Unmet Needs in Mental Health: A Cross‐Sectional Study on Contact Coverage Gaps and Access to Care for Depression and Anxiety Among Adults in Kailali, Nepal
Gayatri Khanal, Y. Selvamani, Prabhat SapkotaABSTRACT
Background
There is a pronounced gap between demand and actual mental health service utilization, with earlier estimates suggesting that nearly 90% of affected individuals with depression or anxiety do not receive the care they need despite being the most prevalent and highest contributor for global burden. The present study aims to identify contact coverage gap and explore barriers while seeking care among those who screen positive for depression and anxiety.
Methods
A community‐based cross‐sectional study was conducted among 1304 adults aged 20–60 years who had resided in Kailali, Nepal for at least 6 months. Multistage random technique was utilized to select the participants from three rural municipalities and three municipalities. Depression and anxiety were assessed by using widely recognized screening tools, namely, the Patient Health Questionnaire‐9 (PHQ‐9) and the Beck Anxiety Inventory (BAI). Barriers to care were measured using the Barriers to Access to Care Evaluation (BACE).
Results
Out of 1304 study participants, around 15.2% were screened positive for at least one (depression and/or anxiety) illness. Screening positive for depression (13.3%) was higher than anxiety (7.5%). Only 28.3% of individuals who were positive for anxiety and/or depression contacted with service providers. Among those who sought care, most had visited traditional healers (98.2%). Major barriers to care were unaffordable cost (38.4%), self‐solving attitude (22.2%), preference for alternative types of care (21.7%), busy schedule with work (16.7%), speculating it will resolve itself (15.2%), and not being sure where to seek for mental health services (12.6%). Contact coverage was significantly associated with morbidity and lack of awareness on available services.
Conclusion
There was a significant contact coverage gap in mental health care, as we found that only 28.3% of adults who tested positive for depression and/or anxiety had contact with any provider, largely due to barriers such as financial constraint, busy schedule, self‐reliant attitude, preference for traditional healing, and lack of awareness on available services. These results warrant efforts to close the gap in coverage for care through addressing barriers.