Highlights
- •Depression, epilepsy, and schizophrenia disproportionately affect low and middle-income countries.
- •Barriers to appropriate treatment include knowledge deficits, beliefs, and stigma.
- •Facilitators are demographics, socioeconomic status, collaboration with traditional healers.
- •Collaboration with stakeholders important to facilitate treatment-seeking behaviors.
- •Nurses uniquely positioned to identify region-specific, culturally appropriate interventions.
Abstract
Despite the severe consequences, the treatment gap for depression, epilepsy, and schizophrenia
continues to be a major concern in low and middle-income countries (LMICs). We conducted
a systematic review of literature on barriers and facilitators of treatment-seeking
behaviors from the perspective of individuals living with depression, epilepsy, and
schizophrenia and stakeholders in LMICs. Knowledge deficits, beliefs, and stigma were
barriers to treatment-seeking across disorders. The most cited facilitators were demographics,
socioeconomic status, and collaboration with traditional healers. Culturally sensitive
interventions in collaboration with stakeholders within the community can facilitate
treatment-seeking behaviors among people living with depression, epilepsy, and schizophrenia.
Keywords
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References
- Public perception and attitude towards people living with epilepsy in Nigeria.Epilepsy & Behavior. 2020; 106107033https://doi.org/10.1016/j.yebeh.2020.107033
- Help-seeking behaviour, barriers to care and experiences of care among persons with depression in Eastern Cape, South Africa.Journal of Affective Disorders. 2013; 151: 439-448https://doi.org/10.1016/j.jad.2013.06.022
- Barriers and facilitators to child and adolescent mental health services in low-and-middle-income countries: A scoping review.Global Social Welfare. 2021; 8: 29-46https://doi.org/10.1007/s40609-019-00158-z
- Barriers to seeking and accepting treatment for perinatal depression: A qualitative study in Rio de Janeiro, Brazil.Community Mental Health Journal. 2019; https://doi.org/10.1007/s10597-019-00450-4
- Epilepsy care in Zambia: A study of traditional healers.Epilepsia. 2005; 46: 1121-1126https://doi.org/10.1111/j.1528-1167.2005.03505.x
- Help-seeking behaviour for depressive disorders among adult cardiovascular outpatient cardiac clinic Jimma University teaching hospital, Jimma, south-West Ethiopia: Crosssectional study.International Journal of Mental Health Systems. 2019; 13
- Proportion of patients without mental disorders being treated in mental health services worldwide.British Journal of Psychiatry. 2015; 206: 101-109https://doi.org/10.1192/bjp.bp.113.141424
- Stigma reduction interventions for epilepsy: A systematized literature review.Epilepsy & Behavior. 2021; 114: 107381https://doi.org/10.1016/j.yebeh.2020.107381
- WHO mental health gap action programme intervention guide (mhGAP-IG): The first pre-service training study.International Journal of Mental Health Systems. 2020; 14: 47https://doi.org/10.1186/s13033-020-00379-2
- An ethnographic study of schizophrenia in Zimbabwe: The role of culture, faith, and religion.Journal of Spirituality in Mental Health. 2020; https://doi.org/10.1080/19349637.2018.1531366
- Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization world mental health surveys.JAMA. 2004; 291: 2581-2590https://doi.org/10.1001/jama.291.21.2581
- Implementation of mhGAP in Mozambique: Integrating epilepsy care into the primary health care system.International Journal of Mental Health Systems. 2019; 13: 36https://doi.org/10.1186/s13033-019-0296-5
- 2017/12/01/). Epidemiology, management, and functional outcomes of traumatic brain injury in Sub-Saharan Africa.World Neurosurgery. 2017; 108: 650-655https://doi.org/10.1016/j.wneu.2017.09.084
- Interventions to increase use of services; mental health awareness in Nigeria.International Journal of Mental Health Systems. 2017; 11: 66https://doi.org/10.1186/s13033-017-0173-z
- Mental health literacy survey among sri lankan carers of patients with schizophrenia and depression.Asian Journal of Psychiatry. 2012; 5: 246-250https://doi.org/10.1016/j.ajp.2012.02.016
- Barriers and facilitators of mental health programmes in primary care in low-income and middle-income countries. The lancet.Psychiatry. 2020; 7: 78-92https://doi.org/10.1016/S2215-0366(19)30125-7
- The psychosis treatment gap and its consequences in rural Ethiopia.BMC Psychiatry. 2019; 19: 1-11
- Treatment gap and mental health service use among Syrian refugees in Sultanbeyli, Istanbul: A cross-sectional survey.Epidemiology and Psychiatric Sciences. 2019; 29e70https://doi.org/10.1017/s2045796019000660
- The experiences of providing caregiving for patients with schizophrenia in the ghanaian context.Archives of Psychiatric Nursing. 2018; 32: 815-822https://doi.org/10.1016/j.apnu.2018.06.005
- Psychiatric morbidity, cultural factors, and health-seeking behaviour in perinatal women: A cross-sectional study from a tertiary care Centre of North India.Indian Journal of Psychological Medicine. 2020; 42: 52-60https://doi.org/10.4103/ijpsym.Ijpsym_96_19
- Integrating mental health into primary care in Nigeria: Report of a demonstration project using the mental health gap action programme intervention guide.BMC Health Services Research. 2015; 15: 242https://doi.org/10.1186/s12913-015-0911-3
- Mixed methods appraisal tool (MMAT) version 2018.2018
- Reducing the stigma of mental health disorders with a focus on low- and middle-income countries.Asian Journal of Psychiatry. 2021; 58102601https://doi.org/10.1016/j.ajp.2021.102601
- Pathway to care of epilepsy patients: Exploratory study from an urban slum in northern India.Annals of Indian Academy of Neurology. 2013; 16: 357-360https://doi.org/10.4103/0972-2327.116930
- Primary care patient beliefs and help-seeking preferences regarding depression in China.Psychiatry Research. 2018; 269: 1-8https://doi.org/10.1016/j.psychres.2018.08.031
- Views on depression from traditional healing and psychiatry clinics in Uganda: Perspectives from patients and their providers.Journal of Cross-Cultural Psychology. 2017; 48: 243-261https://doi.org/10.1177/0022022116675424
- Supernatural beliefs, aetiological models and help seeking behaviour in patients with schizophrenia.Industrial Psychiatry Journal. 2012; 21: 49-54https://doi.org/10.4103/0972-6748.110951
- WHO mental health gap action programme (mhGAP) intervention guide: A systematic review of evidence from low and middle-income countries.Evidence Based Mental Health. 2018; 21: 30-34https://doi.org/10.1136/eb-2017-102750
- Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria.BMC Pregnancy & Childbirth. 2020; 20: 1-8https://doi.org/10.1186/s12884-020-02970-4
- Psychosis and help-seeking behavior in rural KwaZulu Natal: Unearthing local insights.International Journal of Mental Health Systems. 2016; 10
- Depression and health-seeking behaviour among migrant workers in Shenzhen.The International Journal of Social Psychiatry. 2015; 61: 350-357https://doi.org/10.1177/0020764014544767
- The global burden of disease, 1990–2020.Nature Medicine. 1998; 4: 1241-1243https://doi.org/10.1038/3218
- Addressing the problem of severe underinvestment in mental health and well-being from a human rights perspective.Health & Human Rights Journal. 2020; 22: 35-49
- Perceived epilepsy stigma mediates relationships between personality and social well-being in a diverse epilepsy population.Epilepsy & Behavior. 2018; 78: 7-13https://doi.org/10.1016/j.yebeh.2017.10.023
- Projections of global mortality and burden of disease from 2002 to 2030.PLoS Medicine. 2006; 3e442https://doi.org/10.1371/journal.pmed.0030442
- Cross-sectional study of depression and help-seeking in Uttarakhand, North India.BMJ Open. 2015; 5e008992https://doi.org/10.1136/bmjopen-2015-008992
- The epilepsy treatment gap in developing countries: A systematic review of the magnitude, causes, and intervention strategies.Epilepsia. 2008; 49: 1491-1503https://doi.org/10.1111/j.1528-1167.2008.01693.x
- Interrater reliability: the kappa statistic.Biochemia Medica. 2012; 22 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900052/): 276-282
- Health care seeking behavior for depression in Northeast Ethiopia: depression is not considered as illness by more than half of the participants.Annals of General Psychiatry. 2018; 17 (N.PAG-N.PAG)https://doi.org/10.1186/s12991-018-0205-3
- Transitioning mental health into primary care.The Lancet Psychiatry. 2017; 4: 90-92
- Treatment-seeking behavior towards epilepsy among rural residents in Ethiopia: A cross-sectional study.Neuropsychiatric Disease and Treatment. 2020; 16: 433-439https://doi.org/10.2147/ndt.S240542
- Conceptualizing depression in Vietnam: Primary health care providers' explanatory models of depression.Transcultural Psychiatry. 2018; 55: 219-241https://doi.org/10.1177/1363461517748846
- Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990?2010: a systematic analysis for the Global Burden of Disease Study 2010.The Lancet. 2012; 380: 2197-2223
- Prevalence and determinants of depression among patients under the care of traditional health practitioners in a Kenyan setting: Policy implications.Transcultural Psychiatry. 2017; 54: 285-303
- Help-seeking behaviors among caregivers of schizophrenia and other psychotic patients: A hospital-based study in two geographically and culturally distinct Indian cities.Indian Journal of Psychological Medicine. 2012; 34: 338-345https://doi.org/10.4103/0253-7176.108214
- Digital technology for treating and preventing mental disorders in low-income and middle-income countries: A narrative review of the literature.The Lancet Psychiatry. 2017; 4: 486-500https://doi.org/10.1016/S2215-0366(17)30096-2
- The sociocultural conceptualisations of schizophrenia and patterns of help seeking in south-east Nigeria.Mental Health, Religion & Culture. 2015; 18: 85-96https://doi.org/10.1080/13674676.2014.1000842
- Engaging communities to improve healthcare for non-communicable diseases: Notes from the field in southeastern Nigeria. ENGAGE! Co-created knowledge serving the.City. 2020; 1
- The PRISMA 2020 statement: An updated guideline for reporting systematic reviews.BMJ. 2021; 372https://doi.org/10.1136/bmj.n71
- Factors associated with help-seeking behaviors in mexican older individuals with depressive symptoms: A cross-sectional study.International Journal of Geriatric Psychiatry. 2013; 28: 1260-1269https://doi.org/10.1002/gps.3953
- Reassessing the mental health treatment gap: What happens if we include the impact of traditional healing on mental Illness?.Community Mental Health Journal. 2021; 57: 777-791https://doi.org/10.1007/s10597-020-00705-5
- Enhanced care by community health workers in improving treatment adherence to antidepressant medication in rural women with major depression.The Indian Journal of Medical Research. 2014; 139: 236-245
- Depression as seen through the eyes of rural chinese women: Implications for help-seeking and the future of mental health care in China.Journal of Affective Disorders. 2018; 227: 38-47https://doi.org/10.1016/j.jad.2017.10.016
- Explanatory models and medication adherence in patients with depression in South India.Journal of Clinical and Diagnostic Research. 2017; 11: Vc01-vc04https://doi.org/10.7860/jcdr/2017/23954.9170
- Mental health service provision in low- and middle-income countries.Health Services Insights. 2017; 10 (1178632917694350)https://doi.org/10.1177/1178632917694350
- Factors associated with health service utilisation for common mental disorders: A systematic review.BMC Psychiatry. 2018; 18: 262https://doi.org/10.1186/s12888-018-1837-1
- Health care use and treatment-seeking for depression symptoms in rural India: An exploratory cross-sectional analysis.BMC Health Services Research. 2020; 20: 1-13https://doi.org/10.1186/s12913-020-05162-0
- Distance to health services and treatment-seeking for depressive symptoms in rural India: A repeated cross-sectional study.Epidemiology and Psychiatric Sciences. 2020; https://doi.org/10.1017/S204579601900088X
- "Is there a medicine for these tensions?" barriers to treatment-seeking for depressive symptoms in rural India: A qualitative study.Soc Sci Med. 2020; 246112741https://doi.org/10.1016/j.socscimed.2019.112741
- An exploration of illness narratives of mothers with maternal depression in semi-urban areas.Psychiatric Quarterly. 2020; https://doi.org/10.1007/s11126-020-09781-y
- Resources for mental health: Scarcity, inequity, and inefficiency.The Lancet. 2007; 370: 878-889https://doi.org/10.1016/S0140-6736(07)61239-2
- Cultural dimensions of depression in Bangladesh: A qualitative study in two villages of matlab.Journal of Health, Population & Nutrition. 2010; 28: 95-106
- Barriers to professional mental health help-seeking among chinese adults: A systematic review [systematic review].FrontiersPsychiatry. 2020; 11https://doi.org/10.3389/fpsyt.2020.00442
- Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India.BMJ Global Health. 2019; 4e001344https://doi.org/10.1136/bmjgh-2018-001344
- Intention to seek help for depression and associated factors among residents of aykel town, Northwest Ethiopia: Cross-sectional study.Int J Ment Health Syst. 2019; 13: 18https://doi.org/10.1186/s13033-019-0274-y
- The global burden of epilepsy report: Implications for low- and middle-income countries.Epilepsy & Behavior. 2020; 105106949https://doi.org/10.1016/j.yebeh.2020.106949
- Healthcare-Seeking Behavior of Patients with Epileptic Seizure Disorders Attending a Tertiary Care Hospital, Kolkata.Indian Journal of Community Medicine. 2012; 37: 25-29https://doi.org/10.4103/0970-0218.94018
- Explanatory models of mental disorders and treatment practices among traditional healers in Mpumulanga, South Africa: Original article.African Journal of Psychiatry. 2010; 13: 284-290https://doi.org/10.10520/EJC72829
- Prevalence, correlates and help-seeking behaviour for depressive symptoms in rural Uganda: A population-based survey.Global Mental Health. 2019; 6https://doi.org/10.1017/gmh.2019.25
- Symptoms at onset in first episode schizophrenia: Caregivers perspectives.Indian Journal of Psychological Medicine. 2015; 37: 399-402https://doi.org/10.4103/0253-7176.168564
- The epidemiology of major depressive disorder and subthreshold depression in Izmir, Turkey: Prevalence, socioeconomic differences, impairment and help-seeking.Journal of Affective Disorders. 2015; 181: 78-86https://doi.org/10.1016/j.jad.2015.04.017
- Help seeking and suicidality among people with epilepsy in a rural low income country setting: Cross-sectional survey.International Journal of Mental Health Systems. 2017; 11https://doi.org/10.1186/s13033-017-0151-5
- An assessment of awareness of mental health conditions and its association with socio-demographic characteristics: a cross-sectional study in a rural district in Bangladesh.BMC Health Services Research. 2019; 19 (N.PAG-N.PAG)https://doi.org/10.1186/s12913-019-4385-6
- Help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care: A population-based study in Rwanda.Social Psychiatry & Psychiatric Epidemiology. 2016; 51: 81-92https://doi.org/10.1007/s00127-015-1130-2
- The perceived effectiveness of traditional and faith healing in the treatment of mental illness: A systematic review of qualitative studies.Social Psychiatry and Psychiatric Epidemiology. 2018; 53: 555-566https://doi.org/10.1007/s00127-018-1519-9
- Women’s experiences with epilepsy treatment in southern India: A focused ethnography.The Qualitative Report. 2019; 24: 1034-1051
- Living in the epilepsy treatment gap in rural South India: A focused ethnography of women and problems associated with stigma.Health Care for Women International. 2017; 38: 753-764https://doi.org/10.1080/07399332.2017.1321000
- Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019.The Lancet. 2020; 396: 1204-1222https://doi.org/10.1016/S0140-6736(20)30925-9
- Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.The Lancet. 2007; 370: 841-850https://doi.org/10.1016/S0140-6736(07)61414-7
- Factors influencing professional help-seeking behavior during first episode psychosis in schizophrenia: An exploratory study on Caregivers' perspective.Front Psychiatry. 2019; 10: 962https://doi.org/10.3389/fpsyt.2019.00962
- WHO. mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings: mental heatlh Gap Action Programme (mhGAP). World Health Organization.
- mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings.2016
- mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings - version 2.0.
- Enhancing mental health pre-service training with the mhGAP intervention guide: Experiences and lessons learned.2020
- Social determinants of health.
- Help seeking behavior and related factors in schizophrenia patients: A comparative study of two populations from eastern and western Turkey.Düşünen Adam: Journal of Psychiatry and Neurological Sciences. 2015; 28: 154-161https://doi.org/10.5350/DAJPN2015280208
- Explanatory models of illness, help seeking behaviours and related factors in patients with schizophrenia: A comparative study from two different provinces of Turkey.Community Mental Health Journal. 2017; 53: 951-957https://doi.org/10.1007/s10597-016-0074-7
- Mental health help-seeking intentions and preferences of rural chinese adults.PLoS ONE. 2015; 10https://doi.org/10.1371/journal.pone.0141889
Article info
Publication history
Published online: July 14, 2022
Accepted:
July 3,
2022
Received in revised form:
May 13,
2022
Received:
October 26,
2021
Identification
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© 2022 Elsevier Inc. All rights reserved.
