Despite decades of evidence-based interventions, depression remains a great challenge for public health due to enormous treatment gap and lag which, at least partially, result from low professional help-seeking by people suffering from depressive symptoms. In this article, we aim to gain a better understanding of help-seeking behavior in depression, and how to intervene effectively decreasing treatment gap and delay by using a meta-ethnography approach-an interpretive technique to systematically synthesize qualitative data. It integrates views and experiences of 474 individuals with depression across 20 papers. Findings suggest several interrelated major concepts-help-seeking as a threat to identity, social networks as a conflict or support, and alternative coping strategies as the main factor for treatment delay-as well as multiple relational, structural, attitudinal, cognitive, culture-specific, or gender-specific barriers. A model of help-seeking as a threat to identity is developed and discussed in the context of existing research.
Employing Pierre Bourdieu's sociology and his conceptual triad of field, habitus and capital, this article outlines a theoretical approach to empirically analyse helpseeking practices in mental distress. The framework helps to examine why the treatment gap in common mental disorders is wider in one setting than another and why some agents access healthcare more easily than others within the same setting, that may even drive to both overand under-treatment resulting in inequities of access and poor use of resources. In order to understand help-seeking behaviour that varies across settings, time and conditions, it is suggested to relationally analyse how the field of mental healthcare as a structure of positions impacts access to healthcare; how mental structures that mirror cultural context and social conditions where they were acquired influence perceptions of access and, therefore, strategies of help seeking; and what historical genesis of both mental and objectified structures is.
After the regime collapse, the former socialist societies in Central and Eastern Europe experienced rapid social and economic transformations. Consequently, mental health deterioration coupled with ambitions to break with the past triggered reforms of mental health systems. Yet, 30 years later, mental health in the region remains poor. Stigma of mental illness may be one of the factors that delays help seeking and, therefore, maintains status quo. Thus, the aim of the article is to better understand the roots of stigma and the process of stigmatisation in one of these countries – Lithuania. Drawing on Norbert Elias’s model of established‐outsider relations, the article presents the analysis of 23 in‐depth interviews with healthcare providers and users of services diagnosed with depression or anxiety disorders. Said analysis reveals how stigma of mental illness might result in damaged self‐image and shame of feeling different. Mental illness and healthcare seeking are perceived as a threat to culturally and historically determined self‐values, at the core of which seems to be intolerance of difference. The article contributes not only to research concerning mental health in a relatively understudied region of Central and Eastern Europe, but also to existing literature on stigma as embedded in a local context.
With increasing female labour market participation, welfare states in Europe have aimed to reorient their policies to face a newly emerging social risk -difficulties to combine work and family roles. Yet, they differ in the extent of this adaptation, which has been associated with multiple factors including the influence of cultural values or ideas towards care. In this article, we employ the European Social Survey (Round 8) to examine whether and how not only self-interests but also values influence public willingness to pay for extending state's work-family reconciliation policies in Italy, Portugal and Spain, where care provision traditionally was in the family. Although South European welfare states are often considered to be similarly influenced by traditional gender and family values, the findings of this study contribute to the evidence that there are important differences between them.
Using an interpretative comparison in search for cross-case similarities and differences, we examine the evolution of equity of access to healthcare during the economic crisis in two potentially vulnerable Eastern and Southern European countries – Lithuania and Spain. While the type of healthcare system may have shown higher resilience, i.e. equity of access to care during the crisis should have been affected more in Lithuania – a relatively immature health insurance system – than in Spain – a consolidated national health service, the intensity and length of the crisis and types of adjustment measures undertaken may have led, in turn, to different results in terms of equity of access. The analysis focuses on the respective institutional designs and healthcare reforms under austerity as well as subjective and objective indicators of access to care. We conclude that the Lithuanian healthcare system, despite potential comparative disadvantage, has shown greater performance than the Spanish one during the crisis.
The economic, social, and health costs of mental distress are increasingly burdening individuals and societies in Europe. Yet, overmedicalization of mild symptoms is also well documented. This accumulates in more pressures and demands on health care systems. In this article, I explore how the process of help seeking in mental distress might be shaped by health system design and functioning in one of the South European societies—Spain. Employing Bourdieu’s theoretical lens, in-depth interviews with health care providers and users of services are analyzed. I reveal how the logic of the mental health care field, which is reinforced by the market, the state, and the media, may result in medicalization of mild distress while severe mental illness remains undertreated. I also show how mental help-seeking practices could gradually influence the functioning of the treatment system. Nevertheless, points of resistance to medicalization can also be identified.
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