Barriers to mental health service utilization among people living with depression in Indonesia: a qualitative study

Depression is a major public health concern in Indonesia, yet access to mental health services remains limited despite ongoing efforts to expand mental health services. Understanding barriers to mental health service utilization from the perspectives of people living with depression and their families is essential to inform patient-centred and contextually appropriate interventions. This qualitative study employed an exploratory design using semi-structured interviews with 21 participants diagnosed with depression who were receiving outpatient mental health care in public and private hospitals in Indonesia. Participants were recruited purposively to ensure variation in sociodemographic characteristics and healthcare settings. Data were analysed using thematic analysis to identify key barriers to mental health service utilization. Four interrelated themes of barriers were identified: individual-level factors, family and social influences, treatment-related challenges, and health system barriers. At the individual level, difficulties in accepting the diagnosis, medication fatigue, and symptom-driven adherence influenced engagement with care. Family dynamics played a central role, acting as both facilitators and barriers to treatment access and continuation. Treatment-related challenges, including medication side effects and delayed therapeutic response, affected adherence. At the health system level, complex referral pathways, limited communication with healthcare providers, and medication shortages disrupted access and continuity of care. Stigma emerged as a cross-cutting issue influencing all levels of service utilization. Mental health service utilization among people living with depression in Indonesia is shaped by a complex interaction of individual, familial, treatment-related, and health system factors. Improving access requires integrated and patient-centred approaches, including strengthening communication, simplifying referral systems, involving families in care processes, and ensuring consistent service availability. These findings highlight the importance of culturally responsive strategies to improve mental health service delivery in Indonesia.