title: Perceived barriers to mental health service utilization in the United States, Ontario, and the Netherlands.
abstract: OBJECTIVE
  Although rates of mental health service utilization differ dramatically across countries, little information is available about differences in self-reported barriers to mental health service utilization. Perceived barriers were examined in three locations with differing health care systems.
  
  
  METHODS
  Data came from three methodologically similar population-based surveys of adults conducted in the 1990s in Ontario, Canada (N=6,261), the United States (N=5,384), and the Netherlands (N=6,031) that assessed DSM-III-R nonpsychotic mental disorders with the Composite International Diagnostic Interview. Respondents who reported a need for professional help were asked to indicate reasons for not seeking care. Multiple logistic regression analyses were used to determine the sociodemographic, mental disorder, and location-specific correlates of each perceived barrier.
  
  
  RESULTS
  The pattern of reported barriers to mental health service utilization was similar across locations: attitudinal barriers (thoughts that the problem would get better on its own) were more prevalent than structural barriers (inability to get an appointment). Fear of stigmatization was not commonly endorsed. With adjustment for sociodemographic factors and type of mental disorder, low-income respondents were significantly more likely to report a financial barrier in the United States than in either Ontario or the Netherlands.
  
  
  CONCLUSIONS
  Across locations, attitudinal barriers were more likely to be endorsed than structural barriers to service utilization. The most striking reported cross-national difference was structural, with many more U.S. respondents (especially those with low incomes) reporting financial barriers than respondents in either Ontario or the Netherlands.
authors.affiliation: Department of Psychiatry, University of Manitoba, PZ-430 771 Bannatyne Ave., Winnipeg, Manitoba, Canada R3E 3N4. sareen@cc.umanitoba.ca
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
authors.forename: Amit
authors.initials: A
authors.lastname: Jagdeo
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cox
authors.forename: Ian
authors.initials: I
authors.lastname: Clara
authors.forename: Margreet
authors.initials: M
authors.lastname: ten Have
authors.forename: Shay-Lee
authors.initials: SL
authors.lastname: Belik
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D012938:Social Perception; D012959:Socioeconomic Factors; D013240:Stereotyping; D014481:United States / Q000453:epidemiology