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Barriers to mental health treatment: results from the National Comorbidity Survey Replication

  • R. Mojtabai (a1), M. Olfson (a2), N. A. Sampson (a3), R. Jin (a3), B. Druss (a4), P. S. Wang (a5), K. B. Wells (a6), H. A. Pincus (a7) and R. C. Kessler (a3)...

The aim was to examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the US general population.


Respondents in the National Comorbidity Survey Replication with common 12-month DSM-IV mood, anxiety, substance, impulse control and childhood disorders were asked about perceived need for treatment, structural barriers and attitudinal/evaluative barriers to initiation and continuation of treatment.


Low perceived need was reported by 44.8% of respondents with a disorder who did not seek treatment. Desire to handle the problem on one's own was the most common reason among respondents with perceived need both for not seeking treatment (72.6%) and for dropping out of treatment (42.2%). Attitudinal/evaluative factors were much more important than structural barriers both to initiating (97.4% v. 22.2%) and to continuing (81.9% v. 31.8%) of treatment. Reasons for not seeking treatment varied with illness severity. Low perceived need was a more common reason for not seeking treatment among individuals with mild (57.0%) than moderate (39.3%) or severe (25.9%) disorders, whereas structural and attitudinal/evaluative barriers were more common among respondents with more severe conditions.


Low perceived need and attitudinal/evaluative barriers are the major barriers to treatment seeking and staying in treatment among individuals with common mental disorders. Efforts to increase treatment seeking and reduce treatment drop-out need to take these barriers into consideration as well as to recognize that barriers differ as a function of sociodemographic and clinical characteristics.

Corresponding author
*Address for correspondence: Dr R. C. Kessler, Harvard Medical School, Department of Health Care Policy, 180 Longwood Ave., Suite 215, Boston, MA 02115, USA. (Email:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

PS Wang , M Lane , M Olfson , HA Pincus , KB Wells , RC Kessler (2005 b). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 629640.

S Wrigley , H Jackson , F Judd , A Komiti (2005). Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. Australian and New Zealand Journal of Psychiatry 39, 514521.

D Wynaden , R Chapman , A Orb , S McGowan , Z Zeeman , S Yeak (2005). Factors that influence Asian communities' access to mental health care. International Journal of Mental Health Nursing 14, 8895.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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