期刊
PSYCHOLOGICAL MEDICINE
卷 45, 期 1, 页码 11-27出版社
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0033291714000129
关键词
Access; barriers to care; discrimination; help-seeking; service use; stigma
资金
- National Institute for Health Research (NIHR) under Programme Grants for Applied Research (PGfAR) [RP-PG-0606-1053]
- Comic Relief
- UK Government Department of Health
- European Commission
- Erasmus grant from the European Commission
- Biomedical Research Centre for Mental Health at the South London
- Maudsley NHS Foundation Trust
- Institute of Psychiatry, King's College London
- National Institute for Health Research [RP-PG-0606-1053, NF-SI-0611-10053] Funding Source: researchfish
Background. Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: (a) What is the size and direction of any association between stigma and help-seeking? (b) To what extent is stigma identified as a barrier to help-seeking? (c) What processes underlie the relationship between stigma and help-seeking? (d) Are there population groups for which stigma disproportionately deters help-seeking? Method. Five electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted. Results. The review identified 144 studies with 90189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d=-0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma. Conclusions. Stigma has a small-to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.
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