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Perceived Barriers to Mental Health Service Utilization in the United States, Ontario, and the Netherlands
Abstract
OBJECTIVE: Although rates of mental health service utilization differ dramatically across countries, little information is available about differences in self-reported barriers to mental health service utilization. Perceived barriers were examined in three locations with differing health care systems. METHODS: Data came from three methodologically similar population-based surveys of adults conducted in the 1990s in Ontario, Canada (N=6,261), the United States (N=5,384), and the Netherlands (N=6,031) that assessed DSM-III-R nonpsychotic mental disorders with the Composite International Diagnostic Interview. Respondents who reported a need for professional help were asked to indicate reasons for not seeking care. Multiple logistic regression analyses were used to determine the sociodemographic, mental disorder, and location-specific correlates of each perceived barrier. RESULTS: The pattern of reported barriers to mental health service utilization was similar across locations: attitudinal barriers (thoughts that the problem would get better on its own) were more prevalent than structural barriers (inability to get an appointment). Fear of stigmatization was not commonly endorsed. With adjustment for sociodemographic factors and type of mental disorder, low-income respondents were significantly more likely to report a financial barrier in the United States than in either Ontario or the Netherlands. CONCLUSIONS: Across locations, attitudinal barriers were more likely to be endorsed than structural barriers to service utilization. The most striking reported cross-national difference was structural, with many more U.S. respondents (especially those with low incomes) reporting financial barriers than respondents in either Ontario or the Netherlands.
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“This emphasis is partly based on the findings of past research that have identified significant attitudinal barriers to mental health help-seeking (8-12).”
From Attitudes toward mental health help seeking as predictors of future help-seeking behavior and use of mental health treatments (2016) · cites this paper as [10]
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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 Sareen et al., 2007
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Metadata
- Authors
- Sareen, J., Jagdeo, A., Cox, B. J., Clara, I., ten Have, M., Belik, S.-L., de Graaf, R., & Stein, M. B.
- Affiliations
- University of Manitoba (CA)
- Venue
- Psychiatric Services
- Published
- 2007-03
- Volume
- 58
- Issue
- 3
- Pages
- 357-364
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2130770552
- Cited by
- 470
- References
- 53
- Citations by year
- 2026: 13 · 2025: 24 · 2024: 22 · 2023: 41 · 2022: 27 · 2021: 33 · 2020: 31 · 2019: 28 · 2018: 33 · 2017: 28 · 2016: 35 · 2015: 17 · 2014: 30 · 2013: 28 · 2012: 17
- FWCI
- 19.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH-64122, K24MH064122, R01-MH49098, R01MH049098)
- National Institute on Drug Abuse (R01-MH-DA-46376)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- mental health service utilization, barriers to care, help-seeking, attitudinal barriers, structural barriers, financial barriers, low income, stigma, cross-national comparison, health care system, United States, Ontario, Netherlands
- MeSH terms
- Adolescent, Adult, Mental Disorders, Cross-Sectional Studies, Demography, Female, Health Services Accessibility, Humans, Male, Mental Health Services, Middle Aged, Netherlands, Ontario, Social Perception, Socioeconomic Factors, Stereotyping, United States, Prevalence, Diagnostic and Statistical Manual of Mental Disorders
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