title: What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies.
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?
  
  
  METHODS
  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.
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Clement
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK.
authors.forename: O
authors.initials: O
authors.lastname: Schauman
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK.
authors.forename: T
authors.initials: T
authors.lastname: Graham
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK.
authors.forename: F
authors.initials: F
authors.lastname: Maggioni
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Evans-Lacko
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK.
authors.forename: N
authors.initials: N
authors.lastname: Bezborodovs
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK.
authors.forename: C
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Department of Psychiatry II,University of Ulm,Germany.
authors.forename: N
authors.initials: N
authors.lastname: Rüsch
authors.affiliation: Department of Psychology, Institute of Psychiatry,King's College London,UK.
authors.forename: J S L
authors.initials: JS
authors.lastname: Brown
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK.
authors.forename: G
authors.initials: G
authors.lastname: Thornicroft
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008603:Mental Health; D008605:Mental Health Services; D008889:Military Personnel / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care; D036301:Qualitative Research; D057545:Social Stigma