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Table 3 Pathway to Care - Example of Two Cases

From: Barriers and facilitators for treatment-seeking in adults with a depressive or anxiety disorder in a Western-European health care setting: a qualitative study

Marka, male 25 years

Mark experienced (social) phobic symptoms from the age of 8, which were interwoven with his childhood obesity. His insecurity caused by obesity in combination with the life phase he was in made it difficult to properly recognize his mental complaints; he and others attributed his withdrawal behaviour to puberty. At the age of 21 he sought treatment for the first time, suffering from problems in social contact. However, the general practitioner referred him to group therapy, which did not suit his preferences, and he never reached care but let things run their course. During this period, he lost much weight but his anxiety symptoms persisted nonetheless. Because it kept hindering him at work and studies, he started to consider seeking help again and after a year finally took this step. Facilitators were the encouragement from his partner (who was in treatment herself) and the realization that he now had enough time to commit to therapy. The general practitioner referred him to a mental health care institution, where he arrived after four months of waiting time.

Mary-Anna, female 61 years

Mary-Ann has suffered from multiple depressions in her life and has been in treatment several times. Her first depression started in 1983 with treatment starting in 1986. For a long time, Mary-Ann thought her depressive mood was simply part of life, and only because of others’ reactions she discovered this was not normal. Her coping style was hampering as well; isolating herself and putting up a front made it difficult for others to recognize her symptoms. During her first depression, she was eventually encouraged to seek treatment by an acquaintance who managed to break through her façade. However, treatment did not succeed because the psychiatrist wanted to treat her husband and not her, even though she felt she needed treatment herself. This confirmed her negative self-image that she was a hopeless case and could not be helped. Poor experiences with mental health care affected her treatment-seeking behaviour and it took a long time before she took action again. Her belief that depression is a weakness, which was largely confirmed by her environment, also negatively influenced this process. Stigma experienced at the workplace limited possibilities to seek for help or undergo treatment during working time. For a long time she hid her symptoms and tried to keep working. She engaged in treatment in 2004, encouraged by a friend. Because of increasing disease burden, she sought treatment again in 2009 from a psychiatrist. Treatment went well, and on the advice of this psychiatrist she started group therapy, which also helped. When this therapy ended, she had to be referred elsewhere, but experienced various logistic problems causing delay. Eventually she asked for a second opinion, leading to a referral to her current therapy. Overall, Mary-Ann encountered many barriers to care but facilitating factors were the recognition by others, and at a later stage a changing attitude toward herself that she deserves care.

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