Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands

Jitender Sareen, Amit Jagdeo, Brian J Cox, Ian Clara, Margreet ten Have, Shay-Lee Belik, Ron de Graaf, Murray B Stein
Psychiatric Services: a Journal of the American Psychiatric Association 2007, 58 (3): 357-64

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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