Psychological Medicine

Review Articles

What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies

S. Clementa1 c1 , O. Schaumana1 , T. Grahama1, F. Maggionia1, S. Evans-Lackoa1, N. Bezborodovsa1, C. Morgana1, N. Rüscha2, J. S. L. Browna3 and G. Thornicrofta1

a1 Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK

a2 Department of Psychiatry II, University of Ulm, Germany

a3 Department of Psychology, Institute of Psychiatry, King's College London, UK

Abstract

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 90 189 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.

(Received December 24 2012)

(Revised November 12 2013)

(Accepted January 13 2014)

(Online publication February 21 2014)

Key words

  • Access;
  • barriers to care;
  • discrimination;
  • help-seeking;
  • service use;
  • stigma

Correspondence

c1 Address for correspondence: Dr S. Clement, Section of Community Mental Health, PO29, Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email sarah.clement@kcl.ac.uk)

Footnotes

  These authors contributed equally to this work.

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