Barrier to Treatment in Patients with Neurotic, Stress Related and Somatoform Disorders: Study from A Tertiary Centre of North India

  • Anurag Agarwal Assistant Professor, Department of Psychiatry, I.I.M.S. & R, Lucknow
  • Rakesh Yaduvanshi Assistant Professor, Department of Psychiatry, RMCH, Bareilly, UP, India.
Keywords: barrier to treatment, pathway of care, awareness


Background: Psychiatric disorders are highly prevalent and also the leading causes of disability worldwide. Because of multiple factors playing as barriers in help seeking many people who might benefit from the treatment do not obtain it. Data regarding common mental disorders is even more lacking. Methods: Present study was undertaken to assess various treatment barriers affecting help seeking behavior in 156 patients of “neurotic, stress related and somatoform disorders” who were assessed on various tools. The study sample was divided in Aware and Unaware group on the basis of their awareness about psychiatric disorder at the time of onset/initial stages of illness. Results: Inability to recognize patient’s behavioral problem by family members and lack of treatment facility/ resource were important barrier to care. Prevalent nonscientific etiological belief (e.g. supernatural phenomenon, a form of worry or tension) in society also delayed treatment seeking. The observations of present study have helped in revealing the barriers in treatment seeking for patients of neurotic and stress related disorders. Raising awareness about these disorders in community and making psychiatric easily accessible to general population will be helpful in overcoming these barriers.


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1. WHO International Consortium in Psychiatric Epidemiology. Cross-national comparisons of the prevalences and correlates of mental disorders. Bulletin of the World Health Organization 2000; 78:413-25.
2. Zachary Steel, Claire Marnane, Changiz Iranpour, Tien Chey, John W Jackson,Vikram Patel,,Derrick Silove: The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013: Int J Epidemiol (2014) 43 (2): 476-493.
3. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, editors. Global Burden of Disease and Risk Factors. Oxford University Press/World Bank; New York, NY: 2006.
4. Kessler, R. C., Berglund, P. A., Bruce, M. L., Koch, R., Laska, E. M.,Leaf, P. J., et al. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36, 987–1007.
5. Corrigan P (October 2004). How Stigma Interferes With Mental Health Care. American Psychologist, Vol. 59, No. 7, 614–625
6. Post RM. Weiss SR. Sensitization and kindling phenomena in mood, anxiety, and obsessive-compulsive disorders: the role of serotonergic mechanisms in illness progression. Biol Psychiatry. 1998; 44:193–206.
7. Trivedi JK, Gupta PK (2010). An overview of Indian research in anxiety disorders. Indian Journal of Psychiatry, 52, 210-8
8. Altamura AC, Bassetti R, Bignotti S, Sassella, Sassella D., et al (2001) Duration of untreated psychosis as a predictor of outcome in first episode schizophrenia; a retrospective study. Schizophrenia Research, 52 29-36
9. Black, K., Peters, L., Rui, Q., et al (2001) Duration of untreated psychosis predicts treatment outcome in an early psychosis program. Schizophrenia Research, 47, 215 –222.
10. ICD-10, Clinical Descriptions and Diagnostic Guidelines, Classification Of Mental And Behavioral Disorders, WHO, Geneva.
11. Gater R, de Almeida e Sousa B, Barrientos G et al (1991). The pathways to psychiatric care: a cross-cultural study. Psychological Medicine, 21, 761 -774.
12. Gater R, Jordanova V, Maric N, Alikaj V, Bajs M, Cavic T, Dimitrov H, Iosub D, Mihai A, Szalontay AS, Helmchen H, Sartorius N: Pathways to psychiatric care in Eastern Europe. Br J Psychiatry 2005, 186:529-35.
13. Chiang JCS, Chow ASY, Chan RCK, Law CW, Eric YHC. Pathway to care for patients with First-Episode Psychosis, Hong Kong Journal of Psychiatry. 15 (01), 18-22+34
14. Chen H, Parker G, Kua J, Jorm A, Loh J: Mental health literacy in Singapore: a comparative survey of psychiatrists and primary health professionals. Ann Acad Med Singapore 2000, 29:467-473.
15. Scott TL, Gazmararian JA, Williams MV, Baker DW: Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care 2002, 40:395-404.
16. Robert KW, Edwin CS. Evaluating community awareness of a community mental health center. Journal of Community Psychology. Volume 8 Issue 2, Pages 117 – 124
17. Wolff, G., Pathare, S., Craig, T., et al (1996) Community knowledge of mental illness and reaction to mentally ill people. British Journal of Psychiatry, 168, 191-198.
18. Leventhal H, Benyamini Y, Brownlee S, et al. Illness representations: theoretical foundations. In: Petrie KJ, Weinman JA, editors. Perceptions of Health and Illness.Amsterdam: Harwood Academic; 1997. p. 19-45
19. U.S. Department of Health and Human Services, Mental Health: A Report of the Surgeon General, Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999, p. 6.
20. Trivedi JK, Gupta PK. (2010).An overview of Indian research in anxiety disorders. Indian J Psychiatry;52:210-8
21. Reddy M.V., Chandrashekhar C., (1998); Prevalence of Mental and behavioral disorders in India: A meta analysis. Indian Journal of Psychiatry. 40:149-157.
22. Pradhan SC, Singh MM, Singh RA, Das J, Ram D, Patil B, Jain AK, Thomas JK. First care givers of mentally ill patients: A multicenter study. Indian J Med Sci 2001;55:203-8
23. Lahariya C, Singhal S, Gupta S, Mishra A: Pathway of care among psychiatric patients attending a mental health institution in central India. Indian J Psychiatry. 2010 Oct–Dec; 52(4): 333–338.
24. Gureje D, Acha RA, Odejide DA. Pathways to psychiatric care in Ibadan, Nigeria. Trop Geogr Med 1995; 47:125-129.
25. Trivedi JK, Sethi BB. A psychiatric study of traditional healers in Lucknow city. Indian J psychiat. (1979), 21, 133-137.
26. Razali S. M., Khan U. A., Hasanah C. I. (1996). Belief in supernatural causes of mental illness among Malay patients: impact on treatment. Acta Psychiatr. Scand. 94, 229–233. 10.1111/j.1600-0447.1996.tb09854.x
27. Chakraborty K., Das G., Dan A., Bandyopadhyay G., Chaterjee M. (2013). Perceptions about the causes of psychiatric disorders and subsequent help seeking pattern among psychiatric outpatients of in a tertiary care centre in Eastern India. German Journal of Psychiatry, 16, 7–14.
28. Kurihara T, Kato M, Reverger R, Tirta I. Beliefs about causes of schizophrenia among family members: a community-based survey in Bali. Psychiatr Serv. 2006;57:1795–1799.doi: 10.1176/
29. Sheikh, S. and A. Furnham, (2000). A cross-cultural study of mental health beliefs and attitudes towards seeking professional help. Soc. Psychiatry Psychiatr. Epidemiol., 35: 326-334.
30. Jorm AF: (2000) Mental health literacy. Public knowledge and beliefs about mental disorders. Br J Psychiatry, 177:396-401.
31. Boey KW. (1998) Help-seeking pattern of psychiatric outpatients in urban China. Int J Psychiatr Nurs Res.; 4: 433–43.
32. Weiss M. G., Jadhav S., Raguram R., Vounatsou P., Littlewood R. (2001). Psychiatric stigma across cultures: local validation in Bangalore and London. Anthropol. Med. 8, 71–87. 10.1080/13648470120063906
33. Vijayalakshmi P., Reddemma K., Math S. B. (2013). Attitude and response of a rural population regarding person with mental illness. Dysphrenia 4, 42–48.
34. Adewuya A. O., Fwacp R. O. M. (2005). Social distance towards people with mental illness amongst Nigerian university students. Soc. Psychiatry Psychiatr. Epidemiol. 40, 865–868. 10.1007/s00127-005-0965-3
35. Shokoohi-Yekta M, Retish PM., Int J Soc Psychiatry. Attitudes of Chinese and American male students towards mental illness.,1991 Autumn;37(3):192-200.
36. Kurihara T., Kato M., Sakamoto S., Reverger R., Kitamura T. (2000). Public attitudes towards the mentally ill: a cross−cultural study between Bali and Tokyo. Psychiatry Clin. Neurosci. 54, 547–552. 10.1046/j.1440-1819.2000.00751.x
37. Barke A., Nyarko S., Klecha D. (2011). The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients' views. Soc. Psychiatry Psychiatr. Epidemiol. 46, 1191–1202. 10.1007/s00127-010-0290-3
38. Anglin D., Link B., Phelan J. (2006). Racial differences in stigmatizing attitudes toward people with mental illness. Psychiatr. Serv. 57, 857–862. 10.1176/ps.2006.57.6.857
39. Aggarwal ML. Mental health care of rural population in India. J Mental Health Hum Behav 1998:5-10.
40. World Health Organisation. (2011a). Mental Health Atlas 2011: India. Available onlineat:
41. World Health Organisation. (2011b). Mental Health Atlas 2011: United States of America. Available on line at:
42. Khandelwal,S.K.,Jhingan,H.P.,Ramesh,S.,Gupta,R.K.,andSrivastava,V.K. (2004). India mental health country rofile.Int.Rev.Psychiatry16,126–141. doi:10.1080/09540260310001635177
43. Jorm A. F., Korten A. E., Jacomb P. A., Christensen H., Rodgers B., Pollitt P. (1997). Mental health literacy: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med. J. Aust. 166, 182.
44. Trivedi JK, Jilani AQ. (2011). Pathway of psychiatric care. Indian J Psychiatry;53:97-8
45. Bebbington PE, Burgha TS, Meltzer H, Jenkins R, Ceresa C, Farrell M, Lewis G (2000). Neurotic disorders and the receipt of psychiatric treatment. Psychological Medicine 30, 6, 1369-1376
46. Hillert, A., Sandmann, J., Ehmig, S. C., et al (1999) The general public's cognitive and emotional perception of mental illnesses: an alternative to attitude-research. In The Image of Madness: The Public Facing Mental Illness and Psychiatric Treatment (eds J. Guimon, W. Fischer & N. Sartorius), pp. 56-71. Basel: Karger.
47. Fischer, W., Goerg, D., Zbinden, E., et al (1999) Determining factors and the effects of attitudes towards psychotropic medication. In The Image of Madness: The Public Facing Mental Illness and Psychiatric Treatment (eds J. Guimon, W. Fischer & N. Sartorius), pp. 162-186. Basel: Karger.
48. Costello EJ et al. (1998). A family network-based model of access to child mental health services. Research in community and mental health, 9:165–90.
How to Cite
Agarwal A, Yaduvanshi R. Barrier to Treatment in Patients with Neurotic, Stress Related and Somatoform Disorders: Study from A Tertiary Centre of North India. IABCR [Internet]. 23Sep.2017 [cited 19Jul.2019];3(3):27-2. Available from: