|Year : 2020 | Volume
| Issue : 1 | Page : 16-20
A cross-sectional study of the barriers for seeking mental health care among medical undergraduates
Lakshmi Shodhana Kasam1, Raghuram Macharapu1, Vishnu Gade2, Pramod K R. Mallepalli1, Ravulapati Sateesh Babu1, S Manjula1
1 Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
2 Department of Psychiatry, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India
|Date of Submission||15-Aug-2019|
|Date of Decision||16-Aug-2020|
|Date of Acceptance||16-Jan-2020|
|Date of Web Publication||03-Jul-2020|
Dr. Vishnu Gade
Department of Psychiatry, Pratima Medical College, Karimnagar, Telangana
Source of Support: None, Conflict of Interest: None
Aims and Objectives: The aim and objective of this study are to study the major barriers to seeking mental health care among medical undergraduates and to understand the correlation between barriers and demographic factors.
Materials and Methods: This was a cross-sectional study that was conducted with a sample that consists of 100 participants in Mamata Medical College, Khammam and Pratima Medical college, Telangana, India, during the period of 6 months (2019). A semi-structured pro forma was used to collect the sociodemographic details, and the Barriers to Access to Care Evaluation Scale was used to assess the reasons for not seeking mental health services.
Results: This study found that 26% of the participants did not seek any kind of mental health care despite needing it. The analysis revealed that stigmatizing beliefs, difficulty in sharing one's concerns, preference for self-reliance, and difficulty in accessing help were the prominent barrier themes among responders.
Conclusions: This study highlights the vast discrepancy in the number of individuals in need of mental health care and the actual number of people seeking it. The present findings indicate that interventions are required to improve mental health literacy and knowledge of local services.
Keywords: Barriers, health services accessibility, help-seeking behavior, mental health, primary health care, undergraduates
|How to cite this article:|
Kasam LS, Macharapu R, Gade V, R. Mallepalli PK, Babu RS, Manjula S. A cross-sectional study of the barriers for seeking mental health care among medical undergraduates. Arch Ment Health 2020;21:16-20
|How to cite this URL:|
Kasam LS, Macharapu R, Gade V, R. Mallepalli PK, Babu RS, Manjula S. A cross-sectional study of the barriers for seeking mental health care among medical undergraduates. Arch Ment Health [serial online] 2020 [cited 2020 Aug 10];21:16-20. Available from: http://www.amhonline.org/text.asp?2020/21/1/16/288915
| Introduction|| |
According to the National Mental Health Survey of India, conducted by NIMHANS, Bangalore, India, 150 million individuals require active intervention for mental health problems, but only 30 million individuals are undergoing treatment. This survey is a clear representation of the unfavorable attitude toward mental health care. Although there have been continuous efforts to promote mental health and reduce the stigma surrounding it, it is still unlikely for the youth to take help, especially professional help.,,,
Seeking help is the first step toward accessing a better life, but asking for help is not an easy task, especially with the manifest stigma. To solve this, it is prerequisite to enumerate and understand the various barriers. These barriers might include the scarcity of resources, personal attitudes toward mental health care, societal stigma, or others.
When we are well aware of the reasons why people are avoiding professional help, we can come up with more efficient developmental policies and better ideas to solve them.
Several studies, both from India and other countries, have shown that medical students experience high levels of stress and psychological morbidity compared to students pursuing other professional courses as well as the general population.,,
Notwithstanding these obvious implications and availability of help at close quarters, medical students are often found to be hesitant to seek professional help for perceived physical and mental health issues., Despite a considerable amount of need for mental health care, many studies have shown that young students are not very willing to seek any kind of help, and professional help is even more rarely sought after. Against this background, we undertook the present research to compare the barriers to health-care seeking reported by medical undergraduates.
There are only a few studies on barriers among medical undergraduates in India. The importance of studying the various barriers among people is undermined and a neglected domain in psychiatry. We have conducted this study to contribute to an understanding of the various stigma, attitudinal and resource barriers that are most prevalent and also to help in taking the right measures to promote mental health care.
| Materials and Methods|| |
Place of study
This cross-sectional study was carried out at Mamata Medical College, Khammam, Telangana and Prathima Institute of Medical Sciences, Karimnagar, Telangana, India.
This study was conducted from December 2018 to May 2019.
A total of 240 individuals volunteered to participate in the study, of which 107 (44.6%) agreed to have felt the need for mental health services, and 133 (55.4%) denied any felt need for professional help. The individuals who answered in the affirmative were allowed to participate in the survey. Of the 107 who were allowed, seven were eliminated due to the incomplete and incorrect filling of the questionnaire.
A semi-structured questionnaire was used to collect the sociodemographic details, the felt need for mental health service among the students and the various ways help was sought. The participants were presented with the 30-item Barriers to Access to Care Evaluation (BACE) scale, which was used to assess the barriers to seeking professional help. The BACE consists of a stigma scale and attitudinal and instrumental barrier items. The scale rates barrier to mental health care on a Likert scale of 0 – Not at all, 1 – Somewhat, 2 – quite a lot, and 3 – a lot. Some questions were marked not applicable as stated in BACEv3.
Participants were medical undergraduates who felt the need for mental health services. Participants who were willing to participate and give written consent were included in the study.
Participants who were not willing to participate in the study and did not give written consent were excluded from the study.
Data analysis was conducted using IBM SPSS Statistics for Windows, Version 24.0. (Armonk, NY: IBM Corp). The correlation of demographic factors with barriers for seeking professional help was measured using the Pearson's correlation method.
| Results|| |
The scores on the BACE were normally distributed across males (skew = 0.17) and females (skew = 0.60).
This study found that 26% of the participants did not seek any kind of mental health care despite needing it. Furthermore, 51% sought informal help and only 18% of the participants sought professional help [Table 1].
The frequency of all participants reporting the degree to which each barrier item would “stop, delay, or discourage” them from seeking professional help is presented in [Table 2], [Table 3], [Table 4] and [Figure 1], [Figure 2], [Figure 3].
|Table 2: Frequencies and mean scores on treatment stigma subscale of the Barriers to Access to Care Evaluation|
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|Table 3: Frequencies and mean score on attitudinal barrier items of the Barriers to Access to Care Evaluation|
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|Table 4: Frequencies and mean score on instrumental barrier items of the Barriers to Access to Care Evaluation|
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The most commonly rated stigma barrier was the concern that they may be seen as crazy if people found out they were taking professional care. The barrier perceived as a major one by many among stigma barriers was feeling embarrassed to accept help.
The most commonly rated attitudinal barrier wants to solve the problem on their own. An overwhelming proportion of the sample (88%) considered it to be a barrier, and it was also considered a major barrier (with a score >2 on the Likert scale) by 44% of the sample. The most anticipated barrier among instrumental barrier items is difficulty taking time off work. Among all the barriers, being too unwell to ask for help was considered a major barrier by most people (08%).
The gender and the academic year of the undergraduate showed no significant correlation with the scores of BACE, as shown in [Table 5].
|Table 5: Correlation between sociodemographic factors and score of Barriers to Access to Care Evaluation|
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The correlation of various subscales to each other was studied. An interestingly new finding of our study was that all the subscales showed a very high correlation with each other. As shown in [Table 6], the stigma and attitudinal scales had a significant positive correlation with r = 0.54, and the stigma and instrumental barriers also showed a significantly positive correlation (0.43). Of all, the attitudinal and instrumental barriers showed the highest positive correlation (0.60).
|Table 6: Correlation among different subscales of Barriers to Access to Care Evaluation|
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| Discussion|| |
This study found that 26% of the participants did not seek any kind of mental health care despite needing it. Furthermore, 51% sought informal help, and only 18% of the participants sought professional help.
This study consists of 65 female undergraduates and 35 male undergraduates, but there was no significant correlation between gender and the score obtained by BACE (P = 0.05). Medical undergraduates from all academic years took part in this study. In the given study sample, there is no significant correlation between the academic year and score obtained (P = 0.76), this is as per a study conducted by Jones (2015).
This study depicts that most of the barriers were attitudinal or stigma related. The attitudinal barriers may also be resulting from the stigma prevalent in society. Our findings were following the findings of a study conducted by Salaheddin and Mason.
Other studies conducted in different populations like Zehnder et al. and a study conducted among sex workers have also shown that stigma was a major barrier to seeking mental health care.
The analysis of individual questions shows that the barrier with the highest mean of all wants to solve the problem on their own.
Many of the individuals in the study, considered, being called crazy as a major barrier. This finding is corroborated by the study conducted by Luitel et al.
Among the instrumental barriers, lack of time was the most cited barrier, very closely followed by being unsure where to seek professional help. This points out the need for education about the importance of mental health services and where to find them.
A study done by Menon et al. (2015) among medical undergraduates have also pointed out the reasons for not seeking mental health care as a lack of time and being unaware as to where to seek formal help.
A lack of a significant correlation between demographic factors and barriers to care was also seen in the study conducted by Luitel et al. which means that it may be possible to pursue general population-wide approaches to promote the use of services.
In this study, all the subscales show a statistically significant correlation with each other (P < 0.00001). This can be explained by the fact that stigma might largely influence people's attitudes toward mental health services. For instance, the desire to solve the problem on their own which had an overwhelmingly high score may be due to the underlying stigma. Similarly, the unwillingness to seek mental health care or a negative attitude toward professional help may stem from a lack of resources. No studies conducted so far have elicited this noteworthy finding. This study hence has made an important contribution to further the discussion about barriers to seeking care.
| Conclusions|| |
This study is one of the handfuls of studies about the barriers to mental health care among the medical undergraduates in India.
- Despite the proximity of mental health services, 26% of the participants of this study are still not willing to access mental health services or take any kind of help despite feeling the need for it. This depicts that the treatment gap is likely to be even more pronounced where the formal mental health care is nonexistent
- As there is no significant difference between the barriers among male and female undergraduates, similar measures can be enforced among both the genders to decrease the barriers
- Most of the barriers were attitudinal or stigma related
- Nearly 88% preferred solving problems on their own and 59% did not seek help with stigmatizing beliefs such as fear of being called crazy. This finding indicates that interventions are necessary to enhance mental health literacy and knowledge of local services among medical students. Normalization of seeking mental health care is a necessary step toward reaching out to a greater number of people
- This can be achieved by greater exposure to mental health care. Regular screenings for mental health issues must be performed in educational institutions. The curriculum must make mental health education mandatory. Seminars, workshops, and discussions on mental health need to be encouraged
- As all subscales show a significant positive correlation with each other, helping the reduction of stigma barriers will also result in the reduction of other barriers and vice versa.
This study has a few limitations. Small sample size and use of convenient sampling are some of the limitations of the present study that need to be taken into consideration before planning further research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Biddle L, Gunnell D, Sharp D, Donovan JL. Factors influencing help seeking in mentally distressed young adults: A cross-sectional survey. Br J Gen Pract 2004;54:248-53.
Rickwood D, Deane FP, Wilson CJ, Ciarrochi J. Young people's help-seeking for mental health problems. Aust J Adv Ment Health 2005;4:218-51.
Oliver MI, Pearson N, Coe N, Gunnell D. Help-seeking behaviour in men and women with common mental health problems: Cross-sectional study. Br J Psychiatry 2005;186:297-301.
Bebbington PE, Meltzer H, Brugha TS, Farrell M, Jenkins R, Ceresa C, et al
. Unequal access and unmet need: Neurotic disorders and the use of primary care services. Psychol Med 2000;30:1359-67.
Behere SP, Yadav R, Behere PB. A comparative study of stress among students of medicine, engineering, and nursing. Indian J Psychol Med 2011;33:145-8.
] [Full text]
Saipanish R. Stress among medical students in a Thai medical school. Med Teach 2003;25:502-6.
Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ 2005;39:594-604.
Menon V, Sarkar S. Barriers to service utilization among medical students. Int J Adv Med Health Res 2014;1:104-104.
Roberts LW, Hardee JT, Franchini G, Stidley CA, Siegler M. Medical students as patients: A pilot study of their health care needs, practices, and concerns. Acad Med 1996;71:1225-32.
Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G. Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry 2012;12:36.
Jones VL. Barriers to Mental Healthcare Across Age and Education Level. 2015.
Salaheddin K, Mason B. Identifying barriers to mental health help-seeking among young adults in the UK: A cross-sectional survey. Br J Gen Pract 2016;66:e686-92.
Zehnder M, Mutschler J, Rössler W, Rufer M, Rüsch N. Stigma as a barrier to mental health service use among female sex workers in Switzerland. Front Psychiatry 2019;10:32.
Luitel NP, Jordans MJ, Kohrt BA, Rathod SD, Komproe IH. Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal. PLoS One 2017;12:e0183223.
Menon V, Sarkar S, Kumar S. Barriers to healthcare seeking among medical students: A cross sectional study from South India. Postgrad Med J 2015;91:477-82.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]