Delay in seeking treatment for depression. Perceptions of patients with depressive disorders

Manuscript (ελληνικά)
Published: Jul 3, 2023
DOI: https://doi.org/10.12681/psy_hps.30963
Keywords:
depressive disorder treatment gap delayed care seeking qualitative research
Eleni Skoura
University of West Attica
George Koulierakis
University of West Attica
https://orcid.org/0000-0003-3705-1007
Theodoros Fouskas
University of West Attica
Abstract

The aim of the current was to explore the perceptions and convictions of patients diagnosed with depressive disorder, which related to delayed seek for treatment. For this purpose, semi-structured interviews were conducted with ten patients diagnosed with depression, from a public psychiatric hospital and a Mental Health Center. The research material was analysed through Thematic Analysis. From the collected material and the analysis, four main themes were emerged: (a) inability to assess psychopathological symptoms by patients, (b) endogenous/individual features that contribute to delaying seeking treatment, (c) barriers to access mental health services and (d) the role of the family/supportive environment in seeking treatment for depression. Themes include specific factors affecting delayed seeking for treatment. These factors seem to be the perceived stigma, patients’ beliefs and personal views/attitudes, as well as external/practical or environmental barriers, such as lack of resources within health services, lack of information /literacy in mental health and perceptions of the family members aboutmental illness. It is necessary to carry out mental health reforms and also to organize campaigns aimed at raising awareness - informing the population and reducing the therapeutic gap in depressive disorder and more widely in mental illness.

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References
American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). APA Publishing.
Andersen, R., & Newman, J. F. (1973). Societal and Individual Determinants of Medical Care Utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society, 51(1), 95-124. https://doi.org/10.2307/3349613
Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., de Graaf, R., Florescu, S., Gureje, O., Hinkov, H. R., Hu, C., Huang, Y., Hwang, I., Jin, R., Karam, E. G., Kovess-Masfety, V., … Kessler, R. C. (2014). Barriers to mental health treatment: Results from the WHO World Mental Health surveys. Psychological Medicine, 44(6), 1303–1317. https://doi.org/10.1017/S0033291713001943
Barney, L. J., Griffiths, K. M., Jorm, A. F., & Christensen, H. (2006). Stigma about Depression and its Impact on Help-Seeking Intentions. Australian & New Zealand Journal of Psychiatry, 40(1), 51–54. https://doi.org/10.1080/j.1440-1614.2006.01741.x
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychololy, 3, 77–101. https://doi.org/10.1191/1478088706qp063oa
Braun, V., & Clarke, V. (2014). What can ‘thematic analysis’ offer health and wellbeing researchers? International Journal of Qualitative Studies on Health and Well-Being, 9, 26152–26152. https://doi.org/10.3402/qhw.v9.26152
Bryman, A. (2012). Social research methods (4th ed). Oxford University Press.
Burnard, P., Gill, P., Stewart, K., Treasure, E., & Chadwick, B. (2008). Analysing and presenting qualitative data. British Dental Journal, 204(8), 429–432. https://doi.org/10.1038/sj.bdj.2008.292
Γαλάνης, Π. (2017). Βασικές αρχές της ποιοτικής έρευνας στις επιστήμες υγείας. Αρχεία Ελληνικής Ιατρικής, 34(6), 834-840.
Γαλάνης, Π. (2018). Ανάλυση δεδομένων στην ποιοτική έρευνα. Θεματική ανάλυση. Αρχεία Ελληνικής Ιατρικής, 35(3), 416-421.
Colorafi, K. J., & Evans, B. (2016). Qualitative Descriptive Methods in Health Science Research. HERD, 9(4), 16–25. https://doi.org/10.1177/1937586715614171
Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM - Population Health, 15, 100847. https://doi.org/10.1016/j.ssmph.2021.100847
Creswell, J. W. (2008). Educational research: Planning, conducting, and evaluating quantitative and qualitative research (3rd ed.). Pearson.
Cuijpers, P., Quero, S., Dowrick, C., & Arroll, B. (2019). Psychological Treatment of Depression in Primary Care: Recent Developments. Current Psychiatry Reports, 21(12), 129–129. https://doi.org/10.1007/s11920-019-1117-x
da Silva, A. G., Baldaçara, L., Cavalcante, D. A., Fasanella, N. A., & Palha, A. P. (2020). The Impact of Mental Illness Stigma on Psychiatric Emergencies. Frontiers in Psychiatry, 11, 573–573. https://doi.org/10.3389/fpsyt.2020.00573
De las Cuevas, C., & Peñate, W. (2015). Explaining pharmacophobia and pharmacophilia in psychiatric patients: Relationship with treatment adherence. Human Psychopharmacology: Clinical and Experimental, 30(5), 377–383. https://doi.org/10.1002/hup.2487
Dutta, M., Spoorthy, M. S., Patel, S., & Agarwala, N. (2019). Factors responsible for delay in treatment seeking in patients with psychosis: A qualitative study. Indian Journal of Psychiatry, 61(1). https://doi.org/10.4103/psychiatry.IndianJPsychiatry_234_17
Ελληνική Στατιστική Αρχή (2020). ΕΡΕΥΝΑ ΥΓΕΙΑΣ: Έτος 2019. Δελτίο Τύπου. https://www.statistics.gr/documents/20181/5856c8ff-59cd-aef0-2883-f90e4b265706
Farmer, C., Farrand, P., & O’Mahen, H. (2012). ‘I am not a depressed person’: How identity conflict affects help-seeking rates for major depressive disorder. BMC Psychiatry, 12(1), 164. https://doi.org/10.1186/1471-244X-12-164
Fitzpatrick, R., & Boulton, M. (1994). Qualitative methods for assessing health care. Quality in Health Care, 3(2), 107–113. https://doi.org/10.1136/qshc.3.2.107
Fortin, M., Bamvita, J-M., & Fleury, M-J. (2018). Patient satisfaction with mental health services based on Andersen’s Behavioral Model. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 63(2), 103–114. https://doi.org/10.1177/0706743717737030
Fountoulakis, K. N., Apostolidou, M. K., Atsiova, M. B., Filippidou, A. K., Florou, A. K., Gousiou, D. S., Katsara, A. R., Mantzari, S. N., Padouva-Markoulaki, M., Papatriantafyllou, E. I., Sacharidi, P. I., Tonia, A. I., Tsagalidou, E. G., Zymara, V. P., Prezerakos, P. E., Koupidis, S. A., Fountoulakis, N. K., & Chrousos, G. P. (2021). Self-reported changes in anxiety, depression and suicidality during the COVID-19 lockdown in Greece. Journal of Affective Disorders, 279, 624–629. https://doi.org/10.1016/j.jad.2020.10.061
Call, J. B., & Shafer, K. (2018). Gendered Manifestations of Depression and Help Seeking Among Men. American Journal of Men’s Health, 41–51. https://doi.org/10.1177/1557988315623993
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England), 392(10159), 1789–1858. https://doi.org/10.1016/S0140-6736(18)32279-7
Graham, A., Hasking, P., Brooker, J., Clarke, D., & Meadows, G. (2017). Mental health service use among those with depression: an exploration using Andersen's Behavioral Model of Health Service Use. Journal of Affective Disorders, 208, 170–176. https://doi.org/10.1016/j.jad.2016.08.074
Griffiths, K. M., Crisp, D. A., Barney, L., & Reid, R. (2011). Seeking help for depression from family and friends: A qualitative analysis of perceived advantages and disadvantages. BMC Psychiatry, 11, 196–196. https://doi.org/10.1186/1471-244X-11-196
Goepfert, N. C., Conrad von Heydendorff, S., Dreßing, H., & Bailer, J. (2019). Effects of stigmatizing media coverage on stigma measures, self-esteem, and affectivity in persons with depression – an experimental controlled trial. BMC Psychiatry, 19(1), 138. https://doi.org/10.1186/s12888-019-2123-6
Goffman, E. (1968). Stigma: Notes on the Management of Spoiled Identity. Pelican Books.
Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10, 113–113. https://doi.org/10.1186/1471-244X-10-113
Gulliver, A., Griffiths, K. M., Christensen, H., & Brewer, J. L. (2012). A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry, 12(1), 81. https://doi.org/10.1186/1471-244X-12-81
Hamilton, A. B., & Finley, E. P. (2019). Qualitative methods in implementation research: An introduction. Psychiatry Research, 280, 112516. https://doi.org/10.1016/j.psychres.2019.112516
Henderson, C., Evans-Lacko, S., & Thornicroft, G. (2013). Mental illness stigma, help seeking, and public health programs. American Journal of Public Health, 103(5), 777–780. https://doi.org/10.2105/AJPH.2012.301056
Ivbijaro, G. (2012). The case for change: The Global Mental Health Action Plan 2013-2020. Mental Health in Family Medicine, 9(3), 135–135.
Kale, R. (2002). The Treatment Gap. Epilepsia, 43, 31–33. https://doi.org/10.1046/j.1528-1157.43.s.6.13.x
Καλλινικάκη, Θ. (2010). Ποιοτικές μέθοδοι στην έρευνα της κοινωνικής εργασίας. Τόπος.
Kanehara, A., Umeda, M., Kawakami, N., & World Mental Health Japan Survey Group. (2015). Barriers to mental health care in Japan: Results from the World Mental Health Japan Survey. Psychiatry and Clinical Neurosciences, 69(9). 523–533. https://doi.org/10.1111/pcn.12267
Karam, E. G., Karam, G. E., Farhat, C., Itani, L. J., Fayyad, J., Karam, A. N., Mneimneh, Z., Kessler, R., & Thornicroft, G. (2018). Determinants of treatment of mental disorders in Lebanon: barriers to treatment and changing patterns of service use. Epidemiology and Psychiatric Sciences, 28(6), 655-661. https://doi.org/10.1017/S2045796018000422
Κεδράκα, Κ. (2008). Μεθοδολογία λήψης συνέντευξης. Ελληνικό Ανοικτό Πανεπιστήμιο. https://doi.org/10.13140/RG.2.1.5050.9846
Kessler, R. C. (2012). The costs of depression. The Psychiatric clinics of North America, 35(1), 1–14. https://doi.org/10.1016/j.psc.2011.11.005
Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare Management Forum, 30(2), 111–116. https://doi.org/10.1177/0840470416679413
Kohn, R., Saxena, S., Levav, I., & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World Health Organization, 82(11), 858–866.
Kohn, R., Ali, A. A., Puac-Polanco, V., Figueroa, C., López-Soto, V., Morgan, K., Saldivia, S., & Vicente, B. (2018). Mental health in the Americas: An overview of the treatment gap. Revista Panamericana de Salud Publica = Pan American Journal of Public Health, 42, e165–e165. https://doi.org/10.26633/RPSP.2018.165
Kvale, S. (2007). Doing interviews. Sage Publications Ltd. https://doi.org/10.4135/9781849208963
Leventhal, H., Phillips, L. A. & Burns, E. (2016). The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. Journal of Behavioral Medicine, 39, 935–946. https://doi.org/10.1007/s10865-016-9782-2
Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18. https://doi.org/10.1186/1475-9276-12-18
Li, X. Y., Liu, Q., Chen, P., Ruan, J., Gong, X., Luo, D., Zhou, Y., Yin, C., Wang, X. Q., Liu, L., & Yang, B. X. (2022). Predictors of Professional Help-Seeking Intention Toward Depression Among Community-Dwelling Populations: A Structural Equation Modeling Analysis. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.801231
Lindheim, T. (2022). Participant Validation: A Strategy to Strengthen the Trustworthiness of Your Study and Address Ethical Concerns. In G. Espedal, B. Jelstad Løvaas, S. Sirris, & A. Wæraas (Eds.), Researching Values: Methodological Approaches for Understanding Values Work in Organisations and Leadership (pp. 225–239). Springer International Publishing. https://doi.org/10.1007/978-3-030-90769-3_13
Liu, Q., He, H., Yang, J., Feng, X., Zhao, F., & Lyu, J. (2020). Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. Journal of Psychiatric Research, 126, 134–140. https://doi.org/10.1016/j.jpsychires.2019.08.002
Lund, C., Tomlinson, M., De Silva, M., Fekadu, A., Shidhaye, R., Jordans, M., Petersen, I., Bhana, A., Kigozi, F., Prince, M. Thornicroft, G., Hanlon, C., Kakuma, R., McDaid, D., Saxena, S., Chisholm, D., Raja, S., Kippen-Wood, S., Honikman, S. …. Patel, V. (2012). PRIME: A Programme to Reduce the Treatment Gap for Mental Disorders in Five Low- and Middle-Income Countries. PLoS Medicine, 9(12), Article e1001359.
https://doi.org/10.1371/journal.pmed.1001359
Madianos, M. G. (2020). The adventures of psychiatric reform in Greece: 1999–2019. BJPsych International, 17(2), 26–28. Cambridge Core. https://doi.org/10.1192/bji.2019.30
Magaard, J. L., Seeralan, T., Schulz, H., & Brütt, A. L. (2017). Factors associated with help-seeking behaviour among individuals with major depression: A systematic review. PLOS ONE, 12(5), Article e0176730. https://doi.org/10.1371/journal.pone.0176730
Michel, C., Schnyder, N., Schmidt, S. J., Groth, N., Schimmelmann, B. G., & Schultze-Lutter, F. (2018). Functioning mediates help-seeking for mental problems in the general population. European Psychiatry: The Journal of the Association of European Psychiatrists, 54, 1–9. https://doi.org/10.1016/j.eurpsy.2018.06.009
Mojtabai, R., Olfson, M., Sampson, N. A., Jin, R., Druss, B., Wang, P. S., Wells, K. B., Pincus, H. A., & Kessler, R. C. (2011). Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychological Medicine, 41(8), 1751–1761. https://doi.org/10.1017/S0033291710002291
Moser, A., & Korstjens, I. (2018). Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. The European Journal of General Practice, 24(1), 9–18. https://doi.org/10.1080/13814788.2017.1375091
Pathak, V., Jena, B., & Kalra, S. (2013). Qualitative research. Perspectives in Clinical Research 4(3), 192. https://doi.org/10.4103/2229-3485.115389
Patton, Μ. (1990). Qualitative evaluation and research methods. Sage.
Picco, L., Lau, Y. W., Pang, S., Abdin, E., Vaingankar, J. A., Chong, S. A., & Subramaniam, M. (2017). Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: Findings from a cross-sectional survey in Singapore. BMJ Open, 7(8), Article e018228. https://doi.org/10.1136/bmjopen-2017-018228
Pile, V., Smith, P., Leamy, M., Blackwell, S. E., Meiser-Stedman, R., Stringer, D., Ryan, E. G., Dunn, B. D., Holmes, E. A., & Lau, J. Y. F. (2018). A brief early intervention for adolescent depression that targets emotional mental images and memories: Protocol for a feasibility randomised controlled trial (IMAGINE trial). Pilot and Feasibility Studies, 4, 97. https://doi.org/10.1186/s40814-018-0287-3
Qin, X., & Hsieh, C.-R. (2020). Understanding and Addressing the Treatment Gap in Mental Healthcare: Economic Perspectives and Evidence From China. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 57, 004695802095056. https://doi.org/10.1177/0046958020950566
Richards, H. M., & Schwartz, L. J. (2002). Ethics of qualitative research: Are there special issues for health services research? Family Practice, 19(2), 135–139. https://doi.org/10.1093/fampra/19.2.135
Samari, E., Teh, W. L., Roystonn, K., Devi, F., Cetty, L., Shahwan, S., & Subramaniam, M. (2022). Perceived mental illness stigma among family and friends of young people with depression and its role in help-seeking: A qualitative inquiry. BMC Psychiatry, 22(1), 107. https://doi.org/10.1186/s12888-022-03754-0
Santomauro, D. F., Mantilla Herrera, A. M., Shadid, J., Zheng, P., Ashbaugh, C., Pigott, D. M., Abbafati, C., Adolph, C., Amlag, J. O., Aravkin, A. Y., Bang-Jensen, B. L., Bertolacci, G. J., Bloom, S. S., Castellano, R., Castro, E., Chakrabarti, S., Chattopadhyay, J., Cogen, R. M., Collins, J. K., … Ferrari, A. J. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet, 398(10312), 1700–1712. https://doi.org/10.1016/S0140-6736(21)02143-7
Seligman, F., & Nemeroff, C. B. (2015). The interface of depression and cardiovascular disease: therapeutic implications. Annals of the New York Academy of Sciences, 1345, 25–35. https://doi.org/10.1111/nyas.12738
Siva, N. (2021). Severe mental illness: reassessing COVID-19 vaccine priorities. Lancet, 397(10275), 657. https://doi.org/10.1016/S0140-6736(21)00429-3
Skapinakis, P., Bellos, S., Oikonomou, A., Dimitriadis, G., Gkikas, P., Perdikari, E., & Mavreas, V. (2020). Depression and Its Relationship with Coping Strategies and Illness Perceptions during the COVID-19 Lockdown in Greece: A Cross-Sectional Survey of the Population. Depression Research and Treatment, 3158954. https://doi.org/10.1155/2020/3158954
Shumet, S., Azale, T., Ayano, G., Abebaw, D., Amare, T., & Getnet, W. (2019). Intention to seek help for depression and associated factors among residents of Aykel town, Northwest Ethiopia: Cross-sectional study. International Journal of Mental Health Systems, 13(1), 18. https://doi.org/10.1186/s13033-019-0274-y
Simon, J., Wienand, D., Park, A.-L., Wippel, C., Mayer, S., Heilig, D., Laszewska, A., Stelzer, I., Goodwin, G. M., & McDaid, D. (2023). Excess resource use and costs of physical comorbidities in individuals with mental health disorders: A systematic literature review and meta-analysis. European Neuropsychopharmacology, 66, 14–27. https://doi.org/10.1016/j.euroneuro.2022.10.001
Souliotis, K., Agapidaki, E., Tzavara, C., & Economou, M. (2017). Psychiatrists role in primary health care in Greece: Findings from a quantitative study. International Journal of Mental Health Systems, 11(1), 65. https://doi.org/10.1186/s13033-017-0172-0
Subramaniam, M., Abdin, E., Vaingankar, J. A., Shafie, S., Chua, H. C., Tan, W. M., Tan, K. B., Verma, S., Heng, D., & Chong, S. A. (2020). Minding the treatment gap: Results of the Singapore Mental Health Study. Social Psychiatry and Psychiatric Epidemiology, 55(11), 1415–1424. https://doi.org/10.1007/s00127-019-01748-0
Τσιώλης, Γ. (2015). Ανάλυση ποιοτικών δεδομένων: Διλήμματα, δυνατότητες, διαδικασίες. Στο Γ. Πυργιωτάκης, Χρ. Θεοφιλίδης (Επιμ.), Ερευνητική Μεθοδολογία στις Κοινωνικές Επιστήμες και στην Εκπαίδευση. Συμβολή στην επιστημολογική θεωρία και την ερευνητική πράξη (σς. 473-498). Πεδίο.
Τσιώλης, Γ. (2018). Θεματική ανάλυση ποιοτικών δεδομένων. Στο Γ. Ζαϊμάκης (Επιμ.), Ερευνητικές διαδρομές στις κοινωνικές επιστήμες: Θεωρητικές-Μεθοδολογικές συμβολές και μελέτες περίπτωσης (σσ. 97-125). (Πρώτη έκδοση). Πανεπιστήμιο Κρήτης.
van Beljouw, I., Verhaak, P., Prins, M., Cuijpers, P., Penninx, B., & Bensing, J. (2010). Reasons and Determinants for Not Receiving Treatment for Common Mental Disorders. 61(3), 8.
Wang, J., Wu, X., Lai, W., Long, E., Zhang, X., Li, W., Zhu, Y., Chen, C., Zhong, X., Liu, Z., Wang, D., & Lin, H. (2017). Prevalence of depression and depressive symptoms among outpatients: A systematic review and meta-analysis. BMJ Open, 7(8), Article e017173. https://doi.org/10.1136/bmjopen-2017-017173
Waumans, R. C., Muntingh, A., Draisma, S., Huijbregts, K. M., van Balkom, A., & Batelaan, N. M. (2022). Barriers and facilitators for treatment-seeking in adults with a depressive or anxiety disorder in a Western-European health care setting: a qualitative study. BMC Psychiatry, 22(1), 165. https://doi.org/10.1186/s12888-022-03806-5
Wei, Y., McGrath, P. J., Hayden, J., & Kutcher, S. (2015). Mental health literacy measures evaluating knowledge, attitudes and help-seeking: A scoping review. BMC Psychiatry, 15(1), 291. https://doi.org/10.1186/s12888-015-0681-9
Witteman, C., Bolks, L., & Hutschemaekers, G. (2011). Development of the Illness Perception Questionnaire Mental Health. Journal of Mental Health, 20(2), 115–125. https://doi.org/10.3109/09638237.2010.507685
World Health Organization (2020). Depression. https://www.who.int/news-room/fact-sheets/detail/depression
Yang, F., Yang, B. X., Stone, T. E., Wang, X. Q., Zhou, Y., Zhang, J., & Jiao, S. F. (2020). Stigma towards depression in a community-based sample in China. Comprehensive Psychiatry, 97, 152152. https://doi.org/10.1016/j.comppsych.2019.152152
Yi, Y., Turney, K., & Wildeman, C. (2017). Mental Health Among Jail and Prison Inmates. American Journal of Men’s Health, 11(4), 900–909. https://doi.org/10.1177/1557988316681339
Zelmer, J. (2018). Measuring Progress in Access to Health Services. Healthcare Policy = Politiques de Sante, 14(1), 6–9. https://doi.org/10.12927/hcpol.2018.25554
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