Abstract
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.
Highlights
There is a significant gap between the number of individuals in need of mental health care and those who receive treatment, with prior estimates suggesting that more than 56% of persons with depression [1,2,3,4] and 78% of persons with alcohol abuse and dependence [3] have not received care
Presence of DD and alcohol use disorder (AUD) were identified with validated versions of the Patient Health Questionnaire (PHQ-9) and Alcohol Use Disorder Identification Test (AUDIT)
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
Summary
There is a significant gap between the number of individuals in need of mental health care and those who receive treatment, with prior estimates suggesting that more than 56% of persons with depression [1,2,3,4] and 78% of persons with alcohol abuse and dependence [3] have not received care. Studies have documented several adverse consequences of untreated mental illness including pre-mature mortality [6, 7], unemployment [8, 9], poverty [10], homelessness [11], co-morbid substance abuse and addiction [12, 13], poor physical health [14,15,16] and suicide [17]. Some initiatives have been taken recently to reduce the treatment gap for mental health care [18,19,20,21,22]. Various factors are considered to impede mental health treatment including lack of perceived need, stigma, not knowing where to go for treatment, belief that the problem will resolve itself, desire to deal with the problem oneself, inability to afford treatment expenses, doubt regarding the effectiveness of the treatment, and lack of services [24,25,26,27,28,29]
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