This study quantitatively examined the impact that the attributes held by people with mental disorders have on barriers to access to care. Our findings showed that women seem to experience more substantial barriers to care-seeking for their mental health problems than men do, particularly non-stigma-related barriers. Further, it appears that younger patients had experienced more significant treatment stigma. However, no association was found between age and non-stigma-related barriers. In addition, history of hospitalisation for the treatment of mental disorders and primary psychiatric diagnosis did not influence barriers to care-seeking.
Several studies have investigated the impact of gender differences on psychological help-seeking attitudes, suggesting that, compared with men, women’s attitudes towards help-seeking are more positive [15–17]. This study’s results were not consistent with those of previous studies.
Conversely, several studies conducted in Japan showed that, compared to women, men’s attitude towards help-seeking is more positive. For example, in an interview study conducted by Kido et al. involving 1,359 Japanese participants, men were less opposed to treatment and more likely to consult professionals about mental health problems compared with women . A study by Sakamoto et al. also showed that compared with older women, older men were more likely to consult specialists for problems regarding suicidal ideation . Therefore, the influence of gender differences on barriers to care-seeking may differ between Japan and other countries.
One possible reason for this is the difference in the environment in which women survive. According to a study conducted in Japan by Tsukazaki et al., women who lived with three or more other people or were working (including full-time homemakers) had lower rates of receiving medical treatment for mental disorders. The rates of receiving medical treatment were also lower among working men. However, there was no relationship between the number of people living together and the rates of receiving care . This finding suggests that the burden of housework, childcare, and nursing care on Japanese women may inhibit their help-seeking behaviours. According to cross-country data compiled by the Organisation for Economic Co-operation and Development for 2020, Japanese men and women spent 41 and 224 minutes a day, respectively, on housework and childcare (unpaid work), indicating a difference of 5.5 times. This difference in minutes is higher than that in the USA (1.6 times) and the UK (1.8 times) . The considerable barriers to care-seeking that Japanese women face may be attributed to the difficulty in finding time to access care. Further, gender differences were observed only in the case of non-stigma-related barriers, thereby supporting this speculation.
Selection bias is another possible reason for the inconsistency between the finding of this study and those in previous studies from other countries. This study included people with mental disorders who had used mental health services or visited a psychiatric institution within 12 months. Therefore, people with mental disorders who did not seek help and had not yet received treatment were not included in the study. The exclusion of men facing considerable barriers to care-seeking and had not yet received care may have led to the differences in the results. The impact of gender differences on barriers to care-seeking should be investigated in greater detail in the future.
The study also showed that, compared with younger participants, older participants had weaker treatment stigma. Previous studies have shown that older adults are less likely to receive psychological care, mainly because of stigma [22, 23]. However, recent studies suggest that, compared with younger people, older people may show a more positive attitude towards seeking help [24–26], which is consistent with the findings of this study. These findings suggest that the primary reason for older people not receiving psychological care may be non-stigma-related barriers, such as the lack of knowledge about treatment services and financial affordability, rather than stigma issues.
The reason for older people’s treatment stigma being weaker than that of younger people remains unclear. Mackenzie et al. suggested that this may be because older people are less likely to endorse social roles that emphasise strength and independence or because their life experiences have shown them the value of seeking help .
This study also showed that a history of hospitalisation to treat mental disorders did not affect barriers to care-seeking, which indicates that the hospitalisation experience does not reinforce (but also does not reduce) barriers to access to care for patients with mental disorders. Still, previous research has shown that forced hospitalisation in psychiatric institutions can contribute to the stigma experienced by patients . Therefore, although no significant differences were found in this study, forced admission of patients to hospitals should be avoided as far as possible. Further, treatment during hospitalisation should be performed to reduce patients’ treatment stigma.
Finally, this study showed that differences in primary psychiatric diagnosis do not affect barriers to care-seeking. To the best of our knowledge, no study examines the impact of differences in psychiatric diagnoses on stigma-related barriers. Hirai et al. noted that help-seeking behaviour was more likely to be delayed in patients with depressive symptoms, high fatigue, and decreased activity . Moreover, Mojtabai et al. found that patients with suicidal ideation were more likely to recognise the need to receive treatment . In considering barriers to care-seeking for people with mental disorders, it may be necessary to consider clinical symptoms and the severity of psychiatric symptoms, rather than psychiatric diagnoses.
This study has several limitations. First, because this was a web-based survey study, we could not confirm participants’ psychiatric diagnoses or severity of functional impairment. We should also note that the questionnaire was self-administered, and participants could not be assessed through structured interviews.
Second, this study may have selection bias. All participants in this study had received treatment for mental disorders within 12 months. Thus, patients who had never been treated for mental disorders were omitted. However, it was difficult to determine whether patients who had not yet received treatment had mental disorders, and this study could not resolve this limitation. In addition, because all participants in this study were willing and could complete the questionnaire via the Internet, there may be differences in the severity of mental symptoms and functional impairment compared with the overall population with mental disorders.
Third, this study did not assess the participants’ economic status and could not evaluate the impact of their economic situations on stigma-related and non-stigma-related barriers. Previous studies on Filipinos and Chinese Americans have shown that tight economic conditions significantly prevent people with mental disorders from seeking treatment [30, 31]. Further investigation is needed to examine whether similar results can be obtained for Japan, where the medical insurance and social security systems are different.
Furthermore, this study’s sample size was relatively small, albeit with sufficient power for statistical analysis. Replication studies with a larger sample size are needed to confirm this study’s results.