title: Help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care: a population-based study in Rwanda.
abstract: OBJECTIVE
  Mental disorders commonly affect young people but usually go unrecognized and untreated. This study aimed to investigate help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care among young adults with current depression and/or suicidality in a low-income setting.
  
  
  METHODS
  This cross-sectional study used two sub-populations: a sub-sample of those suffering from current depression and/or suicidality (n = 247) and another of those not suffering from these conditions and not suffering from any other mental condition investigated (n = 502). Help-seeking behaviours, barriers to care and self-efficacy for mental health care seeking were measured among those suffering from current depression and/or suicidality (n, %). Logistic regression was used to identify risk factors for experiencing barriers to care. Self-efficacy for seeking mental health care was compared between men and women in the two sub-populations.
  
  
  RESULTS
  Of the 247 men and women with current depression and/or suicidality, 36.0 % sought help at a health care unit and 64.0 % from trusted people in the community. Only six people received help from a mental health professional. The identified barriers were mainly related to accessibility and acceptability of health services. For the population suffering from current depression and/or suicidality, the self-efficacy scale for seeking mental health care suggested a low confidence in accessing mental health care but a high confidence in respondents' ability to successfully communicate with health care staff and to cope with consequences of seeking care.
  
  
  CONCLUSIONS
  The current study clearly highlights young adults' poor access to mental health care services. To reach universal health coverage, substantial resources need to be allocated to mental health, coupled with initiatives to improve mental health literacy in the general population.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. aumubyey@nursph.org.|Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. aumubyey@nursph.org.
authors.forename: Aline
authors.initials: A
authors.lastname: Umubyeyi
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Mogren
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ntaganira
authors.affiliation: Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Krantz
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D000066505:Help-Seeking Behavior; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012432:Rwanda; D020377:Self Efficacy; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Barriers to health care; Depression; Help seeking; Self-efficacy for seeking mental health care; Suicidality