., & Klein, M. (2019) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2019.11.008 · Cited by 121 · see citing works
Suicide Prevention in the COVID-19 Era
Moutier, C. Y. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.3746 · Cited by 127 · see citing works
A new era in Internet interventions: The advent of Chat-GPT and AI-assisted therapist guidance
Carlbring, P., Hadjistavropoulos, H. D., Kleiboer, A. M., & Andersson, G. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100621 · Cited by 120 · see citing works
Green, J. G., McLaughlin, K. A., Fillbrunn, M. K., Fukuda, M., Jackson, J. S., Kessler, R. C., Sadikova, E., Sampson, N. A., Vilsaint, C. L., Williams, D. R., et al. (2020) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-020-01021-6 · Cited by 123 · see citing works
Self-citationRamos, G., Ponting, C., Labao, J. P., & Sobowale, K. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103990 · Cited by 122 · see citing works
Mackenzie, C. S., Heath, P. J., Vogel, D. L., & Chekay, R. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22845 · Cited by 118 · see citing works
Recchia, F., Leung, C. K., Chin, E. C., Fong, D. Y., Montero, D., Cheng, C. P., Yau, S. Y., & Siu, P. M. (2022) · British Journal of Sports Medicine · doi:10.1136/bjsports-2022-105964 · Cited by 117 · see citing works
Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review.
Kelson, J., Rollin, A., Ridout, B., & Campbell, A. (2019) · Journal of Medical Internet Research · doi:10.2196/12530 · Cited by 107 · see citing works
Determinants of help-seeking behavior in depression: a cross-sectional study
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Domhardt, M., Steubl, L., & Baumeister, H. (2020) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000625 · Cited by 101 · see citing works
Velazquez, E., & Hernandez, M. Y. (2019) · Policing An International Journal · doi:10.1108/pijpsm-09-2018-0147 · Cited by 105 · see citing works
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Diagnosed Mental Health Conditions and Risk of Suicide Mortality
Yeh, H.-H. H., Westphal, J. A., Hu, Y., Peterson, E. L., Williams, L. K., Prabhakar, D., Frank, C. B., Autio, K., Elsiss, F., Simon, G. E., et al. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201800346 · Cited by 107 · see citing works
Sander, L. B., Schorndanner, J., Terhorst, Y., Spanhel, K., Pryss, R., Baumeister, H., & Messner, E.-M. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1701788 · Cited by 102 · see citing works
Nuyen, J., Tuithof, M., de Graaf, R., van Dorsselaer, S., Kleinjan, M., & ten Have, M. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-019-01778-8 · Cited by 100 · see citing works
Treatment utilization and treatment barriers in individuals with body dysmorphic disorder
Schulte, J., Schulz, C., Wilhelm, S., & Buhlmann, U. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02489-0 · Cited by 97 · see citing works
Preliminary Evaluation of the Engagement and Effectiveness of a Mental Health Chatbot
Daley, K., Hungerbuehler, I., Cavanagh, K., Claro, H. G., Swinton, P. A., & Kapps, M. (2020) · Frontiers in Digital Health · doi:10.3389/fdgth.2020.576361 · Cited by 101 · see citing works
“Reasons cited for this discrepancy include structural barriers such as a lack of availability, high cost and attitudinal barriers such as perceived stigma (3, 4).”
BackgroundReins, J. A., Buntrock, C., Zimmermann, J., Grund, S., Harrer, M., Lehr, D., Baumeister, H., Weisel, K. K., Domhardt, M., Imamura, K., et al. (2020) · Psychotherapy and Psychosomatics · doi:10.1159/000507819 · Cited by 97 · see citing works
Goldberg, S. B., Imhoff-Smith, T., Bolt, D. M., Wilson-Mendenhall, C. D., Dahl, C. J., Davidson, R. J., & Rosenkranz, M. A. (2020) · JMIR Mental Health · doi:10.2196/23825 · Cited by 97 · see citing works
“Barriers for the dissemination of MBIs are similar to those facing other evidence-based psychotherapies (eg, lack of available providers, cost, logistical challenges) [23-25].”
BackgroundLin, J., Faust, B., Ebert, D. D., Krämer, L., & Baumeister, H. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9925 · Cited by 97 · see citing works
Nakku, J. E. M., Okello, E. S., Kizza, D., Honikman, S., Ssebunnya, J., Ndyanabangi, S., Hanlon, C., & Kigozi, F. N. (2016) · BMC Health Services Research · doi:10.1186/s12913-016-1547-7 · Cited by 103 · see citing works
Machine learning models to detect anxiety and depression through social media: A scoping review
Ahmed, A., Aziz, S., Toro, C. T., Alzubaidi, M. S., Irshaidat, S., Serhan, H. A. A., Abd-Alrazaq, A. A., & Househ, M. S. (2022) · Computer Methods and Programs in Biomedicine Update · doi:10.1016/j.cmpbup.2022.100066 · Cited by 106 · see citing works
Hadjistavropoulos, H. D., Nugent, M. M., Dirkse, D., & Pugh, N. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1496-7 · Cited by 94 · see citing works
Barriers to access and participation in community mental health treatment for anxious children
Salloum, A., Johnco, C. J., Lewin, A. B., McBride, N. M., & Storch, E. A. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.02.026 · Cited by 92 · see citing works
Obstacles to Help-Seeking for Sexual Offenders: Implications for Prevention of Sexual Abuse
Levenson, J., Willis, G., & Vicencio, C. P. (2017) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2016.1276116 · Cited by 94 · see citing works
Kählke, F., Berger, T., Schulz, A., Baumeister, H., Berking, M., Auerbach, R. P., Bruffaerts, R., Cuijpers, P. J., Kessler, R. C., & Ebert, D. D. (2019) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1766 · Cited by 90 · see citing works
Self-citationMcLaren, T., Peter, L.-J., Tomczyk, S., Muehlan, H., Schomerus, G., & Schmidt, S. (2023) · BMC Public Health · doi:10.1186/s12889-022-14937-5 · Cited by 93 · see citing works
Wasil, A. R., Gillespie, S., Patel, R., Petre, A., Venturo-Conerly, K. E., Shingleton, R. M., Weisz, J. R., & DeRubeis, R. J. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000604 · Cited by 89 · see citing works
Using children’s literature to strengthen social and emotional learning
Heath, M. A., Smith, K., & Young, E. L. (2017) · School Psychology International · doi:10.1177/0143034317710070 · Cited by 89 · see citing works
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- Authors
- Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., de Graaf, R., Florescu, S., Gureje, O., Hinkov, H. R., Hu, C., Huang, Y., Hwang, I., Jin, R., Karam, E. G., Kovess-Masfety, V., Levinson, D., Matschinger, H., O'Neill, S., Posada-Villa, J., Sagar, R., Sampson, N. A., Sasu, C., Stein, D. J., Takeshima, T., Viana, M. C., Xavier, M., & Kessler, R. C.
- Affiliations
- Universidade de São Paulo (BR)
- Municipal Institute for Medical Research (ES)
- University of Michigan (US)
- University of Otago (NZ)
- University of Al-Qadisiyah (IQ)
- Universidad Autónoma Metropolitana (MX)
- Stony Brook University (US)
- KU Leuven (BE)
- National School of Public Health, Management and Professional Development (RO)
- University of Ibadan (NG)
- National Center of Public Health and Analyses (BG)
- Shenzhen KangNing Hospital (CN)
- Peking University (CN)
- Harvard University (US)
- Harvard Pilgrim Health Care (US)
- Saint George Hospital (LB)
- Israel Ministry of Health (IL)
- Leipzig University (DE)
- Pontificia Universidad Javeriana (CO)
- All India Institute of Medical Sciences (IN)
- University of Cape Town (ZA)
- National Center of Neurology and Psychiatry (JP)
- Universidade Federal do Espírito Santo (BR)
- Universidade Nova de Lisboa (PT)
- Corresponding author
- Kessler, R. C.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-08-09
- Volume
- 44
- Issue
- 6
- Pages
- 1303-1317
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC4100460
- OpenAlex
- W2100695323
- Cited by
- 1,289
- References
- 59
- Citations by year
- 2026: 109 · 2025: 155 · 2024: 154 · 2023: 152 · 2022: 151 · 2021: 134 · 2020: 125 · 2019: 86 · 2018: 85 · 2017: 63 · 2016: 40 · 2015: 24 · 2014: 9 · 2012: 1
- FWCI
- 36.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion, other-oa)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- Funders
- Public Health Agency (RES/4792/13)
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- National Institute of Mental Health (R13-MH-066849, R0 1-MH61905, R01‐MH070884, U01-MH-60220, R01MH061905, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (R03TW006481)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Social Sciences › Gender Studies › Gender Roles and Identity Studies
- Keywords
- barriers to mental health care, common mental disorders, help-seeking, treatment initiation, treatment discontinuation, perceived need for treatment, attitudinal barriers, structural barriers, mental health literacy, clinical severity, gender differences, age differences
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Attitude to Health, Female, Health Services Accessibility, Humans, Male, Mental Health Services, Middle Aged, Global Health, World Health Organization, Young Adult
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