Barriers to mental health services utilisation in Portugal – results from the National Mental Health Survey

Abstract

Background

The treatment gap for mental disorders remains a challenge worldwide. Identifying reasons for nontreatment may contribute to reducing this gap.

Aims

To evaluate sociodemographic and clinical factors associated with use and barriers to treatment in Portugal.

Method

Data from the 2009 National Mental Health Survey were used. Participants reported 12-month treatment and reasons for nontreatment. Logistic regression models analysed the association between sociodemographic (education; employment; income; marital status) and clinical variables (mental disorder diagnosis; disability) with treatment and type of barriers (low perceived need; structural; attitudinal).

Results

The majority of participants with a mental disorder was not treated. Treatment was more common among participants with mood disorders (OR = 4.19; 95% CI: 2.72–6.46), and disability (OR = 2.43; 95% CI: 1.33–4.46), and less common among single participants (OR = 0.38; 95% CI: 0.20–0.70) and those with basic/secondary education (OR = 0.42; 95% CI: 0.24–0.73). Attitudinal barriers were more likely among participants with none/primary (OR = 2.90; 95% CI: 1.42–5.90) and basic/secondary education (OR = 1.70; 95% CI: 1.01–2.85), and less likely among those with substance use disorders (OR = 0.27; 95% CI: 0.10–0.70). Low perceived need was higher among single people (OR = 1.77; 95% CI: 1.01–3.08), and lower among those with anxiety (OR = 0.50; 95% CI: 0.28–0.90) and mood disorders (OR = 0.16; 95% CI: 0.09–0.30). Unemployed participants had higher odds of reporting structural barriers (OR = 3.76; 95% CI: 1.29–10.92).

Conclusions

This study identifies factors associated with nontreatment, providing useful evidence to develop policies and effective interventions.

Keywords:

• Mental healthcare
• treatment seeking
• barriers to use
• health policy
• social inequalities

Acknowledgements

The authors thank the World Mental Health Survey Initiative staff for their assistance with instrumentation, fieldwork and data analysis. A complete list of funding support and publications can be found at: http://www.hcp.med.harvard.edu/wmh.

Compliance with ethical standards

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the Nova Medical School, Nova University of Lisbon (ref. 10/2008), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent: Informed consent was obtained from all individual participants included in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The Portuguese Mental Health Study was carried out by the Department of Mental Health, Nova Medical School, Nova University of Lisbon, with collaboration of the CESOP–Portuguese Catholic University and was funded by the Champalimaud Foundation, the Gulbenkian Foundation, the Foundation for Science and Technology (FCT) and the Ministry of Health. The Portuguese Mental Health Study was carried out in conjunction with the World Health Organization WMH Survey Initiative which is supported by the National Institute of Mental Health [NIMH; R01MH070884], the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the U.S. Public Health Service [R13-MH066849, R01-MH069864 and R01-DA016558], the Fogarty International Center [FIRCA R03-TW006481], the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline and Bristol-Myers Squibb. The National Mental Health Survey Follow-Up was funded by the Public Health Initiatives Programme [PT06], financed by EEA Grants Financial Mechanism 2009–2014. For further information, please visit http//www.eeagrants.gov.pt/.