Psychiatric taboo? : Mental health problems and help-seeking

Mental health disorders are common conditions in the general population, yet only about half of those with mental health problems have health care contacts for their problems. The pathway for help-seeking is complex, and may be influenced by sociodemographic factors, as well as more complex characteristics such as personality, attitudes and personal preferences. This thesis aimed to improve knowledge of factors associated with help-seeking for mental health problems. One focus was on lay people’s opinions and expectations of mental health care. The present study was conducted in two stages. An initial postal questionnaire was distributed to a random sample of the general population aged 20-64 in Skaraborg, Sweden, to assess mental health status and history of treatment contact. Data from Skaraborg (n=3 538) was compared to questionnaire data from the PART study, Stockholm (n=10 441). Information from the questionnaire also served as basis for a stratified selection of subsamples. In stage II a total of 358 participants, 125 persons with symptoms of mental disorders with healthcare contact, 105 persons with symptoms of mental disorders without health care contact, and 128 mentally healthy participated in a face-to-face interview. The interview inclined a semi structured diagnostic interview (SCAN), a personality inventory (SSP), a vignette to assess mental health literacy, and open-ended questions about expectations concerning a hypothetical contact with mental health care. Data from the questionnaire stage showed that mental health problems were common in both the rural and urban area. Harmful alcohol use, however, was less common among rural women compared to their urban counterparts. Overall contact with health care was more often reported by urban residents, regardless of age, gender, or presence of mental health problems. Results from the interview stage: Personality traits such as Somatic Trait Anxiety and Stress Susceptibility were associated with help-seeking for mental health problems. Mental health literacy was poor among the respondents; only one third could correctly recognise depression from a vignette. A majority of the respondents were positive about counselling and psychotherapy. Persons with a history of mental health care contacts were more positive to medical interventions such as antidepressants, hypnotics, and admission to a psychiatric ward. Non help-seekers were more optimistic than help-seekers concerning the prognosis of depression without professional help. The quality of interaction between patient and provider was by far the most important theme when the respondents expressed their wishes concerning a hypothetical contact with health care for mental health problems. Only a minority expressed wishes for specific treatments. Urbanity was associated with overall utilisation of health care during the last year. Personality traits were associated with help-seeking. Persons with health care contact for mental health problems were more in tune with the professional point of view with rating interventions. The quality of interaction between patient and provider is highly important in health care contacts for mental health problems. Key-words: mental disorder, depression, help-seeking, rural, urban, personality, mental health literacy, attitudes, patients’ preferences and expectations LIST OF PUBLICATIONS I. Dahlberg K. , Forsell Y. , Damström-Thakker K. , Runeson B. Mental health problems and healthcare contacts in an urban and a rural area. Comparisons of two Swedish counties. Nordic Journal of Psychiatry, 2007, Vol 61, 1, 40-46 II. Dahlberg K. M. , Gustavsson P., Runeson B. Personality traits in people seeking help for common mental health problems. submitted III. Dahlberg K. M. , Waern M. , Runeson B. Mental health literacy and attitudes in a Swedish community sample -Investigating the role of personal experience of mental health care. BMC, Public Health 2008, 8:8 IV. Dahlberg K. M. , Lundqvist-Persson C. , Runeson B. People’s expectations on the health care system when seeking for mental health problems. submitted