Stigma- and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers

Dockery, Lisa; Jeffery, Debra; Schauman, Oliver; Williams, Paul; Farrelly, Simone; Bonnington, Oliver; Gabbidon, Jheanell; Lassman, Francesca; Szmukler, George; Thornicroft, Graham; Clément, Sarah

doi:10.1016/j.psychres.2015.05.044

Cited by 57 publications

(41 citation statements)

References 58 publications

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“…The most frequently reported major barriers (>10%) were lacking financial means to afford care; fear of being perceived as crazy; lack of information about treatment places; fear of being perceived as weak for having mental health problems; lack of interest in talking about one’s feelings, emotions or thoughts; and preferring alternative treatment. The major barriers in this study are also consistent with the barriers reported in studies conducted in the United States [ 55 ], United Kingdom [ 56 ], Nigeria [ 57 ] and India [ 29 ]. We did not find any association between barriers to care and demographic characteristics except for occupation.…”

Section: Discussionsupporting

confidence: 90%

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

Luitel¹,

et al. 2017

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ContextThere is limited research on the gap between the burden of mental disorders and treatment use in low- and middle-income countries.ObjectivesThe 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.MethodsA 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).ResultsIn 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.ConclusionsWith 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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Section: Discussionsupporting

confidence: 90%

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

Luitel¹,

et al. 2017

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“…Dabei weisen die wenigen Untersuchungen in diesem Bereich darauf hin, dass aus Sicht der Betroffenen hier durchaus ein ernstzunehmendes Problem bestehen könnte. In einer ersten quantitativen Studie [Wahl, 1999] [Dockery et al, 2015].…”

Section: Blind Spots? the Role Of Stigma In Providing Psychotherapy Tunclassified

Blinde Flecken? Der Einfluss von Stigma auf die psychotherapeutische Versorgung von Menschen mit Schizophrenie

Schlier

Lincoln²

2016

Verhaltenstherapie

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Schizophreniepatienten beklagen eine geringe Verfügbarkeit von Psychotherapie als häufige Form der Stigmatisierung. In diesem Artikel untersuchen wir, inwiefern Patienten mit Schizophrenie psychotherapeutisch unterversorgt sind und ob es eine Benachteiligung von Patienten mit Schizophrenie gegenüber anderen Patientengruppen gibt. Weiterhin prüfen wir, inwiefern eine Benachteiligung durch individuelle und strukturelle Stigmatisierung verursacht wird. Zunächst erfolgt eine systematische Übersicht über die mögliche Unterversorgung und Benachteiligung bei der stationären und ambulanten psychotherapeutischen Behandlung. Anschließend beleuchten wir strukturelle Ursachen sowie Hinweise auf individuelle Stigmatisierung durch Behandler und stellen Studien vor, die den Zusammenhang zwischen individueller Stigmatisierung durch Behandler und versorgungsrelevanten Entscheidungen untersuchen. Hierbei zeigt sich, dass ein Großteil der Patienten mit Schizophrenie keine Psychotherapie erhält. Während die Datenlage zur stationären Versorgung nicht ausreicht, um eine etwaige Benachteiligung gegenüber anderen Patienten zu beurteilen, deuten Versorgungsquoten in der ambulanten Behandlung auf eine solche Benachteiligung hin. Mögliche strukturelle Ursachen hierfür sind die Aufrechterhaltung von Fehlannahmen über Schizophrenie in der Ausbildung und durch Entscheidungsträger im Versorgungssystem sowie die Komm-Struktur des Versorgungssystems. Stigmatisierende Einstellungen von Behandlern, insbesondere ein prognostischer Pessimismus, stellen potenzielle individuumsbezogene Ursachen dar. Eine Stigmatisierung im Versorgungssystem erfolgt sowohl durch Versorgungsstrukturen als auch individuell durch Behandler. Mögliche Maßnahmen zur Verbesserung dieses Missstands werden diskutiert.

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“…Existing research (Chang et al., ; Dockery et al., ; Nunley, ) has indicated the importance of reducing affiliate stigma among family caregivers. First, family caregivers with affiliate stigma may feel more difficulty providing care for their closely affiliated stigmatized patient.…”

Section: Introductionmentioning

confidence: 99%

Correlates of affiliate stigma among family caregivers of people with mental illness: A systematic review and meta‐analysis

Shi

Shao

et al. 2018

Psychiatric Ment Health Nurs

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Accessible Summary What is known on the subject? A growing body of qualitative and quantitative research has investigated the experiences of affiliated stigma for family members of PWMI. Some findings are contradictory and have not been considered systematically. What does the paper adds to existing knowledge? Family caregivers of PWMI may encounter affiliate stigma, but no systematic review or meta‐analysis has been conducted to evaluate affiliate stigma among them. We identified eight variables significantly related to affiliate stigma among caregivers of PWMI. The findings can be used to help clinical practice to develop health promotion and prevention strategies. What are the implications for practice? Affiliate stigma was prevalent among the family caregivers of PWMI and is important for clinicians to consider. Health‐focused interventions for family caregivers can mediate the impact of affiliated stigma through provision of social support by practitioners, such as respite care based on the “Senses Framework,” self‐help groups and online support program. And the caregivers of PWMI might benefit from further support (e.g., psychoeducation) to improve their knowledge about mental illness. Abstract IntroductionMany studies have investigated the correlates of affiliate stigma among family caregivers of people with mental illness (PWMI). Thus far, no systematic review or meta‐analysis has been conducted to synthesize these results. Aims/QuestionThis review aims to identify the correlates of affiliate stigma among family caregivers of PWMI. MethodWe searched four databases including PubMed, PsycINFO, EMBASE and Web of Science for studies that investigated the association of affiliate sigma with socio‐demographic, psychosocial and disease‐related factors. ResultsTwenty‐two studies including 3,381 participants met the inclusion criteria. Eighteen variables were included for the meta‐analysis. For disease‐related characteristics, only “disease attribution” and “care time/day” were associated with affiliate stigma. For psychosocial characteristics, “support from others,” “burden,” “depression,” “stress,” “distress” and “face concern” were related to affiliate stigma. DiscussionThis review is the first to assess the association of affiliate stigma with other characteristics of interest. However, the findings are limited due to a very small number of studies. Researchers should conduct in‐depth study in this area and improve the quality of the literature. Implications for practiceHealth‐focused interventions for family caregivers such as respite care, self‐help groups, online support program and psychosocial education can mediate the impact of affiliated stigma.

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Stigma- and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers

Cited by 57 publications

References 58 publications

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

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

Blinde Flecken? Der Einfluss von Stigma auf die psychotherapeutische Versorgung von Menschen mit Schizophrenie

Correlates of affiliate stigma among family caregivers of people with mental illness: A systematic review and meta‐analysis

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