Treatment gap and barriers for mental health care: a cross-sectional community survey in Nepal

Luitel, Nagendra P.; Jordans, Mark J. D.; Kohrt, Brandon A.; Rathod, Sujit D.; Komproe, Ivan H.

doi:10.1371/journal.pone.0183223

Cited by 165Mental Health Treatment and AccessMigration, Health and TraumaPsychiatric care and mental health services

Treatment gap and barriers for mental health care: a cross-sectional community survey in Nepal

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Luitel, Nagendra P., Jordans, Mark J. D., Kohrt, Brandon A., Rathod, Sujit D., Komproe, Ivan H.·2017·PLOS ONE

DOI 10.1371/journal.pone.0183223PMC PMC5560728

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Abstract

CONTEXT: There is limited research on the gap between the burden of mental disorders and treatment use in low- and middle-income countries. OBJECTIVES: The aim of this study was to assess the treatment gap among adults with depressive disorder (DD) and alcohol use disorder (AUD) and to examine possible barriers to initiation and continuation of mental health treatment in Nepal. METHODS: A three-stage sampling technique was used in the study to select 1,983 adults from 10 Village Development Committees (VDCs) of Chitwan district. Presence of DD and AUD were identified with validated versions of the Patient Health Questionnaire (PHQ-9) and Alcohol Use Disorder Identification Test (AUDIT). Barriers to care were assessed with the Barriers to Access to Care Evaluation (BACE). RESULTS: In this sample, 11.2% (N = 228) and 5.0% (N = 96) screened positive for DD and AUD respectively. Among those scoring above clinical cut-off thresholds, few had received treatment from any providers; 8.1% for DD and 5.1% for AUD in the past 12 months, and only 1.8% (DD) and 1.3% (AUD) sought treatment from primary health care facilities. The major reported barriers to treatment were lacking financial means to afford care, fear of being perceived as "weak" for having mental health problems, fear of being perceived as "crazy" and being too unwell to ask for help. Barriers to care did not differ based on demographic characteristics such as age, sex, marital status, education, or caste/ethnicity. CONCLUSIONS: With more than 90% of the respondents with DD or AUD not participating in treatment, it is crucial to identify avenues to promote help seeking and uptake of treatment. Given that demographic characteristics did not influence barriers to care, it may be possible to pursue general population-wide approaches to promoting service use.

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The AUD treatment gap is particularly marked in low-income and lower-middle-income countries.
“This gap is particularly marked in low-income and lower-middle-income countries (9, 11, 12).”
From Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review (2022) · cites this paper as [12]
AUD is often not detected by health care providers in sub-Saharan Africa, contributing to a wide treatment gap.
“Despite this, AUD is often not detected in health care settings, which contributes to a wide treatment gap.”
From Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review (2022) · cites this paper as [12]

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Self-guided Cognitive Behavioral Therapy Apps for Depression: Systematic Assessment of Features, Functionality, and Congruence With Evidence
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Psychological Distress among Caregivers of Children with Neurodevelopmental Disorders in Nepal
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Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study
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Factors affecting the utilization of mental health services among undergraduate students in a Nigerian University
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Traditional and biomedical care pathways for mental well‐being in rural Nepal
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Effectiveness of Group Problem Management Plus (Group-PM+) for adults affected by humanitarian crises in Nepal: study protocol for a cluster randomized controlled trial
Hof, E. V., Sangraula, M., Luitel, N. P., Turner, E. L., Marahatta, K., van Ommeren, M., Shrestha, P., Bryant, R. A., Kohrt, B. A., & Jordans, M. J. D. (2020) · Trials · doi:10.1186/s13063-020-04263-9 · Cited by 33 · see citing works
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Reassessing the Mental Health Treatment Gap: What Happens if We Include the Impact of Traditional Healing on Mental Illness?
Pham, T. V., Koirala, R., Wainberg, M. L., & Kohrt, B. A. (2020) · Community Mental Health Journal · doi:10.1007/s10597-020-00705-5 · Cited by 36 · see citing works
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Barriers and Facilitators to Substance Use Disorder Treatment in Low-and Middle-Income Countries: A Qualitative Review Synthesis
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Wolfe, D. M., Hutton, B., Corace, K., Chaiyakunapruk, N., Ngorsuraches, S., Nochaiwong, S., Presseau, J., Grant, A., Dowson, M., Palumbo, A., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1296239 · Cited by 29 · see citing works
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Health care use and treatment-seeking for depression symptoms in rural India: an exploratory cross-sectional analysis
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Using qualitative comparative analysis and theory of change to unravel the effects of a mental health intervention on service utilisation in Nepal
Breuer, E., Subba, P., Luitel, N. P., Jordans, M. J. D., Silva, M. J. D., Marchal, B., & Lund, C. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-001023 · Cited by 29 · see citing works
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Healthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in Nepal
Rajan, S., Rathod, S. D., Luitel, N. P., Murphy, A., Roberts, T., & Jordans, M. J. D. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05094-9 · Cited by 26 · see citing works
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Utilizing passive sensing data to provide personalized psychological care in low-resource settings
Byanjankar, P., Poudyal, A., Kohrt, B. A., Maharjan, S. M., Hagaman, A. K., & van Heerden, A. C. (2020) · Gates Open Research · doi:10.12688/gatesopenres.13117.1 · Cited by 24 · see citing works
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Parental depression and nutrition: findings from a cross-sectional household survey in Nepal
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Anxiety and Depression among Hypertensive Adults in Tertiary Care Hospitals of Nepal
Shah, S., Adhikari, S., Aryal, S., Adhikari, T. B., Sah, S. K., Paudel, B. S., & Pradhan, P. M. S. (2022) · Psychiatry Journal · doi:10.1155/2022/1098625 · Cited by 22 · see citing works
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Kaiser, B. N., Gurung, D., Rai, S., Bhardwaj, A., Dhakal, M., Cafaro, C. L., Sikkema, K. J., Lund, C., Patel, V., Jordans, M. J. D., et al. (2022) · International Journal of Mental Health Systems · doi:10.1186/s13033-022-00546-7 · Cited by 23 · see citing works
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Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal
Markkula, N., Lehti, V., Adhikari, P., Peña, S., Heliste, J., Mikkonen, E., RAUTANEN, M. T., Salama, E. S. S., & Guragain, B. (2019) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2019.15 · Cited by 19 · see citing works
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Access to Mental Health Care in Nepal: Current Status, Potential Challenges, and Ways Out
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Trauma related psychiatric disorders and their correlates in a clinical sample: A cross-sectional study in trauma affected patients visiting a psychiatric clinic in Nepal
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Impact of a district mental health care plan on suicidality among patients with depression and alcohol use disorder in Nepal
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Further Reduction in Help-Seeking Behaviors Amidst Additional Barriers to Mental Health Treatment in Asian Populations: A Contemporary Review
Naito, T., Chin, J., Kim, T. U., Veera, S., Jeannette, M., & Lomiguen, C. M. (2020) · Cureus · doi:10.7759/cureus.11455 · Cited by 14 · see citing works
Lay community mental health workers (cadres) in Indonesian health services: A qualitative exploration of the views of people with mental health problems and their families
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Nepal’s mental health system from public health perspective: a thematic synthesis based on health system building blocks
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Gender Differences in the Prevalence of Depression among the Working Population of Nepal
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A brief web‐based screening plus emotional‐disorder health education was associated with improvement of mental health awareness and service‐seeking attitudes among patients seeking nonpsychiatric clinical services in China
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Cost-effectiveness of psychological intervention within services for depression delivered by primary care workers in Nepal: economic evaluation of a randomized control trial
Aldridge, L. R., Luitel, N. P., Jordans, M. J. D., Bass, J., & Patenaude, B. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.54 · Cited by 11 · see citing works
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Adaptation of a model for integration of interventions for alcohol use disorders in primary health care in Tanzania
Mushi, D., Hanlon, C., Francis, J. M., Candida, M., Demissie, M., & Teferra, S. (2023) · BMC Family Practice · doi:10.1186/s12875-023-02061-1 · Cited by 10 · see citing works
Perception of the criminality of attempted suicide in Nepal and its impact on suicide reporting
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Mental health–related structural stigma and discrimination in health and social policies in Nepal: A scoping review and synthesis
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Validating measures of stigma against those with mental illness among a community sample in Kilifi Kenya
Bitta, M. A., Baariu, J. K., Fondo, E., Kariuki, S. M., Lennox, B., & Newton, C. R. J. C. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.26 · Cited by 11 · see citing works
A cross-sectional mixed methods protocol to describe correlates and explanations for a long duration of untreated psychosis among patients with first episode psychosis in Uganda
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Pathways of association between husbands’ migration and mental health of their wives who stay behind
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Treatment-seeking behavior and barriers to mental health service utilization for depressive symptoms and hazardous drinking: The role of religious and traditional healers in mental healthcare of Northwest Ethiopia
Mekonen, T., Chan, G., Belete, H., Hides, L. M., & Leung, J. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.88 · Cited by 15 · see citing works
Bidirectional relationship between physical health symptoms and depressive symptoms in the pre- and postpartum period.
Gómez-Pérez, L., Cumsille, P., & Román, C. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110280 · Cited by 9 · see citing works
Barriers and facilitators to the diagnosis and treatment of depression in primary care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives
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Improving mental health education in nursing school
Bennett, C. (2021) · Nursing · doi:10.1097/01.nurse.0000769868.09336.15 · Cited by 9 · see citing works
International perspective on integrated care models in child and adult mental health
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Mental health education in undergraduate medical curricula across Nepalese universities
Marahatta, K., Pant, S. B., Basnet, M., Sharma, P., Risal, A., & Ojha, S. P. (2021) · BMC Medical Education · doi:10.1186/s12909-021-02743-3 · Cited by 8 · see citing works
Effectiveness of Interventions in Reducing Substance-Related Stigma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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The use of medications approved for alcohol use disorders in Italy
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Mental health care seeking behavior in Bangladesh: determinants and treatment gaps
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Chinese Cancer Patients’ Attitudes Toward Psychotherapy and Their Willingness to Participate in Clinical Trials of Psychotherapy
Zeng, Z., Deng, Y., Liu, J., Yang, K., Peng, H., & Jiang, Y. (2022) · Cancer Control · doi:10.1177/10732748221112664 · Cited by 6 · see citing works
Association Between Mental Health Literacy and Stigma: A Review
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Autorreconocimiento de trastornos y problemas mentales por la población adulta en la Encuesta Nacional de Salud Mental en Colombia
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Enhancing Type 2 diabetes risk communication with message framing and tailored risk feedback: an online randomised controlled trial
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Alcohol consumption in low-and middle-income settings
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Treatment of depression by traditional faith healers in Nepal: A qualitative study
Luitel, N. P., Lamichhane, B., Koirala, P., Sainju, P., Ghimire, A., Gautam, K., Jordans, M. J. D., & Kohrt, B. A. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100425 · Cited by 5 · see citing works
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Insights on historical milestones of mental health in Nepal: Country profile
Khanal, G., Selvamani, Y., & Sapkota, P. (2023) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_197_23 · Cited by 5 · see citing works
A cross-sectional study of the barriers for seeking mental health care among medical undergraduates
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Promoting treatment access following pediatric primary care depression screening: Randomized trial of web-based, single-session interventions for parents and youthsPreprint
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Willingness of individuals with eating disorders to participate in health research
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Coping strategies and perceptions of mental health services among women in South India
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Dynamic Insights into Dengue: Leveraging Spatio-Temporal Graph Convolution Networks
Bhandari, H. C., Pandey, H. R., Pandeya, Y. R., & Jha, K. (2024) · Journal of Nepal Mathematical Society · doi:10.3126/jnms.v7i2.73102 · Cited by 3 · see citing works
Feasibility and Applicability of Implementing the Framework for Comprehensive Understanding of Structural Stigma in Mental Healthcare Systems: A Case Example of Nepal
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Barreras y facilitadores para el diagnóstico y tratamiento de la depresión en atención primaria en Colombia: Perspectivas de los proveedores, administradores de atención médica, pacientes y representantes de la comunidad
Bartels, S. M., Cárdenas, P., Uribe-Restrepo, J. M., Cubillos, L., Torrey, W. C., Castro, S., Williams, M. J., Oviedo-Manrique, D. G., Gómez–Restrepo, C., & Marsch, L. A. (2021) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2021.01.001 · Cited by 3 · see citing works
Relapse among MHCUs after a Short-Term Admission in an Acute Psychiatric Unit: Primary Caregivers’ Perspective
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Treatment gap for mental and behavioral disorders in Punjab
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A qualitative study on the adaptation of community programmes for the promotion of early detection and health-seeking of perinatal depression in Nepal
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Authors: Luitel, N. P., Jordans, M. J. D., Kohrt, B. A., Rathod, S. D., & Komproe, I. H.
Affiliations: King's College London (GB)
Duke University (US)
London School of Hygiene & Tropical Medicine (GB)
Utrecht University (NL)
Corresponding author: Luitel, Nagendra P.
ORCID: Luitel, Nagendra P.
Jordans, Mark J. D.
Kohrt, Brandon A.
Rathod, Sujit D.
Komproe, Ivan H.
Venue: PLOS ONE
Publisher: Public Library of Science (PLoS)
Published: 2017-08-17
Volume: 12
Issue: 8
Pages: e0183223
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0183223
PMC: PMC5560728
OpenAlex: W2746688446
Cited by: 165
References: 59
Citations by year: 2026: 12 · 2025: 21 · 2024: 13 · 2023: 28 · 2022: 21 · 2021: 21 · 2020: 29 · 2019: 15 · 2018: 5
FWCI: 19.18
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: PLoS ONE (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
RePEc: Research Papers in Economics (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Research Portal (King's College London) (submittedVersion, cc-by)
Funders: Government of the United Kingdom
National Institute of Mental Health (K01MH104310)
Topics: Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords: treatment gap, barriers to mental health care, depressive disorders, alcoholism, help-seeking, mental health service utilization, primary care, stigma, financial barriers, Nepal, Chitwan district
MeSH terms: Adolescent, Adult, Cross-Sectional Studies, Female, Humans, Male, Mental Health Services, Middle Aged, Nepal, Young Adult

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Treatment gap and barriers for mental health care: a cross-sectional community survey in Nepal

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