Psychological Medicine

Original Articles

Barriers to mental health treatment: results from the National Comorbidity Survey Replication

R. Mojtabaia1, M. Olfsona2, N. A. Sampsona3, R. Jina3, B. Drussa4, P. S. Wanga5, K. B. Wellsa6, H. A. Pincusa7 and R. C. Kesslera3 c1

a1 Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA

a2 Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA

a3 Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

a4 Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA

a5 Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA

a6 Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA

a7 Department of Psychiatry, Columbia University, New York, NY, USA


Background The aim was to examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the US general population.

Method Respondents in the National Comorbidity Survey Replication with common 12-month DSM-IV mood, anxiety, substance, impulse control and childhood disorders were asked about perceived need for treatment, structural barriers and attitudinal/evaluative barriers to initiation and continuation of treatment.

Results Low perceived need was reported by 44.8% of respondents with a disorder who did not seek treatment. Desire to handle the problem on one's own was the most common reason among respondents with perceived need both for not seeking treatment (72.6%) and for dropping out of treatment (42.2%). Attitudinal/evaluative factors were much more important than structural barriers both to initiating (97.4% v. 22.2%) and to continuing (81.9% v. 31.8%) of treatment. Reasons for not seeking treatment varied with illness severity. Low perceived need was a more common reason for not seeking treatment among individuals with mild (57.0%) than moderate (39.3%) or severe (25.9%) disorders, whereas structural and attitudinal/evaluative barriers were more common among respondents with more severe conditions.

Conclusions Low perceived need and attitudinal/evaluative barriers are the major barriers to treatment seeking and staying in treatment among individuals with common mental disorders. Efforts to increase treatment seeking and reduce treatment drop-out need to take these barriers into consideration as well as to recognize that barriers differ as a function of sociodemographic and clinical characteristics.

(Received December 23 2009)

(Revised October 01 2010)

(Accepted October 01 2010)

(Online publication December 07 2010)


c1 Address for correspondence: Dr R. C. Kessler, Harvard Medical School, Department of Health Care Policy, 180 Longwood Ave., Suite 215, Boston, MA 02115, USA. (Email: