Whether and how people reach care.
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26 to 50 of 2,047Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence.
Background: Studies of cognitive behavioural therapy delivered by computer (cCBT) show clinical efficacy for treating anxiety and depression, but have not focused on barriers to uptake. Potential barriers include adverse consequences, accessibility and acceptability.
Method: An integrated systematic review was conducted of quantitative and qualitative studies and surveys from multiple electronic databases where computers delivered cCBT for anxiety or depression.
Results: Substantial numbers of potential participants are lost prior to trials commencing with little explanation. Among trial participants, drop-outs may be higher in the cCBT groups (odds ratio 2.03, 95% confidence interval 0.81-5.09). Only a median of 56% completed a full course of cCBT and personal circumstance was a more common cause of drop-out than difficulties with the technology or social background. Risk was rarely ass…
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Discrimination in health care against people with mental illness.
This paper discusses factors associated with low rates of help-seeking and poorer quality of physical healthcare among people with mental illnesses. Evidence is reviewed on the associations between low rates of mental health literacy, negative attitudes towards people with mental illness, and reluctance to seek help by people who consider that they may have a mental disorder. People with mental illness often report encountering negative attitudes among mental health staff about their prognosis, associated in part with 'physician bias'. 'Diagnostic overshadowing' appears to be common in general health care settings, meaning the misattribution of physical illness signs and symptoms to concurrent mental disorders, leading to underdiagnosis and mistreatment of the physical conditions.
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Webb R, Uddin N, Ford E, Easter A, Shakespeare J, Roberts N, Alderdice F, Coates R, Hogg S, Cheyne H, Ayers S, MATRIx study team (2021)meta-analysisMEDLINE-indexed journal, not yet read by usThe lancet. Psychiatry88 citations Barriers and facilitators to implementing perinatal mental health care in health and social care settings: a systematic review.
The improvement of perinatal mental health formed part of WHO's Millennium Development Goals. Research suggests that the implementation of perinatal mental health care is variable. To ensure successful implementation, barriers and facilitators to implementing perinatal mental health services need to be identified. Therefore, we aimed to identify the barriers and facilitators to implementing assessment, care, referral, and treatment for perinatal mental health into health and social care services. In this systematic review, we searched CINAHL, Embase, MEDLINE, and PsycINFO with no language restrictions for primary research articles published between database inception and Dec 11, 2019. Forward and backward searches of included studies were completed by March 31, 2020. Studies were eligible if they made statements about factors that either facilitated or impeded the implementation of perin…
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Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review.
Background: Early intervention services for psychosis aim to detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments.
Aims: To evaluate the effectiveness of early intervention services, cognitive-behavioural therapy (CBT) and family intervention in early psychosis.
Method: Systematic review and meta-analysis of randomised controlled trials of early intervention services, CBT and family intervention for people with early psychosis.
Results: Early intervention services reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission.
Conclusions: For people with early psychosis, early intervention services app…
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Help-Seeking and Barriers to Care in Intimate Partner Sexual Violence: A Systematic Review.
Intimate partner sexual violence (IPSV) is a prevalent phenomenon, yet an under-researched topic. Due to the complex nature of balancing love and fear, individuals who experience IPSV have unique needs and face unique barriers to seeking care. The purpose of this systematic review was to examine the literature on help-seeking and barriers to care in IPSV. Articles were identified through PubMed, CINAHL, PsycINFO, and Web of Science. Search terms included terms related to IPSV, intimate partner violence (IPV), domestic violence, sexual assault, and rape. The review was limited to the United States, and articles that were included needed to specifically measure or identify sexual violence in an intimate relationship and analyze or discuss IPSV in relation to help-seeking behaviors or barriers to care. Of the 17 articles included in this review, 13 were quantitative studies and four were qu…
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Can a documentary increase help-seeking intentions in men? A randomised controlled trial.
Background: We investigated whether a public health intervention-a three-part documentary called Man Up which explored the relationship between masculinity and mental health, well-being and suicidality-could increase men's intentions to seek help for personal and emotional problems.
Methods: We recruited men aged 18 years or over who were not at risk of suicide to participate in a double-blind randomised controlled trial. Participants were randomly assigned (1:1) via computer randomisation to view Man Up (the intervention) or a control documentary. We hypothesised that 4 weeks after viewing Man Up participants would report higher levels of intention to seek help than those who viewed the control documentary. Our primary outcome was assessed using the General Help Seeking Questionnaire, and was analysed for all participants. The trial was registered with the Australian New Zealand Clinica…
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The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study.
Background: Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps.
Objective: This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups.
Methods: We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participan…
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Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK.
Objective: Lack of access to mental health services during the perinatal period is a significant public health concern in the UK. Barriers to accessing services may occur at multiple points in the care pathway. However, no previous reviews have investigated multilevel system barriers or how they might interact to prevent women from accessing services. This review examines women, their family members' and healthcare providers' perspectives of barriers to accessing mental health services for women with perinatal mental illness in the UK.
Design: A systematic review and meta-synthesis of qualitative studies.
Data sources: Qualitative studies, published between January 2007 and September 2018, were identified in MEDLINE, PsycINFO, EMBASE and CINAHL electronic databases, handsearching of reference lists and citation tracking of included studies. Papers eligible for inclusion were conducted in…
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Derr AS (2016)systematic reviewMEDLINE-indexed journal, not yet read by usPsychiatric services (Washington, D.C.)278 citations Mental Health Service Use Among Immigrants in the United States: A Systematic Review.
Objective: Immigrants face stressors unique to the experience of migration that may exacerbate or cause mental health problems but access care at rates far below the general population, leaving them at risk of untreated mental health conditions. This review synthesizes current findings on mental health service utilization among immigrants to inform future research efforts addressing disparities in access to care.
Methods: A systematic literature search of seven databases yielded 62 articles that met inclusion criteria: peer-reviewed reports of empirical studies based in the United States with an explicit focus on immigrant mental health service use. Each article was evaluated, and information was extracted by using a structured abstracting form.
Results: Studies have shown that immigrants from Asia, Latin America, and Africa use mental health services at lower rates than nonimmigrants, d…
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Increasing treatment-seeking intentions of US veterans in the Covid-19 era: A randomized controlled trial.
Background: Veterans have higher rates of anxiety, depression, and posttraumatic stress disorder (PTSD), and may be vulnerable to mental health consequences of the Covid-19 pandemic. More than half of veterans who meet mental illness criteria do not seek help. This study screened for clinical symptoms and evaluated the efficacy of a brief, online social-contact-based video intervention in increasing treatment-seeking intentions among veterans. We hypothesized that the video-based intervention would increase treatment-seeking intentions more than written vignette and control conditions.
Methods: One hundred seventy-two veterans were randomized to either a (a) brief video-based intervention; (b) written vignette intervention, or (c) nonintervention control group. In the 3-min video, a veteran previously diagnosed with PTSD described his symptom reactivation by Covid-19, his barriers to car…
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A comparison of barriers to accessing services for mental and physical health conditions in a sample of rural Australian adults.
Introduction: The prevalence of chronic disease, mortality and suicide rates is higher in rural Australia than in urban centres. Understanding rural Australians' barriers to accessing health services requires urgent attention. The purpose of this study was to compare barriers to help-seeking for physical and mental health issues among rural South Australian adults.
Methods: A total of 409 people from three rural and remote regions in South Australia completed a computer-assisted telephone interview. They were presented a physical or mental health scenario and rated the extent to which barriers would prevent them from seeking help for that condition. Responses ranged from 1 ('strongly disagree') to 5 ('strongly agree') and were averaged to form domain scores (higher scores representing stronger barriers to seeking support), in addition to being examined at the item level.
Results: Men rep…
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"Youth friendly" clinics: considerations for linking and engaging HIV-infected adolescents into care.
Linkage and engagement in care are critical corollaries to the health of HIV-infected adolescents. The adolescent HIV epidemic and adolescents' unique barriers to care necessitates innovation in the provision of care, including the consideration of the clinical experience. Little research has addressed how "youth friendly" clinics may influence care retention for HIV-infected youth. We conducted 124 interviews with providers, outreach workers, and case managers, at 15 Adolescent Medicine Trials Network clinics. Photographs of each clinic documented the characteristics of the physical space. Constant comparison and content and visual narrative methods were utilized for data analysis. Three elements of youth friendliness were identified for clinics serving HIV-infected youth, including: (1) role of target population (e.g., pediatric, adolescent, HIV); (2) clinics' physical environment; and…
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Emery JD, Walter FM, Gray V, Sinclair C, Howting D, Bulsara M, Bulsara C, Webster A, Auret K, Saunders C, Nowak A, Holman CD (2013)cohort or longitudinalMEDLINE-indexed journal, not yet read by usFamily practice74 citations Diagnosing cancer in the bush: a mixed-methods study of symptom appraisal and help-seeking behaviour in people with cancer from rural Western Australia.
Background: Previous studies have focused on the treatment received by rural cancer patients and have not examined their diagnostic pathways as reasons for poorer outcomes in rural Australia.
Objectives: To compare and explore symptom appraisal and help-seeking behaviour in patients with breast, lung, prostate or colorectal cancer from rural Western Australia (WA).
Methods: A mixed-methods study of people recently diagnosed with breast, lung, prostate or colorectal cancer from rural WA. The time from first symptom to diagnosis (i.e. total diagnostic interval, TDI) was calculated from interviews and medical records.
Results: Sixty-six participants were recruited (24 breast, 20 colorectal, 14 prostate and 8 lung cancer patients). There was a highly significant difference in time from symptom onset to seeking help between cancers (P = 0.006). Geometric mean symptom appraisal for colorectal …
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Breast cancer delay: a grounded model of help-seeking behaviour.
The conventional definition and classifications of breast cancer delay are based on arbitrary empirical time cut-offs. In general, studies of cancer delay are based on these traditional definitions of patient and provider delay and are essentially atheoretical. If we aim to better understand delay, a reconsideration of its traditional conceptualisation and study methods is warranted. We propose a multidimensional model of breast cancer delay grounded in data from in-depth interviews with symptomatic patients and nested in the theory of illness behaviour. Our results show that delay prior to the first encounter with health services has to do with more than simply the patient as an individual, and delay posterior to this encounter is not due only to the health care providers. In fact, delay is a result of the interplay between the patient's socio-cultural context, individual characteristic…
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Jamison JM, Fourie E, Siper PM, Trelles MP, George-Jones J, Buxbaum Grice A, Krata J, Holl E, Shaoul J, Hernandez B, Mitchell L, McKay MM, Buxbaum JD, Kolevzon A (2017)randomised controlled trialMEDLINE-indexed journal, not yet read by usJournal of autism and developmental disorders51 citations Examining the Efficacy of a Family Peer Advocate Model for Black and Hispanic Caregivers of Children with Autism Spectrum Disorder.
Autism spectrum disorder (ASD) affects individuals across all racial and ethnic groups, yet rates of diagnosis are disproportionately higher for Black and Hispanic children. Caregivers of children with ASD experience significant stressors, which have been associated with parental strain, inadequate utilization of mental health services and lower quality of life. The family peer advocate (FPA) model has been utilized across service delivery systems to provide family-to-family support, facilitate engagement, and increase access to care. This study used a randomized controlled design to examine the efficacy of FPAs in a racially and ethnically diverse sample. Results demonstrate significantly increased knowledge of ASD and reduced levels of stress for caregivers who received the FPA intervention as compared to treatment as usual.
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Ricketts EJ, Goetz AR, Capriotti MR, Bauer CC, Brei NG, Himle MB, Espil FM, Snorrason Í, Ran D, Woods DW (2016)randomised controlled trialMEDLINE-indexed journal, not yet read by usJournal of telemedicine and telecare74 citations A randomized waitlist-controlled pilot trial of voice over Internet protocol-delivered behavior therapy for youth with chronic tic disorders.
Introduction: Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be efficacious for chronic tic disorders (CTDs), but utilization is limited by a lack of treatment providers and perceived financial and time burden of commuting to treatment. A promising alternative to in-person delivery is voice over Internet protocol (VoIP), allowing for remote, real-time treatment delivery to patients' homes. However, little is known about the effectiveness of VoIP for CTDs. Therefore, the present study examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT (CBIT-VoIP).
Methods: Twenty youth (8-16 years) with CTDs participated in a randomized, waitlist-controlled pilot trial of CBIT-VoIP. The main outcome was pre- to post-treatment change in clinician-rated tic severity (Yale Global Tic Severity Scale). The secondary outcome was clinical responder r…
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Use of standardised outcome measures in adult mental health services: randomised controlled trial.
Background: Routine use of standardised outcome measures is not universal.
Aims: To evaluate the effectiveness of standardised outcome assessment.
Method: A randomised controlled trial, involving 160 representative adult mental health patients and paired staff (ISRCTN16971059). The intervention group (n=101) (a) completed monthly postal questionnaires assessing needs, quality of life, mental health problem severity and therapeutic alliance, and (b) received 3-monthly feedback. The control group (n=59) received treatment as usual.
Results: The intervention did not improve primary outcomes of patient-rated unmet need and of quality of life. Other subjective secondary outcome measures were also not improved. The intervention reduced psychiatric inpatient days (3.5 v.16.4 mean days, bootstrapped 95% CI1.6-25.7), and hence service use costs were 2586 UK pounds (95% CI 102-5391) less for inter…
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Systematic review of interventions to reduce mental health stigma in India.
Background: Stigma is a barrier for help-seeking, mental health service access, and contributes to the mental health treatment gap. Because the mental health treatment gap is greatest in low- and middle-income countries, it is vital to identify effective strategies to reduce stigma in these settings. To date, there has been a lack of synthesis of findings from interventions to reduce stigma related to mental disorders within India.
Method: A systematic review was conducted to provide an overview of the characteristics and effectiveness of stigma reduction interventions studies in India. PubMed, Embase and PsycINFO databases were searched for literature published up to 30th June 2020.
Results: From a total of 1,984 articles identified, only 9 were eligible for final inclusion, published between 1990-2020. No study was found from North, North-East, Central or East India. Most stigma-reduct…
matched on Mental Health Services (mesh), help-seeking (text), treatment gap (text)
Association between mental health-related stigma and active help-seeking: systematic review and meta-analysis.
BackgroundMental disorders create high individual and societal costs and burden, partly because help-seeking is often delayed or completely avoided. Stigma related to mental disorders or mental health services is regarded as a main reason for insufficient help-seeking. AimsTo estimate the impact of four stigma types (help-seeking attitudes and personal, self and perceived public stigma) on active help-seeking in the general population. MethodA systematic review of three electronic databases was followed by random effect meta-analyses according to the stigma types. ResultsTwenty-seven studies fulfilled eligibility criteria. Participants' own negative attitudes towards mental health help-seeking (OR = 0.80, 95% CI 0.73-0.88) and their stigmatising attitudes towards people with a mental illness (OR = 0.82, 95% CI 0.69-0.98) were associated with less active help-seeking. Self-stigma showed i…
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Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review.
Background: Despite the well-documented risk factors and health consequences of postpartum depression, it often remains undetected and untreated. No study has comprehensively examined postpartum depression help-seeking barriers, and very few studies have specifically examined the acceptability of postpartum depression treatment approaches. The objective of this study was to examine systematically the literature to identify postpartum depression help-seeking barriers and maternal treatment preferences.
Methods: Medline, CINAHL, and EMBASE databases were searched using specific key words, and published peer-reviewed articles from 1966 to 2005 were scanned for inclusion criteria.
Results: Of the 40 articles included in this qualitative systematic review, most studies focused on women's experiences of postpartum depression where help seeking emerged as a theme. A common help-seeking barrier …
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Suicide after leaving the UK armed forces--a cohort study.
Background: Few studies have examined suicide risk in individuals once they have left the military. We aimed to investigate the rate, timing, and risk factors for suicide in all those who had left the UK Armed Forces (1996-2005).
Methods and findings: We carried out a cohort study of ex-Armed Forces personnel by linking national databases of discharged personnel and suicide deaths (which included deaths receiving either a suicide or undetermined verdict). Comparisons were made with both general and serving populations. During the study period 233,803 individuals left the Armed Forces and 224 died by suicide. Although the overall rate of suicide was not greater than that in the general population, the risk of suicide in men aged 24 y and younger who had left the Armed Forces was approximately two to three times higher than the risk for the same age groups in the general and serving popula…
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Stigma and help seeking for mental health among college students.
Mental illness stigma has been identified by national policy makers as an important barrier to help seeking for mental health. Using a random sample of 5,555 students from a diverse set of 13 universities, we conducted one of the first empirical studies of the association of help-seeking behavior with both perceived public stigma and people's own stigmatizing attitudes (personal stigma). There were three main findings: (a) Perceived public stigma was considerably higher than personal stigma; (b) personal stigma was higher among students with any of the following characteristics: male, younger, Asian, international, more religious, or from a poor family; and (c) personal stigma was significantly and negatively associated with measures of help seeking (perceived need and use of psychotropic medication, therapy, and nonclinical sources of support), whereas perceived stigma was not significa…
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Gender and health care utilization: the role of mental distress and help-seeking propensity.
Many studies report higher levels of health care utilization among women. Understanding how gender influences health care utilization is still unresolved. We developed a model that could explain these gender-related differences. The possible pathways assumed by this model that relate gender to utilization, can be summarized as follows: (1) utilization may be influenced by somatic morbidity, mental distress, perceived symptoms, poor subjective health and propensity to use services; (2) women have higher levels of these variables than men (mediating effect); and (3) the direct effects of some of these variables on utililization are moderated by gender, i.e. they are stronger for women than for men (moderating effect). Data were drawn from a community-based sample of adult enrollees of a sickness fund in the Netherlands, who had responded to a mailed health survey (N = 8698). This survey co…
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South Asian older adults with memory impairment: improving assessment and access to dementia care.
Objective: With increasing international migration, mental health care of migrants and ethnic minorities is a public health priority. South Asian older adults experience difficulties in accessing services for memory impairment, dementia and mental illness. This review examines barriers and facilitators in the pathway to culturally appropriate mental health care.
Methods: Web of Knowledge, Pubmed and Ovid databases were searched for literature on South Asian older adults or their family carers, their understandings of mental illness and dementia and their pattern of service use. Dates were from 1984 to 2012. Abstracts were assessed for relevance, followed by detailed reading of salient papers. Three researchers rated the quality of each included study. A narrative synthesis was undertaken of extracted and charted data.
Results: Eighteen studies met the eligibility criteria for the review.…
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Autism in Brazil: a systematic review of family challenges and coping strategies.
Objective: To describe the challenges faced by families caring for children with autism spectrum disorder (ASD) in Brazil and the coping strategies employed.
Sources: Systematic review of articles published until September of 2013, without language restrictions, using quality appraisal (AMSTAR and CASP/Oxford instruments).
Summary of the findings: The literature shows parental emotional overload as one of the main challenges faced by families, especially mothers. The main stressors were diagnostic postponement, difficulty dealing with the diagnosis and associated symptoms, and poor access to health services and social support. The predominant coping strategies found included information exchange between affected families and integrated healthcare network for patient and family support.
Conclusion: ASD exerts strong influence on family dynamics, resulting in caregiver overload, especially…
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