title: Barriers to psychotherapy among depressed and nondepressed primary care patients.
abstract: BACKGROUND
  Most primary care patients who experience depression state that they would prefer psychotherapy over antidepressant medications. However, when referrals for psychotherapy are made, only 20% ever follow up, and of these, half drop out of treatment. This suggests that there are substantial barriers to accessing psychotherapy.
  
  
  OBJECTIVE
  The aim of this study was to investigate perceived barriers to psychotherapy in a sample of primary care patients and to test the hypothesis that these barriers would be more common among patients with depression.
  
  
  METHODS
  Patients were sampled from a large primary care service and mailed a survey. The survey included evaluation of barriers using items identified in previous published research, which we refer to as Perceived Barriers to Psychotherapy (PBP). Depression was measured using the Perceived Health Questionnaire-9 (PHQ-9).
  
  
  RESULTS
  Of the 904 surveys sent, 290 (32.1%) were returned. The PBP produced two factors-practical barriers and emotional barriers-explaining 58.2% of the variance with an internal reliability of alpha = .79. Among all patients, 59.5% reported at least one barrier that would make it very difficult or impossible to participate in psychotherapy. Depression was associated with increased frequency of perceived barriers, with 74.0% of depressed patients reporting one or more barriers, versus 51.4% of nondepressed patients (p = .008). One or more perceived practical barriers were reported by 56.6% of the sample, whereas only 11.1% reported perceived emotional barriers. Depression was consistently associated with increased emotional barriers. Practical barriers were not consistently associated with depression but were influenced by history of psychotherapy.
  
  
  CONCLUSIONS
  The majority of primary care patients surveyed reported one or more perceived barriers that would interfere with or prevent initiation or regular attendance of psychotherapy. Perceived barriers were more common among depressed than nondepressed patients making depression both an indicator for psychotherapy and a barrier to receiving it.
authors.affiliation: University of California, Veterans Administration Medical Center, San Francisco, California, USA. david.mohr@ucsf.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Hart
authors.forename: Isa
authors.initials: I
authors.lastname: Howard
authors.forename: Laura
authors.initials: L
authors.lastname: Julian
authors.forename: Lea
authors.initials: L
authors.lastname: Vella
authors.forename: Claudine
authors.initials: C
authors.lastname: Catledge
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Feldman
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D011320:Primary Health Care; D011613:Psychotherapy; D012017:Referral and Consultation; D016312:Treatment Refusal / Q000523:psychology
chemical_list: D000928:Antidepressive Agents