Normative and perceived unmet mental health needs, health care use and barriers to care for mental health problems in a general population sample

Background: Mental health problems often remain undetected and untreated. Prior research suggests that this is mainly due to a lack of need-perception and attitudinal barriers. The aim of this study is to examine unmet mental health needs using both a normative (assessed using screening scales) and a self-perceived approach. Methods: A cross-sectional survey study with a weighted and representative sample of 1208 individuals aged 15 – 80 years old was carried out in 2021 in the province of Antwerp (Belgium). The questionnaire consisted of screening scales for depression (PHQ-9), anxiety (GAD-7) and alcohol abuse (AUDIT-C and CAGE), and questions about dysfunction in daily life, 12-month health care use for mental health problems, self-perceived unmet mental health needs and reasons for not seeking (extra) help. Logistic regression analyses were used to explore the predictors of mental health problems, health care use, and objective and subjective unmet mental health needs. Results: One in five respondents had a probable mental health problem according to screening scales. Among those, only one in three used health care for their mental health, resulting in a population prevalence of 14% objective unmet mental health needs. Likewise, 14% of the total sample perceived an unmet mental health need. However, more women and younger people perceived unmet needs, while normative unmet needs were higher among men and older people. One in six of the total sample used health care for their mental health, half of whom did not have a mental health problem according to the screening scales. Motivational reasons were most often endorsed for not seeking any help, while a financial barrier was the most important reason for not seeking extra help. Conclusions: The prevalence of unmet mental health needs is high. Normative and perceived (unmet) mental health needs are both relevant and complementary, but are predicted by different factors. More research is needed on this discrepancy.