title: Study of Barrier to Help Seeking and its Relationships with Disability in Patients with Headache.
abstract: BACKGROUND
  Headache is among the first three most prevalent disorders with a wide treatment gap due to barriers in help seeking. Headache has been associated with disability. However, the relationship of barriers to help-seeking and disability are unexplored.
  
  
  OBJECTIVE
  To find out the barriers to help seeking and its relationship with headache related disability in patients with headache.
  
  
  METHODS
  In this hospital based cross-sectional study, 200 consecutive subjects with headache attending a tertiary care centre were recruited as per selection criteria and assessed with Sociodemographic & Clinical Proforma, Mini International Neuropsychiatric Interview (MINI), Barriers to Help Seeking Scale (BHSS), The Henry Ford Hospital Headache Disability Inventory (HDI).
  
  
  RESULTS
  High mean score was observed on BHSS subscale need for control and self reliance (19.45; SD ±9.66) and minimizing problem and resignation (10.02; SD ±6.98). Mean score on the HDI was 25.65 (SD ± 14.09). Socioeconomic status of the patient was statistically significant and positively associated with need for control and self reliance (p=0.035), concrete barriers and distrust of care givers (p=0.039), emotional control (p=0.005), and privacy (p=0.002). Occupational status had significant association with need for control and self-reliance (p=0.01), minimizing problem and resignation (p=0.033), and emotional control (p=0.006). Score on hospital headache disability inventory significantly predicted the value of score on concrete barriers and distrust of caregivers domain of HDI (p=0.001).
  
  
  CONCLUSIONS
  Autonomy and under estimation of seriousness of headache are common barriers to help seeking. Pattern of help seeking barriers may vary with socio-economic status and occupational status, while disability varies with gender and severity of headache. Headache associated disability is positively associated with concrete barriers.
authors.affiliation: Resident, Department of Neurology, JSS Medical College , Mysore, Karnataka, India .
authors.forename: Deepa
authors.initials: D
authors.lastname: John
authors.affiliation: Associate Professor, Department of Psychiatry, JSS Medical College , Mysore, Karnataka, India .
authors.forename: Dushad
authors.initials: D
authors.lastname: Ram
authors.affiliation: Professor, Department of Neurology, JSS Medical College , Mysore, Karnataka, India .
authors.forename: Harsha
authors.initials: H
authors.lastname: Sundarmurthy
authors.affiliation: Resident, Department of Neurology, JSS Medical College , Mysore, Karnataka, India .
authors.forename: Harshal
authors.initials: H
authors.lastname: Rathod
authors.affiliation: Pathologist, Apollo Hospital , Mysore, Karnataka, India .
authors.forename: Snehal
authors.initials: S
authors.lastname: Rathod
keywords: Functional impairment; Illness behaviour; Treatment barriers