Reasons For Unmet Need Research Articles

Unmet need for contraception among married women of reproductive age in rural Maharashtra

Background: The concept of “unmet need” for contraceptive points to the gap between women’s reproductive intention and their contraceptive behavior. About 12.8% of currently married women in India have an unmet need for contraception. The present descriptive cross-sectional survey was initiated to address the research questions regarding unmet need for contraception among married women of reproductive age group in rural Maharashtra.Methods: 400 married women of reproductive age living in rural area of Sangli district of Maharashtra state interviewed. The survey based on women’s response to survey questions regarding family information, fertility profile and attitude and practice of contraceptive use. Expanded formulation used for surveys to assess the size and characteristics of unmet need group, dividing it into distinct subgroups and to explore the reasons for unmet need using in-depth qualitative research. Data analyzed with absolute number and percentage of women having unmet need which is useful to set priorities in program for effective fertility control. The data was tabulated and analyzed using MS Excel.Results: Total unmet need for contraception was found 27.50% women, which comprises need for ‘spacing’ in 12.25% women, need for ‘limiting birth’ in 13.25% women and need for ‘appropriate contraception’ in 2.0% women among 400 married women of reproductive age. Most unmet need among younger women is for spacing birth (67.18%) while in older women above age 30 year; most unmet need (68.18%) is for limiting birth. The education of women does not affect significantly the unmet need for spacing and limiting birth. After first child the unmet need for spacing decreases with each additional child. On the contrary unmet need for limiting birth increases with each additional child after first child and it was maximum (96.55%) among women having 3 or more children.Conclusions: The study group expresses multiple reasons for the unmet need. Many of the reasons are not directly related to contraception. Most women with unmet need desire to use contraception in future favours spacing methods. People should have access to good quality information and services. Health education and motivation is needed to overcome these causes.

Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study

BackgroundUnmet need for family planning points to the gap between women’s reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Despite its prevalence, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. There is demographic survey data on women’s self-reported reasons for non-use, but these data provide limited insight on the full set of possible obstacles to use, and one may doubt the meaningfulness of explanations provided by non-users alone. To rectify this evidence gap, this study will gather extensive information on women’s perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys.MethodsA multi-site cohort study will be conducted in urban Kenya, rural Kenya, and rural Bangladesh. In each setting trained fieldworkers will recruit and interview 2600 women, with participants re-interviewed at 12 and 18 months. Data will be collected using a questionnaire whose development was informed by a review of existing literature and instruments from past studies in both developed and developing countries. Dozens of experts in the field were consulted as the instrument was developed. The questionnaire has three main components: a sub-set of Demographic and Health Survey items measuring socio-demographic characteristics, reproductive history, and sexual activity; additional questions on prospective and retrospective fertility preferences designed to capture ambivalence and uncertainty; and two large blocks of items on (i) generic concerns about contraception and (ii) method-specific attributes. The method-specific items encompass eight modern and traditional methods.DiscussionPolicy and programmes intended to reduce unmet need for contraception in developing countries should be informed by clear understanding of the causes of this phenomenon to better reflect the population needs and to more effectively target planning and investments. To this end, this study will field an innovative instrument in Kenya and Bangladesh. The information to be collected will support a rigorous assessment of reasons for unmet need for family planning.

Subjective perceptions of unmet need for health care in Europe among social groups: Findings from the European social survey (2014) special module on the social determinants of health.

Unmet need can be defined as the individually perceived subjective differences between services judged necessary to deal with health problems and the services actually received. This study examines what factors are associated with unmet need, as well as how reasons for unmet need are distributed across socioeconomic and demographic groups in Europe. Multilevel logistic regression models were employed using data from the 7th round of the European Social Survey, on people aged 25–75. Self-reported unmet need measured whether respondents had been unable to get medical consultation or treatment in the last 12 months. Reasons for unmet need were grouped into three categories: availability, accessibility and acceptability. Health status was measured by self-reported health, non-communicable diseases and depressive symptoms. Two-thirds of all unmet need were due waiting lists and appointment availability. Females and young age groups reported more unmet need. We found no educational inequalities, while financial strain was found to be an important factor for all types of unmet need for health care in Europe. All types of health care use and poor health were associated with unmet need. Low physician density and high out-of-pocket payments were found to be associated with unmet need due to availability. Even though health care coverage is universal in many European welfare states, financial strain appeared as a major determinant for European citizens’ access to health care. This may suggest that higher income groups are able to bypass waiting lists. European welfare states should, therefore, intensify their efforts in reducing barriers for receiving care.

Unmet need for family planning among married women of reproductive age group in rural and urban area of Shimla, India

Background: The concept of unmet need points to the gap between some women’s reproductive intentions and their contraceptive behavior. Unmet need for family planning (FP) is a concept that has influenced the development of FP programs for the past few decades. Objectives: The objective of this study was to determine the prevalence of “unmet need for FP” and its sociodemographic determinants among married women of reproductive age group. Materials and Methods: The study was a community-based, cross-sectional design among married women of the reproductive age group in Shimla. A sample of 1600 women in urban and rural settings has been studied using systematic random sampling. Results: The prevalence of unmet need for FP was found 10.3% (11.50% in rural area and 8.75% in urban area). Unmet need for spacing and limiting family was found 6.9% and 3.13%, respectively. Family opposition and fertility concern were the major reasons for unmet need for FP. Age, type of family, and higher education were found to be associated with high unmet need for FP. Conclusion: Unmet need for FP in the current study has been found better than national averages. Still considering better acceptance for health and family welfare services in this particular state of India, there are a lot of scopes for improvements.

Equity in access to health care in a rural population in Malaysia: A cross-sectional study.

To examine the extent of equity in access to health care, their determinants and reasons of unmet need of a rural population in Malaysia. Exploratory cross-sectional survey administered by trained interviewers among participants of a health screening program. A rural plantation estate in the West Coast of Peninsular Malaysia. One hundred and thirty out of 142 adults above 18years old who attended the program. Percentages of respondents reporting realised access and unmet need to health care, determinants of both access indicators and reasons for unmet need. Realised access associated with need but not predisposing or enabling factors and unmet need not associated with any variables were considered equitable. A total of 88 (67.7%) respondents had visited a doctor (realised access) in the past 6months and 24.8% (n=31) experienced unmet need in the past 12months. Using logistic regression, realised access was associated with presence of chronic disease (OR 6.97, P<0.001), whereas unmet need was associated with low education level (OR 6.50, P<0.05), 'poor' or 'fair' self-assessed health status (OR 6.03, P<0.05) and highest income group (>RM 2000 per month) (OR 51.27, P<0.05). Personal choice (67.7%) was more commonly expressed than barriers (54.8%) as reasons for unmet need. The study found equity in realised access and inequity in unmet need among the rural population, the latter associated with education level, subjective health status and income. Despite not being generalisable, the findings highlight the need for a national level study on equity in access before the country reforms its health system.

Exploring Demographic Factors Influencing Acceptance of Family Planning Methods in Aligarh

Introduction: Population of India has jumped to 1,290,974,613 (1.29 billion) on Dec 07, 2015. There are certain demographic factors, which affect the acceptance of family planning methods. Therefore this study was conducted to determine the extent of felt need of family planning methods and to assess the demographic factors influencing the contraceptive acceptance. Materials and Methods: This cross-sectional study was conducted in J.N. Medical College, AMU, Aligarh, for a period of two and half year. Only the mothers in the post partum period were interviewed. Those mothers who had already accepted family planning methods were not included in the study. 1383 mothers were interviewed. Data were tabulated and analysed using SPSS version 20. Chi-square test (χ2) was applied to know the statistical significance. Results: Significant number of mothers (39.6%) had planned to adopt family planning methods. Majority of the mothers (71.4%) were in the age group of 21-30 years. In this age group, 39.7% mothers wanted to adopt family methods. As the age of the mothers increased, the acceptance rate also increased. Majority of mothers (52.9%) admitted in the hospital were Hindus. Among Muslims, 40.3 per cent mothers had felt need of family planning methods. Mostly the mothers were illiterate (50.8%). 30.8 per cent of these illiterate mothers wanted to accept family planning methods. Similar felt need (36.4%) was observed in mothers with education up to primary level (V standard). As the birth order increased, felt need also increased. Conclusion: It may be concluded that significant number of mothers had planned to adopt family planning methods. Though the campaign to promote family planning methods in our country is being carried out, the message should be given more vigorously through information, education and communication (IEC) activities and involvement of non-governmental organisations (NGO). Concerted efforts are needed to find out the reasons for unmet need and its solution

A Cross Sectional Study of Contraceptive Uses and Unmet Need for Family Planning Among Rural Population of Vadodara.

Introduction: Unmet need of contraception remains a national problem. The study was conducted among the eligible couples of rural area of Vadodara district, India, to assess the unmet need for contraception and to determine the use of different types of contraception along with the reasons associated with the unmet needs of contraception. Objective: This study aimed to measure the prevalence of contraception and reasons for unmet need of contraception. Methods: This was community based cross-sectional study. In this study 100 couples who were sexually active, fecund and in which women are in reproductive age group were enrolled. The sample population was selected by two stage random sampling method. A pre-tested structured questionnaire was used to collect data from the respondents with written consent. Results: This study enlighten that, in a rural area 72% of eligible couple was practicing any type of family planning method. Unmet need for contraception was 20 per cent. Among those having unmet need (n=20), lack of knowledge (55%), ignorance (25%), inaccessibility (10%) and non-affordability (10%) were responsible factors for unmet need. Conclusion: This study revealed lack of knowledge was the main reason for the unmet need of contraception among study population. Government should have to organise frequent family planning awareness programme at community level.

Levels, trends and reasons for unmet need for family planning among married women in Botswana: a cross-sectional study

ObjectivesThe objectives of this study are: (1) to estimate the prevalence of unmet need for family planning among married women using Botswana Family Health Survey 2007 data and (2) to...

Revealing unmet need for contraception among married women in an urban slum of Nagpur

Background: An estimated 17% of married women in the developing world have an unmet need for contraception. Understanding the magnitude of unmet contraceptive need and the underlying reasons of this phenomenon will help to reduce the number of unwanted pregnancies. Objective:To assess the extent of unmet need for family planning among women in the reproductive age group (i.e., 15–49 years) in an area of urban health training center; to explore the common reasons for unmet need for family planning. Materials and Methods: A community-based cross-sectional study was conducted in field practice area of urban health training centre, an adopted area under the administrative control of a tertiary-care hospital. The study subjects consisted of all married women in the age group of 15–49 years. Women who were divorced, widows, those who refused to participate, those who had undergone hysterectomy, and menopausal women were excluded from the study. Result: Unmet need for family planning was present in 22.1% among all women under study; 13.9% women revealed unmet need for spacing and 8.2% women unmet need for limiting. A statistically significant association was found between literacy and type of family with unmet need (P < 0.05). Common reasons for unmet need were fear of side effects (34.9%), opposition from family (25.3%), and so on. Conclusion: Unmet need is higher in younger women; therefore, family planning program should focus this age group and target illiterate people and urban slum areas. Family planning should emphasize communication and counseling to the women and explain all sorts of information about the side effects and other misconceptions about contraceptives.

Sociodemographic disparities associated with perceived causes of unmet need for mental health care.

Mental disorders are among the leading causes of disability in the United States. In 2011, over 10 million adults felt that even though they needed treatment for mental health problems, they received insufficient or no mental health care and reported unmet need. This article assesses associations between sociodemographic characteristics and perceived causes of unmet needs for mental health care. A sample of 2,564 adults with unmet mental health need was obtained from the National Survey on Drug Use and Health. Outcome variables were 5 main reasons for unmet need: cost, stigma, minimization, low perceived treatment effectiveness, and structural barriers. Each cause of unmet need was regressed on sociodemographic, health, and service use characteristics. Women had higher odds of cost-related reasons for unmet need than men. Odds of stigma and structural barriers were greater among Blacks than Whites, and among rural than metropolitan residents. Compared with the uninsured, insured persons were less likely to report cost barriers. However, insured persons had higher odds of stigma and minimization of mental disorders. Insurance alone is unlikely to resolve the problem of unmet need. Understanding the social epidemiology of perceived unmet need will help identify populations at risk of not receiving mental health care or insufficient care. Focusing on specific programs and services that are designed to address the causes of perceived unmet need in particular populations is important. Future research should explore how intersecting social statuses affect the likelihood of perceived unmet need.

Unmet need among homeless and non-homeless patients served at health care for the homeless programs.

This study compared the level of unmet need for medical, dental, mental health (MH), and substance use disorder (SUD) treatment between homeless and non-homeless patients served at Health Care for the Homeless programs. Using the 2009 Health Center Patient Survey, logistic regression models were used to assess the relationship between homelessness and unmet need for care. Descriptive statistics were then used to examine reasons for unmet need. Homeless patients were just as likely as non-homeless patients to have medical and dental treatment needs met. However, they were significantly more likely to report an unmet need for MH counseling and less likely to report an unmet need for SUD treatment. The primary reasons underlying unmet need were an inability to afford care and a lack of knowledge about where to obtain it. Results highlight the benefits of allotting additional funding to HCH programs so that they have the capacity to expand their overall scope of services.

Unmet need for contraception and unintended pregnancies among women of reproductive age group: A situation analysis

Each year approximately 210 million pregnancies occur worldwide and more than one-third (75 to 80 million) of these are unintended, more than half of these (46 million) unintended pregnancies undergo unsafe abortions. In Pakistan 16% of the births are reported to be unwanted and if the unwanted fertility is eliminated, total fertility in Pakistan would be 3.1 births per woman. Total demand for family planning in Pakistan is 55%, while the contraceptive prevalence rate is 35% and unmet need for family planning is 20%. Reasons for unmet need and unintended pregnancy include lack of permission, fear of side effects, poor quality and limited access to family planning services. Moreover, non-use of contraceptive methods and method failure are important reasons for unintended pregnancy. Women of reproductive age experience multiple adverse outcomes due to unintended pregnancy. These women neither care for themselves nor for their family and due to such careless behavior the likelihood of maternal and neonatal morbidity and mortality increases. Research on intervention programs for unintended pregnancy needs to be done in future. It is important to focus on how intervention programs should be designed, delivered and examined. Intervention strategies should aim to reduce unintended pregnancy by focusing on all the identified factors so that infant and maternal mortality and morbidity as well as the need for abortion is decreased and the overall well-being of the family is maintained and enhanced. Thus, improved community efforts are required to educate women about family planning as well about the proper use of family planning methods. Improved counseling and proper follow up is required especially of those women who adopt any method. Since improper treatment, incomplete follow up and limited choice of method might lead the women to discontinue the methods, therefore role of quality of care of existing services in improving women’s ability to achieve their desired reproductive goals should be given an attention. In addition to improving the quality of existing family planning services, the focus should be on the follow up of women for assessing the adherence to method and addressing their problems related to any method.

Unmet need for contraception: issues and challenges.

Unmet need for contraception has been a central indicator for monitoring the progress of family planning programs for 25 years. The purpose of this article is to provide a broad context for the more focused contributions that follow in this special issue. The validity and measurement of the concept of unmet need are discussed. We then present regional trends among married women since 1970. Major reductions in unmet need have been achieved, with the clear exception of sub-Saharan Africa. Less success can be claimed in addressing the needs of sexually active unmarried women, who contribute nearly 20 percent to overall unmet need in developing countries. Prominent reasons for unmet need in settings where contraceptive uptake is low include social resistance and insufficient information concerning methods. As contraceptive use increases, the importance of these reasons wanes, but concerns regarding side effects and health impact remain a barrier, and discontinued users now constitute a large proportion of those with unmet need. Drawing on these reasons, we outline measures to further reduce unmet need.

Reasons for Unmet Need for Child and Family Health Services among Children with Special Health Care Needs with and without Medical Homes

ObjectivesMedical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need. MethodsData are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics. ResultsWeighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05). ConclusionsCSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.

Nonfinancial Barriers and Access to Care for U.S. Adults

To identify prevalences and predictors of nonfinancial barriers that lead to unmet need or delayed care among U.S. adults. 2007 Health Tracking Household Survey. Reasons for unmet need or delayed care in the previous 12months were assigned to one of five dimensions in the Penchansky and Thomas model of access to care. Prevalences of barriers in each nonfinancial dimension were estimated for all adults and for adults with affordability barriers. Multivariable logistic regression models were used to estimate associations between individual, household, and insurance characteristics and barriers in each access dimension. Eighteen percent of U.S. adults experienced affordability barriers and 21 percent experienced nonfinancial barriers that led to unmet need or delayed care. Two-thirds of adults with affordability barriers also reported nonfinancial barriers. Young adults, women, individuals with lower incomes, parents, and persons with at least one chronic illness had higher adjusted prevalences of nonfinancial barriers. Nonfinancial barriers are common reasons for unmet need or delayed care among U.S. adults and frequently coincide with affordability barriers. Failure to address nonfinancial barriers may limit the impact of policies that seek to expand access by improving the affordability of health care.

A Study On The Extent And Reasons Of Unmet Need for Family Planning Among Women Of Reproductive Age Group In Rural Area Of Haryana

Research Question: To find out the extent and reasons of unmet need for Family Planing among rural women of reproductive age group and its association with some demogaphic factors. Objectives: (a) To estimate the magnitude of unmet need for family planing among women of reproductive age group. (b) To find out the association of socio-demographic factors with the unmet need for family planning and contraceptive users. (c) To explore common reasons for unmet need for family planning. Study Design: Community based cross-sectional study. Setting: Primary Health Training Centre (PHTC), Agroha (Hisar). Participants: Four hundred and eighty three willing women of reproductive age group. Materials and Methods: The primary tool in this study was predesigned and pretested questionnaire for recording of individual informations. Statistical analysis: Proportions & Univariate analysis (Chi Square test). Results : The extent of unmet need for family planning was 41.61%, of which 25.46% were limiters and 16.15% were spacers. Only 45.55% women were contraceptive users. Contraceptive use rate increased significantly X2(4, N = 483) = 11.00, p = .026 with the advancement of age. Limiters increased significantly X2(4, N = 201) = 15.67, p = .003 with advancement of age with proportionate decrease of spacers. Women’s education exert a powerful influence on unmet need X2(4, N = 483) = 14.56, p = .005. With increasing level of literacy, significant X2 (3, N = 201) = 28.59, p = <.001 increase in the prevalence of spacers with reciprocal decrease in the limiters were noticed. Neither the type of family nor the number of living children was significantly associated with the unmet need for family planning. However the prevalence of spacers had significantly decreased and limiters increased with increase in numbers of living children. The major reasons for unmet need were opposition from husband & family members (34.83%) and lack of information regarding the different methods of family planning (29.35%). Conclusions: Prevalence of unmet need was higher in more fertile age group (i.e.<30 years), therefore family planning program should focus more on this age group along with targetting illiterate people in rural areas.

Reasons for Self-Reported Unmet Healthcare Needs in Canada: A Population-Based Provincial Comparison

In this study, we compare self-perceived unmet need across Canadian provinces and assess how the reasons for unmet need - problems with availability, accessibility and acceptability - vary. This cross-sectional study uses data from the Canadian Community Health Survey (2.1) conducted in 2003. Overall, 11.7% perceived having had unmet healthcare needs in the previous 12 months. The adjusted provincial rates varied from 13.3% in Manitoba to 7.8% in Prince Edward Island. Among those reporting unmet health service needs, the leading reason was problems of availability of services (54.9%), followed by acceptability (42.8%) and accessibility related to cost or transportation (12.7%). Unmet need due to problems of availability was most likely in Quebec, Newfoundland and Manitoba, while Alberta and British Columbia had the highest likelihood of unmet need due to accessibility problems. Those in British Columbia, Saskatchewan and Manitoba were more likely to report problems of acceptability. The reasons for unmet need vary across provinces, with each reason having different policy implications.

Rising Inability to Obtain Needed Health Care Among Homeless Persons in Birmingham, Alabama (1995–2005)

Homeless persons depend disproportionately on the health-care safety net for medical services. National reports identify financial strains to this safety net. Whether this has affected homeless persons is unknown. We quantified changes in the proportion of homeless persons reporting unmet need for health care in Birmingham, Alabama, comparing two periods, 1995 and 2005. We assessed whether a period effect was independent of characteristics of persons surveyed. Analysis of two surveys conducted with identical methods among representative samples of homeless persons in 1995 (n = 161) and 2005 (n = 161). Report of unmet need (inability to obtain care when needed) was the dependent variable. Two survey periods (1995 and 2005) were compared, with multivariable adjustment for sociodemographic and health characteristics. Reasons for unmet need were determined among the subset of persons reporting unmet need. Unmet need for health care was more common in 2005 (54%) than in 1995 (32%) (p < 0.0001), especially for non-Blacks (64%) and females (65%). Adjusting for individual characteristics, a survey year of 2005 independently predicted unmet need (odds ratio 2.68, 95% CI 1.49-4.83). Among persons reporting unmet need (87 of 161 in 2005; 52 of 161 in 1995), financial barriers were more commonly cited in 2005 (67% of 87) than in 1995 (42% of 52) (p = 0.01). A rise in unmet health-care needs was reported among Birmingham's homeless from 1995 to 2005. This period effect was independent of population characteristics and may implicate a local safety net inadequacy. Additional data are needed to determine if this represents a national trend.

Unmet Need for Treatment of Major Depression in the United States

This study examined the extent and correlates of perceived unmet need for treatment among individuals with depression in the U.S. general population. Analyses were based on a representative sample of 6,510 adult participants in the 2005 and 2006 National Surveys on Drug Use and Health who reported a major depressive episode in the past 12 months. A total of 3,568 (62.4%) participants had sought mental health treatment in the past 12 months, and 2,942 (37.6%) had not; 34.9% and 26.8% of these groups, respectively, reported unmet need for treatment. In both groups, older age was associated with a lower likelihood of reporting unmet need for treatment, whereas greater distress and impairment and higher education were associated with a greater likelihood of reporting unmet need. Among treatment seekers, treatment from general medical providers was associated with greater likelihood of unmet need, and more outpatient visits and insurance coverage for the full year were associated with a lower likelihood of unmet need. The most common reason for not seeking needed treatment was a concern about costs (cited as a reason by 46.0% of the total sample). Even though rates of treatment seeking have increased, many persons with major depression continue to experience unmet need for treatment, which in this study was mainly attributable to concerns about treatment costs.

Perceived Unmet Need for Mental Health Care for Canadians With Co-occurring Mental and Substance Use Disorders

Previous analyses demonstrated an elevated occurrence of perceived unmet need for mental health care among persons with co-occurring mental and substance use disorders in comparison with those with either disorder. This study built on previous work to examine these associations and underlying reasons in more detail. Secondary data analyses were performed on a subset of respondents to the 2002 Canadian Community Health Survey (unweighted N=4,052). Diagnostic algorithms classified respondents by past-year substance dependence and selected mood and anxiety disorders. Logistic regressions examined the associations between diagnoses and unmet need in the previous year, accounting for recent service use and potential predisposing, enabling, and need factors often associated with help seeking. Self-reported reasons underlying unmet need were also tabulated across diagnostic groups. Of persons with a disorder, 22% reported a 12-month unmet need for care. With controls for service use and other potential confounders, the odds of unmet need were significantly elevated among persons with co-occurring disorders (adjusted odds ratio=3.25; 95% confidence interval=1.96-5.37). Most commonly, the underlying reason involved a preference to self-manage symptoms or not getting around to seeking care, with some variation by diagnosis. The findings highlight potential problems for individuals with mental and substance use disorders in accessing services. The elevated occurrence of perceived unmet need appeared to be relatively less affected by contact with the health care system than by generalized distress and problem severity. Issues such as stigma, motivation, and satisfaction with past services may influence help-seeking patterns and perceptions of unmet need and should be examined in future work.