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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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“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
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“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]
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“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]
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“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
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“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]
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“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]
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“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]
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“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]
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“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
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“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]
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“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].”
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“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”
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“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
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“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
Experimental — accuracy not yet measuredIn the citing paper
“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
In the citing paper
“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]
In the citing paper
“Reasons for undertreatment include stigmatisation, lack of trained therapists and the costs of therapy [8].”
In the citing paper
“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]
In the citing paper
“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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“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
Brief Unstructured Interaction with a Dog Reduces Distress
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Public attitudes toward guided internet-based therapies: web-based survey study
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Preferences for Exercise as a Treatment for Depression
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Suicide Prevention in the COVID-19 Era
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A new era in Internet interventions: The advent of Chat-GPT and AI-assisted therapist guidance
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“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).”
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“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].”
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“Other factors, such as internet usage and anxiety [41,43], uncertainty concerning data security, discomfort with use of IMIs and psychological interventions in general, and social influence by friends, family, and health professionals as well as a lack of trust in the effectiveness of IMIs are often reported to influe…”
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Metadata
- 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
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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