Underutilization Of Mental Health Services Research Articles

Facilitators and barriers to mental health help-seeking in Indian immigrant youth in Gauteng, South Africa.

International literature has documented significant underutilisation of mental health services among Indian immigrants. This study aimed to identify facilitators and barriers to mental health help-seeking among Indian immigrant youth in South Africa by evaluating their personal and lived experiences. A qualitative study with a phenomenological design was conducted to understand the lived experiences of Indian immigrant youth regarding mental health help-seeking. Nine participants were recruited through purposive sampling from Gauteng. Data collection was performed through online interviews exploring participants' lived experiences. Thematic analysis was used to analyse the data. Five facilitator subthemes were identified: encouragement to seek help for mental health difficulties, social media and mass media influence, university and school environments, availability and awareness of resources, and open conversations about mental health. Four barrier subthemes emerged: individual perspectives on mental health, lack of access to resources, parental factors discouraging help-seeking, and community factors discouraging help-seeking. An improved understanding of these barriers and facilitators may allow other Indian immigrant youth to better manage their help-seeking processes while increasing awareness about similar experiences within the community.

Precipitating Factors and Receptivity of Psychoanalytic Treatments among Chinese Americans

ABSTRACT Chinese Americans have been known for underutilization of mental health services and premature termination. This study explores these phenomena through Chinese cultural and psychoanalytical perspectives. Specifically, two sets of factors were identified: precipitating and receptivity factors. The precipitating factors include childrearing practices and pursuit of education by studying abroad at an early age. The receptivity factors include the lack of familiarity with psychoanalysis, the emphasis of efficiency in Chinese culture, shame and stigma associated with mental illness, and the seeming reluctance of this ethnic group to opening up to professional strangers. A brief review of studies on Asian American mental health was conducted. Early termination was further discussed through psychoanalytic concepts and theories including Bion’s maternal reverie, attacks on linking, and container and contained; Winnicott’s primary maternal preoccupation; and Meltzer’s apprehension of beauty and aesthetic conflict.

A Review of Factors Contributing to Asian Americans' Underutilization of Mental Health Services

Asian American and Pacific Islander (AAPI) people are three times less likely than white Americans to seek any type of mental health care services or resources. Understanding this phenomenon requires a nuanced approach due to the cultural differences and heterogeneity within Asian American (AA) communities. The purpose of this review is to explore the multitude of factors that contribute to the underutilization of mental health services among AAs. I will synthesize peer-reviewed articles that cover factors contributing to AAs’ attitudes and behaviors related to mental health and mental health services. Primary mechanisms include stigma and shame, knowledge and beliefs about mental health treatment, and access to care. Additionally, implications for understanding and treating AA communities will be discussed.

Parent-Child Interaction Therapy for Muslim-American Parents and Young Children

There are limited data available regarding early childhood mental health in the Muslim American population. Nevertheless, the literature has shown that American Muslims are more likely to experience mental health disorders, including being twice as likely to report a history of suicide attempt1 compared to other religious communities.2 Despite these challenges, Muslims in America are often underserved and tend to underutilize mental health services, compared to other minority groups.2-5 The combination of Muslim children with significant mental health challenges and caregivers who underutilize mental health services reduces the likelihood that effective treatments will be used and increases risk of long-term harm for Muslim American children. Research has shown that Muslim American populations may be hesitant in seeking mental health treatment for a variety of reasons, including associated stigma behind mental illness within the community, fears related to past experiences of racism and discrimination in a post-9/11 world, differing way of conceptualizing mental illness and psychological distress that may lead to seeking alternative supports within family and community instead of mental health providers, and lack of knowledge about how to access formal mental health services.6,7 Another plausible reason for the underutilization of mental health services in this population is the concern that mental health treatment may not align with religious or cultural values.3

Willingness to use mental health counseling in diverse groups of Asian Americans.

Responding to the underutilization of mental health services in Asian American communities, we examined factors associated with their willingness to use mental health counseling. Applying Andersen's Behavioral Health Service Model, we focused on the role of mental health needs and prior use of mental health counseling in shaping the attitudes toward mental health counseling of diverse groups of Asian Americans. We conducted a secondary analysis of data from 2,609 Asian Americans aged 18 or older who participated in the Asian American Quality of Life (AAQoL) survey conducted in central Texas. Logistic regression models of willingness to use mental health counseling were tested with predisposing (age, gender, marital status, education, nativity, and English-speaking ability), mental health needs (mental distress and self-rated mental health) and enabling (prior use of mental health counseling) variables. About 67% of the overall sample indicated their willingness to use mental health counseling. Individuals who met the criteria for mental distress showed 17% lower odds of willingness to use mental health counseling. The enabling role of prior use of mental health counseling was supported; those who had used counseling were over three times more likely to be willing to use counseling in the future than their counterparts without such an experience. Given the inverse association between mental health needs and the willingness to use mental health counseling, further attention should be paid to improving Asian Americans' recognition of mental health symptoms and awareness of the benefit of mental health services. The enabling role of prior use of counseling also highlights the importance of increasing the exposure to mental health services for Asian Americans. In efforts to promote mental health literacy, reduce cultural stigma, and advocate for mental health service use, consideration of cultural and linguistic diversity within the Asian American population is imperative.

Mental Health Care Utilization and its Barriers among Iranian Breast Cancer Survivors: A Cross-sectional Study.

Depression and anxiety are common comorbidities complicating the care of breast cancer patients, but many patients do not receive the needed care. We aimed to assess utilization of mental health care and its barriers in breast cancer survivors. This cross-sectional study was conducted on 311 patients with breast cancer, in Iran, November 2021 to March 2022. Perceived need and utilization of mental health care and barriers to service utilization were measured based on self-report. Depression, Anxiety, and Stress Scale-21 and Multidimensional Scale of Perceived Social Support were used to assess depression, anxiety, and stress as well as social support, respectively. A linear and logistic regression model was used to analyze the data using SPSS version 22. A P-value less than 0.05 was considered statistically significant. 70.1% of the participants perceived need for mental health care, 28.0% of them had used mental health services, and 72% were classified as having unmet needs. The most common perceived barrier to service use was patients' self-adequacy. The prevalence of extremely severe levels of depression, anxiety, and stress was 14.8%, 23.5%, and 10.6%. Also, 48.6%, 78.5%, and 75.6% of patients received a high level of social support from friends, family, and significant others. Findings highlight a substantial unmet need for mental health care and low utilization of mental health services among breast cancer survivors. Given the significant prevalence of depression, anxiety, and stress in this population, it is imperative to address the underutilization of mental health services and to further examine the barriers preventing patients from seeking the care they require.

Why are African immigrants in Montreal reluctant to use mental health services?: a systematic inventory of reasons.

Previous research has shown that non-Caucasian immigrants in Western countries are less likely than native-born people to use mental health services. This study examined the reasons underlying reluctance to use mental health services among African immigrants in Montreal, Canada. The study participants were 280 African immigrants who had experienced symptoms suggesting depression but did not use formal mental health services. They were presented with a questionnaire that contained 65 statements referring to reasons for not using formal mental health services while experiencing those symptoms and were asked to indicate their degree of agreement with each of the statements on a scale of 0-10. Responses were then analyzed using factor analysis. An eight-factor structure of reasons was found: "Minimizing symptoms and perceived self-efficacy" (61% of the sample), "Relying on spiritual care" (56% of the sample), "Cost and waiting time" (45% of the sample), "Influence of significant others" (34% of the sample), "Lack of cultural competence" (32% of the sample), "Fear of stigmatization" (23% of the sample), "Nature of the consultation" (10% of the sample) and "Social models" (8% of the sample). Scores on these factors were related to participants' demographics. Effectively addressing the underutilization of mental health services among African immigrants requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various barriers to care.

Co-designing Mental Health Technologies with International University Students in Canada

Mental health problems are a serious concern among university students, and international students in Canada are known to be particularly vulnerable due to the underutilization of mental health services and unfamiliarity with Western approaches to mental health. However, international students' mental well-being remains underexplored in HCI. In this study, we conducted remote synchronous remote co-design sessions with 19 participants (14 international students, 5 mental health professionals) to understand concretely what types of designs for interactive technologies suit these students' mental health needs and challenges. Based on their brainstormed ideas and sketches, we produced a set of design dimensions that span different types of support, interaction, and safety. The dimensions were then used to develop a set of four medium-fidelity mockups that spanned these dimensions, presenting a diverse range of design features. Using these mockups, we elicited feedback in an online survey from the same participants. Findings suggest that the students negotiate a complex understanding of helpfulness, comfort, and trust when they consider what types of designs to consider using. Each mockup highlights different ways to support individual differences and preferences. Our work serves as a foundation for designing technologies that can ease issues with accessibility and be more inclusive of international students' cultural backgrounds.

Associations of historical trauma and racism with health care system distrust and mental health help-seeking propensity among American Indian and Alaska Native college students.

In the American Indian and Alaska Native (AIAN) population there is a discrepancy between high rates of mental health needs and low utilization rates of mental health services. This study sought to explore whether historical trauma and racial discrimination are associated with health care system (HCS) distrust and negative attitudes toward seeking mental health services. Participants were AIAN college students (n = 392) who completed a cross-sectional online survey. A sequential mediation analysis examined whether historical trauma (thoughts and associated symptoms) was associated with less favorable attitudes toward seeking mental health services, and whether distrust of the HCS mediated this association. A second mediation analysis examined whether perceived racial discrimination was associated with less favorable attitudes toward seeking mental health services, and whether distrust of the HCS mediated this association. Greater reported historical trauma (thoughts and associated symptoms) and racial discrimination were associated with greater distrust of the HCS, which in turn was associated with less favorable attitudes toward seeking mental health services. Perceived racial discrimination was also directly associated with less favorable attitudes toward seeking mental health services. Historical trauma and perceived racial discrimination appear to contribute to less favorable attitudes toward seeking mental health services through their association with distrust of the HCS. This suggests that attempts to address the underutilization of mental health services in the AIAN population should consider the potential roles of historical trauma, racial discrimination, and distrust. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The impact of COVID-19 quarantine on mental health: an observational study from an outpatient service for non-psychotic patients in Russia (Moscow)

We aimed to compare psychiatric hospital visits during the COVID-19 quarantine period with the same period in 2019, to reveal the predictors of underutilization of mental health services. We then investigated the fluctuation of telemedicine service during the quarantine period. The retrospective study included patients with non-psychotic mental disorders who consecutively visited the Moscow clinic. The number of outpatient visits, inpatient admissions, sociodemographic factors were analyzed. We assessed the sample within two periods - the “quarantine period” (March 30 - June 9, 2020) and “control period” (March 30 - June 9, 2019). Psychiatric visits decreased in older, retired and disabled persons, and increased among the unemployed. In multivariate analysis, the reduction became significant for the number of inpatient admissions. Telemedicine calls gradually increased from the start of the service, but decreased towards the end of the quarantine. In conclusion, referrals to outpatient and inpatient psychiatric services decreased during the quarantine period, with newly established TMS potentially compensating for that decrease. The strongest factor associated with visits during the pandemic is employment status.

Nonsuicidal self-injury among veterans is associated with psychosocial impairment, suicidal thoughts and behaviors, and underutilization of mental health services

Nonsuicidal self-injury (NSSI) is a robust predictor of suicide attempts. However, understanding of NSSI and associated treatment utilization among Veterans is limited. Although impairment may be assumed, few studies examine the association between NSSI and psychosocial functioning, a core component of the rehabilitation framework of mental health. In a national survey of Veterans, current NSSI (n = 88) was associated with higher rates of suicidal thoughts and behaviors and more severe psychosocial impairment after adjusting for demographics and probable diagnoses of posttraumatic stress disorder, major depressive disorder, and alcohol use disorder, compared to Veterans without NSSI (n = 979). Only half of Veterans with NSSI were engaged with mental health services, with few appointments attended, suggesting that these Veterans are not receiving treatment interventions. Results underscore the adverse outcomes associated with NSSI. Underutilization of mental health services highlights the importance of screening for NSSI among Veterans to improve psychosocial outcomes.

Understanding the intention and behavior of psychological help-seeking among Chinese college students using theory of planned behavior: a three-month follow-up study

ABSTRACT Underutilization of mental health services is common and associated with substantial suffering, mental disorders and death. The present study aimed to explore factors significantly affecting the professional psychological help-seeking behavior based on the Theory of Planned Behavior (TPB). A sample of 597 Chinese college students recruited online completed the questionnaires, which measured four constructs of TPB including help-seeking intention, attitude, subjective norm and perceived behavioral control in December 2020. Help-seeking behaviors were evaluated three months later in March 2021. A two-step structural equation modeling procedure was used to test the TPB model. Findings show that partially consistent with TPB, more positive attitudes about seeking professional help (Β = .258, p = .001) and higher perceived behavioral control (Β = .504, p < .001) directly predicted higher intention to seek mental health services, and perceived behavioral control (Β = .230, p = .006) directly predicted help-seeking behavior. However, behavioral intention (Β = −.017, p = .830) did not statistically significantly predict help-seeking behavior, while subjective norm (Β = .047, p = .356) did not predict help-seeking intention as well. The model accounted for 49.9% of the variance modeling help-seeking intention and 12.4% of the variance modeling help-seeking behavior. The results revealed the importance of attitude and perceived behavioral control in predicting help-seeking intention and behavior among Chinese college students and indicated that there existed a gap between intention and actual help-seeking behavior.

Recommendations for design of a mobile application to support management of anxiety and depression among Black American women.

Black American women experience adverse health outcomes due to anxiety and depression. They face systemic barriers to accessing culturally appropriate mental health care leading to the underutilization of mental health services and resources. Mobile technology can be leveraged to increase access to culturally relevant resources, however, the specific needs and preferences that Black women feel are useful in an app to support management of anxiety and depression are rarely reflected in existing digital health tools. This study aims to assess what types of content, features, and important considerations should be included in the design of a mobile app tailored to support management of anxiety and depression among Black women. Focus groups were conducted with 20 women (mean age 36.6 years, SD 17.8 years), with 5 participants per group. Focus groups were led by a moderator, with notetaker present, using an interview guide to discuss topics, such as participants' attitudes and perceptions towards mental health and use of mental health services, and content, features, and concerns for design of a mobile app to support management of anxiety and depression. Descriptive qualitative content analysis was conducted. Recommendations for content were either informational (e.g., information to find a Black woman therapist) or inspirational (e.g., encouraging stories about overcoming adversity). Suggested features allow users to monitor their progress, practice healthy coping techniques, and connect with others. The importance of feeling "a sense of community" was emphasized. Transparency about who created and owns the app, and how users' data will be used and protected was recommended to establish trust. The findings from this study were consistent with previous literature which highlighted the need for educational, psychotherapy, and personal development components for mental health apps. There has been exponential growth in the digital mental health space due to the COVID-19 pandemic; however, a one-size-fits-all approach may lead to more options but continued disparity in receiving mental health care. Designing a mental health app for and with Black women may help to advance digital health equity by providing a tool that addresses their specific needs and preferences, and increase engagement.

Factors affecting the utilization of mental health services among undergraduate students in a Nigerian University

Under-utilization of mental health services among university students is a major public health concern. This study assessed the factors affecting the utilization of mental health services among undergraduate students.This research was a cross-sectional survey carried out among students of Afe Babalola University, Ado-Ekiti, Nigeria. A semi-structured self-administered questionnaire was used for data collection and multi-stage sampling technique was used in sampling the participants. Utilization, attitude, and health seeking behavior were categorized into good (≥50% score), and poor (<50% score), while social support was categorized into poor (8–18), moderate (19–25), and strong (26–32). Chi-square test and Logistic regression were used to assess the relationship between the categorical variables.450 students enrolled in this study of which 52.4% were females and mean age of 19.40 ± 1.65 years. Most students showed a good attitude (87.5%), health seeking behavior (67.8%), and poor social support (69.4%) towards mental health services. There was an association between source of information (p = 0.005), health seeking behavior (p = 0.001) and utilization of mental health services. There was also a higher likelihood for students of female gender (OR: 1.621 (1.072–2.452)) and being aged above 20 years (OR: 1.331 (0.822–2.153)) to have good utilization of mental health services.Majority of the students showed good attitude and health seeking behavior towards mental health services but there was poor utilization as well as poor to moderate social support towards mental health services. Gender, age, attitude, source of information as well as health seeking behavior are important factors that can affect the utilization of mental health services among undergraduate students. Interventions targeted towards these factors should be done to ultimately improve utilization of mental health services among undergraduate students.

Attitudes and stigma toward seeking psychological help among Saudi Adults

BackgroundIn the Kingdom of Saudi Arabia (KSA), public attitudes and stigma toward mental health illness seem to prevent people from seeking psychological help, which negatively impacts an individual's life. The primary objective of this study was to investigate people's attitudes toward seeking psychological help and identify the extent to which the associated stigma is responsible for preventing them from seeking psychological help.MethodsTwo hundred eighteen adults recruited from the community living in the Eastern Province of the KSA completed the questionnaires, customized to create the Arabic version of Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF-A), the Arabic version of Stigma Scale for Receiving Psychological Help (SSRPH-A), and the Arabic version of Hopkins Symptom Checklist-25 (HSCL-25-A).ResultsBoth stigma and psychological distress significantly affected attitudes toward seeking professional help. Furthermore, it indicated that attitudes were negatively correlated with stigma while positively correlated with psychological distress. No significant difference in attitudes toward psychological help-seeking was identified between male and female participants. However, males displayed higher levels of stigma, while females showed greater psychological distress. Furthermore, the groups who received psychological treatment demonstrated more favorable attitudes toward seeking psychological help.ConclusionStigma and psychological stress influence attitudes toward treatment-seeking behavior for mental illness, making them two major predictors responsible for the underutilization of mental health services. More research is needed to assess specific sociodemographic disparities across more data sources and the factors that further contribute to stigma and psychological distress.

Examining the help‐seeking intentions of Chinese individuals in the United States

AbstractThe underutilization of mental health services by Chinese individuals in the United States is concerning. In this study, we examined Chinese individuals’ help‐seeking intentions utilizing the theory of planned behavior. Two hundred fifty‐one participants were recruited for this study. The results revealed that help‐seeking attitudes (β = 0.28, p &lt; 0.001), perceived behavioral control (β = 0.21, p &lt; 0.001), and subjective norms (β = 0.13, p &lt; 0.001) were found to be significant predictors of help‐seeking intentions. The implications of the results are discussed.

Personality traits and mental health care utilization: Longitudinal findings from the MIDUS

Underutilization of mental health services is prevalent in the U.S., and an understanding of utilization patterns can inform interventions to enhance treatment use. The current study investigated longitudinal associations between changes in mental health care utilization (MHCU) and Big Five personality traits. Data included three waves (4,658 adult participants) of the Midlife Development in the United States (MIDUS) study. 1,632 participants provided data at all three waves. Second-order latent growth curve models showed that MHCU level predicted an increase in emotional stability, and emotional stability level predicted a decrease in MHCU. Increases in emotional stability, extraversion, and conscientiousness predicted decreases in MHCU. These results indicate that personality is associated with MHCU over time and may inform interventions to increase MHCU.

Why Do People of Asian Descent Not Utilize Mental Health Treatments Compared to Other Ethnic Groups in the United States?

Racial and ethnic minorities like Asians in the United States are significantly less likely to receive mental health treatment than Caucasians. Using 2012 Behavioral Risk Factor Surveillance System data, we examined the underutilization of mental health treatment in the US and find that being over 65 or 35–44, being unmarried, and being insured were positively associated with mental health treatment utilization, and as mentally unhealthy days increased, the utilization of treatment also increased. The paper offers a discussion on why there is this underutilization of mental health services amongst Asians and what steps can be taken to improve utilization.

Are all children treated equally? Psychiatric care and treatment receipt among migrant, descendant and majority Swedish children: a register-based study.

Underutilisation of mental health services among migrant youth has been demonstrated repeatedly, but little is known about potential discrepancies in terms of treatment receipt for those who do reach services. This study examines the type and level of care received among migrant children and descendants of migrants, particularly investigating disparities in treatment receipt given a specific diagnosis. We used register data of the total population aged 6-17 years in Stockholm, followed from 2006 to 2015, comprising 444 196 individuals, categorised as refugees, non-refugee migrants, descendants of migrants and Swedish-born. To identify recommended treatments for specific diagnoses we used official clinical guidelines. We report logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) of diagnosis receipt, treatment provision and level of care where a diagnosis was first registered. Migrant children had a lower likelihood of receiving a wide range of psychiatric diagnoses, including mood disorder (OR 0.58; 95% CI 0.52-0.64), anxiety disorder (OR 0.62; 95% CI 0.57-69) and neurodevelopmental disorder (OR 0.59; 95% CI 0.55-0.63). Moreover, when these diagnoses were set, migrant children had a lower likelihood of receiving the recommended treatments for these conditions compared to the majority individuals with the same diagnosis (OR of receiving psychotherapy for anxiety disorder and depression: 0.71; 95% CI 0.62-0.95 and 0.50; 95% CI 0.33-0.75, respectively; OR for receiving ADHD-medication: 0.49; 95% CI 0.43-0.54). Migrant children risk underdiagnosis of various mental health conditions, and, when reaching mental health services, risk not receiving the optimal care available.

Mental Health Literacy: a Critical Target for Narrowing Racial Disparities in Behavioral Health.

One of the most persistent and troubling health disparities is the underutilization of mental health services, particularly for depression and anxiety, commonly occurring behavioral health concerns. The gap between individuals who need mental health care and those who receive care is large, and identified barriers to treatment include poor mental health and insurance literacy, as well as stigmatizing attitudes toward mental health disorders. The present study presents the results of an inquiry into the mental health literacy, insurance literacy, internalized stigma, and mental health symptoms. Results suggest that mental health literacy is poor and associated with higher rates of depression, anxiety, stress, internalized stigma, and caregiver burden. Implications of poor mental health literacy, as well as demographic disparities in literacy, are discussed.