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

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  • Nagendra P Luitel
  • Mark J D Jordans
  • Brandon A Kohrt
  • Sujit D Rathod
  • Ivan H Komproe

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.

Suggested Citation

  • Nagendra P Luitel & Mark J D Jordans & Brandon A Kohrt & Sujit D Rathod & Ivan H Komproe, 2017. "Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-15, August.
    • Handle: RePEc:plo:pone00:0183223
    DOI: 10.1371/journal.pone.0183223
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    References listed on IDEAS

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    1. Lund, Crick & Breen, Alison & Flisher, Alan J. & Kakuma, Ritsuko & Corrigall, Joanne & Joska, John A. & Swartz, Leslie & Patel, Vikram, 2010. "Poverty and common mental disorders in low and middle income countries: A systematic review," Social Science & Medicine, Elsevier, vol. 71(3), pages 517-528, August.
    2. Tol, Wietse A. & Kohrt, Brandon A. & Jordans, Mark J.D. & Thapa, Suraj B. & Pettigrew, Judith & Upadhaya, Nawaraj & de Jong, Joop T.V.M., 2010. "Political violence and mental health: A multi-disciplinary review of the literature on Nepal," Social Science & Medicine, Elsevier, vol. 70(1), pages 35-44, January.
    3. Sujit D Rathod & Mary J De Silva & Joshua Ssebunnya & Erica Breuer & Vaibhav Murhar & Nagendra P Luitel & Girmay Medhin & Fred Kigozi & Rahul Shidhaye & Abebaw Fekadu & Mark Jordans & Vikram Patel & M, 2016. "Treatment Contact Coverage for Probable Depressive and Probable Alcohol Use Disorders in Four Low- and Middle-Income Country Districts: The PRIME Cross-Sectional Community Surveys," PLOS ONE, Public Library of Science, vol. 11(9), pages 1-15, September.
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    1. Adalberto Campo-Arias & Guillermo A Ceballos-Ospino & Edwin Herazo, 2020. "Barriers to access to mental health services among Colombia outpatients," International Journal of Social Psychiatry, , vol. 66(6), pages 600-606, September.
    2. Rishav Koirala & Erik Ganesh Iyer Søegaard & Saroj Prasad Ojha & Edvard Hauff & Suraj B Thapa, 2020. "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," PLOS ONE, Public Library of Science, vol. 15(6), pages 1-16, June.

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