An Examination of Barriers to Accessing Mental Health Care, and Their Association with Depression, Stress, Suicidal Ideation, and Wellness in a Bangladeshi University Student Sample
Abstract
:1. Introduction
2. Materials & Methods
2.1. Survey Development
2.2. Study Sample
2.3. Data Handling
2.4. Statistical Analysis
2.5. Measures
2.5.1. Demographic Characteristics
2.5.2. Dependent Variables
2.5.3. Independent Variables
3. Results
3.1. Descriptive Results
3.1.1. Instrumental Barriers
3.1.2. Attitudinal Barriers
3.1.3. Stigma Barriers
3.2. Logistic Regression Results
3.2.1. Depression
3.2.2. Perceived Stress
3.2.3. Suicidal Ideation
3.2.4. Wellness
4. Discussion
4.1. Implications
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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BACE Item | Not at All a Barrier | A Little Bit of a Barrier | Quite a Lot of a Barrier | A Lot of a Barrier |
---|---|---|---|---|
% | % | % | % | |
Instrumental Barriers | ||||
Being unsure where to go to get professional help | 51.8 | 15.0 | 25.1 | 8.1 |
Problems with transport or traveling to appointments | 74.5 | 12.6 | 8.0 | 4.9 |
Not being able to afford the financial costs involved | 43.8 | 19.5 | 19.5 | 17.1 |
Professionals from ethnic/cultural group not available | 83.3 | 6.5 | 6.5 | 3.6 |
Being too unwell to ask for help | 82.6 | 9.8 | 5.5 | 2.1 |
Difficulty taking time off work | 67.6 | 16.6 | 10.1 | 5.7 |
Having problems with childcare while I receive professional care | 84.0 | 8.2 | 4.1 | 3.7 |
Having no one who could help me get professional care | 67.4 | 14.2 | 13.3 | 5.1 |
Having too many academic demands | 63.6 | 16.2 | 12.0 | 8.1 |
Too many non-academic/personal time commitments | 52.2 | 19.4 | 20.1 | 8.3 |
Lack of private space for virtual therapy | 58.5 | 17.3 | 17.9 | 6.4 |
Lack of technological resources to facilitate participation | 70.3 | 13.6 | 10.2 | 5.9 |
Attitudinal Barriers | ||||
Wanting to solve the problem on my own | 5.5 | 6.6 | 27.6 | 60.3 |
Fear of being put in hospital against my will | 84.3 | 7.6 | 5.5 | 2.6 |
Thinking the problem would get better by itself | 23.5 | 17.1 | 31.5 | 27.9 |
Preferring alternative (traditional/religious healing) care | 42.9 | 18.7 | 26.3 | 12.1 |
Thinking that professional care would not help | 64.9 | 17.3 | 12.6 | 5.3 |
Dislike of talking about my feelings, emotions or thoughts | 34.6 | 19.9 | 26.1 | 19.4 |
Concerns about the effects of the treatments available | 48.2 | 24.2 | 19.4 | 8.2 |
Having had previous bad experiences | 85.1 | 5.5 | 6.8 | 2.6 |
Preferring to get help from family or friends | 30.1 | 19.1 | 37.1 | 13.7 |
Thinking I did not have a problem | 43.8 | 17.8 | 24.1 | 14.4 |
Stigma-related Barriers | ||||
Concern that I might be seen as weak for having a mental health problem | 50.4 | 15.0 | 21.6 | 13.0 |
Concern that it might harm my chances when applying for jobs | 75.8 | 10.1 | 8.4 | 5.7 |
Concern about what my family might think, say, do or feel | 36.2 | 18.3 | 24.3 | 21.2 |
Feeling embarrassed or ashamed | 43.1 | 21.4 | 23.7 | 11.8 |
Concern that I might be seen as ‘crazy’ | 77.1 | 10.3 | 8.8 | 3.8 |
Concern that people I know might find out | 63.2 | 17.1 | 14.4 | 5.4 |
Concern that people might not take me seriously if they found out I was having professional care | 70.0 | 14.1 | 10.5 | 5.4 |
Not wanting a mental health problem to be on my medical records | 59.1 | 14.5 | 16.0 | 10.4 |
Concern about what my friends might think, say or do | 61.1 | 19.0 | 16.0 | 3.9 |
Concern about what people at work might think, say or do | 69.4 | 14.1 | 12.8 | 3.6 |
%/M (SD) | |
Age (18–41) a | 22.7 (1.86) |
Gender | |
Male | 59.2% |
Female and Gender Minority | 40.8% |
Sexual Orientation (% Heterosexual/Straight) | 93.9% |
Childhood SES (% Low SES) | 28.3% |
Relationship Status (% Non-partnered) | 76.8% |
Year/Semester in School b | |
1st–3rd/First year | 20.6% |
4th–6th/Second year | 19.4% |
7th–9th/Third year | 20.0% |
10th–12th/Fourth year | 19.4% |
12th+/Fourth year+ | 20.6% |
Religiosity (1–10) | 6.33 (2.00) |
Wellness (0–50) | 26.12 (10.37) |
Wellness (% High) | 24.9% |
Perceived Stress (0–16) | 8.46 (3.41) |
Perceived Stress (% High) | 28.0% |
Depressive Symptoms (0–6) | 2.60 (1.69) |
High Depressive Symptoms (>3) | 43.4% |
Suicidal Ideation (Lifetime) c | 28.0% |
Barriers to Care: Stigma (0–3) | 0.64 (0.63) |
Barriers to Care: Non-Stigma (0–3) | 0.86 (0.45) |
Barriers to Care: Attitudinal (0–3) | 1.10 (0.50) |
Barriers to Care: Instrumental (0–3) | 0.62 (0.55) |
Individual Models of Each Barriers’ Relationship with Depression | Model Including Both Stigma and Non-Stigma-Related Barriers | |||
---|---|---|---|---|
Outcome: Perceived Stress (High vs. Low), n = 323 | ||||
OR (95% CI) | p | aOR (95% CI) | p | |
Stigma Barriers to Care | 2.17 (1.46, 3.21) | <0.001 | 1.47 (0.82, 2.65) | 0.199 |
Non-Stigma Barriers to Care (Mean of Instrumental and Attitudinal Barriers) | 3.17 (1.79, 5.62) | <0.001 | 2.10 (0.90, 4.91) | 0.087 |
Instrumental barriers to care | 2.41 (1.52, 3.82) | <0.001 | - | |
Attitudinal barriers to care | 2.35 (1.39, 3.98) | 0.001 | ||
Nagelkerke R squared | − | 0.108 | ||
p | − | 0.003 | ||
Outcome: Depression (Yes vs. No), n = 323 | ||||
Stigma Barriers to Care | 2.41 (1.63, 3.58) | <0.001 | 1.42 (0.81, 2.49) | 0.217 |
Non-Stigma Barriers to Care (Mean of Instrumental and Attitudinal Barriers) | 4.01 (2.28, 7.05) | <0.001 | 2.80 (1.26, 6.22) | 0.011 |
Instrumental barriers to care | 2.58 (1.64, 4.05) | <0.001 | ||
Attitudinal barriers to care | 3.08 (1.86, 5.10) | <0.001 | ||
Nagelkerke R squared | − | 0.147 | ||
p | − | <0.001 |
Individual Models of Each Barriers’ Relationship with Depression | Model Including Both Stigma and Non-Stigma-Related Barriers | |||
---|---|---|---|---|
OR (95% CI) | p | aOR (95% CI) | p | |
Stigma Barriers to Care | 2.93 (1.85, 4.62) | <0.001 | 2.97 (1.49, 5.92) | 0.002 |
Non-Stigma Barriers to Care (Mean of Instrumental and Attitudinal Barriers) | 3.03 (1.63, 5.63) | <0.001 | 0.97 (0.38, 2.51) | 0.952 |
Instrumental barriers to care | 2.29 (1.37, 3.81) | 0.001 | - | |
Attitudinal barriers to care | 2.41 (1.36, 4.30) | 0.003 | ||
Nagelkerke R squared | − | 0.235 | ||
p | − | <0.001 |
Individual Models of Each Barriers’ Relationship with Depression | Model Including Both Stigma and Non-Stigma-Related Barriers | |||
---|---|---|---|---|
OR (95% CI) | p | aOR (95% CI) | p | |
Stigma Barriers to Care | 0.43 (0.26, 0.72) | 0.001 | 0.48 (0.24, 0.98) | 0.043 |
Non-Stigma Barriers to Care (Mean of Instrumental and Attitudinal Barriers) | 0.41 (0.22, 0.77) | 0.006 | 0.80 (0.32, 1.97) | 0.629 |
Instrumental barriers to care | 0.68 (0.41, 1.15) | 0.150 | - | |
Attitudinal barriers to care | 0.38 (0.21, 0.66) | 0.001 | ||
Nagelkerke R squared | − | <0.001 | ||
p | − | 0.140 |
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Sifat, M.; Huq, M.; Baig, M.; Tasnim, N.; Green, K.M. An Examination of Barriers to Accessing Mental Health Care, and Their Association with Depression, Stress, Suicidal Ideation, and Wellness in a Bangladeshi University Student Sample. Int. J. Environ. Res. Public Health 2023, 20, 904. https://doi.org/10.3390/ijerph20020904
Sifat M, Huq M, Baig M, Tasnim N, Green KM. An Examination of Barriers to Accessing Mental Health Care, and Their Association with Depression, Stress, Suicidal Ideation, and Wellness in a Bangladeshi University Student Sample. International Journal of Environmental Research and Public Health. 2023; 20(2):904. https://doi.org/10.3390/ijerph20020904
Chicago/Turabian StyleSifat, Munjireen, Maisha Huq, Mirza Baig, Naima Tasnim, and Kerry M. Green. 2023. "An Examination of Barriers to Accessing Mental Health Care, and Their Association with Depression, Stress, Suicidal Ideation, and Wellness in a Bangladeshi University Student Sample" International Journal of Environmental Research and Public Health 20, no. 2: 904. https://doi.org/10.3390/ijerph20020904