Table 2 Main Themes and Subthemes in Treatment-Seeking Behaviour

Individual aspects

Mental health literacy

Having adequate (+) or limited (−) knowledge of mental disease and pathway to care

Adequate (+) or inadequate (−) recognition of own symptoms

Disease burden

Increasing mental distress and dysfunctioning (+), sometimes leading to habituation (−)

Hindering disease characteristics; e.g. avoidance behaviour and isolation (−)

Stigma & Attitudinal aspects

Stigma and shame (−)

Negative (−) or positive (+) beliefs about oneself or about treatment

Previous experience

Previous positive (+) or negative (−) experiences with mental health care

Coping style

E.g. denial of symptoms (−), symptom suppression (−), solving problems alone (−)

Physical symptoms

Somatic symptoms related to psychological disorder leading to recognition (+) or delay in psychological treatment due to somatic referral (−)

Social problems

Housing problems (−) or occupancy with other tasks (−)

Personal social system

Recognition and encouragement from social network

Family and friends noticing (+) or not noticing (−) participants’ symptoms and encouraging treatment (+)

Judgment from others

(Perceived) Negative social judgment about psychological complaints and treatment (−)

Health care system

Recognition and referral by professional

Correct (+) or incorrect (−) diagnosis and referral by a professional

Therapeutic relationship with general practitioner

Having a good (+) or difficult (−) therapeutic relationship with the general practitioner

Waiting time & Logistic barriers

Long waiting time (−)

Having to find a therapist oneself (−), obstacles related to the referral process (−) and communication problems (−)

Sociocultural background

Stigma in the context of cultural background

Culture-related stigma (−)

Media and societal influences

Information from internet or television (+)

Society lacking knowledge of depression, burnout and anxiety disorder (−)