ing, for example, making sure that families with depression have health insurance or recognizing that, with depression, parents will need additional support to get tasks done.

BARRIERS TO CARE

Like a variety of other health services, access to care for depression may be influenced by geographic, physical, financial, sociocultural, and temporal barriers. Such barriers include transportation issues, physical disabilities, language barriers, cultural customs and beliefs, and health insurance coverage. Furthermore, an individual’s ability to access and use care may be affected by demographic characteristics (i.e., age, gender, education level, occupation, race/ethnicity), need (i.e., perceived health) and enabling characteristics (i.e., language, income, convenience, transportation, health system characteristics like infrastructure, linkages to a variety of providers). Stigma is a major barrier to seeking mental health treatment. Both self-stigma (people’s own responses to depression and help-seeking) and perceived stigma (perceptions of others’ negative responses) partially account for people’s reluctance to seek treatment (Barney et al., 2006; Halter, 2004). Many people are not familiar with treatment options, there is stigma associated with mental health treatments, and many providers are not aware of their patients’ preferences (Dwight-Johnson et al., 2000; Givens et al., 2007; Jaycox et al., 2006).

A number of institutional and sociocultural barriers are responsible for causing and maintaining existing disparities in access to and quality of mental health services received by minority groups. A succinct summary of the complex constellation of barriers is that “disparities result from ongoing interactions among factors at the levels of the health care environment, health care organization, community, provider, and person throughout the course of the depression development and treatment-seeking process” (Chin et al., 2007; Van Voorhees et al., 2007, p. 1617). Social marginalization, which has played a key role in rendering some populations disproportionately vulnerable to and affected by incidence of depression, extends its adverse impact by limiting the engagement of and treatment in historically underserved communities (Aguilar-Gaxiola et al., 2008). These groups’ isolation from mainstream society because of linguistic barriers, geographic isolation, a history of oppression, racism, discrimination, poverty, and immigration status plays a key role in creating and perpetuating many of the barriers to treatment.

In addition to individual and provider barriers to care specific to depression in adults, a body of literature continues to document the system-level limitations in mental health care generally. As described in a 2006 Institute of Medicine report entitled Improving the Quality of Health Care



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