Table 5 Help-seeking: barriers and facilitators

Ayres 2019 [26]

Lack of time; no one to look after child while attending appointment

Encouragement by family

Encouraged by midwife / GP / obstetrician

Azale 2016 [27]

Fear of cost (56.0%); distance (50.4%)

Problem would get better by itself (76.1%); wanting to solve the problem by herself (66.7%)

Strong social support; perceived physical cause; perceived higher severity; perceived need for treatment; PHQ score; disability ^a

Barrera 2015 [28]

Non-help seekers: I figured that it would pass (83.8%); I didn’t think others would understand; (77.0%); I didn’t think anyone could help me (67.4%), I didn’t know what I was feeling (65.0%), I didn’t think it was that important (59.4%), I was afraid of my feelings (53.5%); I was ashamed of my feelings (50.2%); I was embarrassed of my feelings (49.8%)

current major depressive episode; income ^a

Bina 2014 [29]

High confidence in mental health professional, higher levels of depressive symptoms^a

DaCosta 2018 [33]

Being too busy (26.1%); waiting time too long (18%); cost (22.6%); not available at time required (10.4%)

Not having gotten around to it (46.1%); deciding not to seek care (24.3%); not knowing where to go (19.1%); felt help would be inadequate (16.5%)

Less severe depressive symptoms; prior consultation for mental health^a

Dunford 2017 [34]

Shame proneness significantly predicted negative attitudes towards help-seeking^b

Fonseca 2015 [35]

Not be able to afford treatment (63.7%); do not have time to go to psychology and/or psychiatry appointments (51.9%); have sanctions for missing work to go to psychology and /or psychiatric appointments; (38.6%); do not have means to travel to psychology and/or psychiatry appointments (19.3%).

Attitudinal barriers: thinking that no one will be able to help me deal with my problems (47.4%); being afraid of what my family and/or friends might think of me (32.2%); being ashamed to talk to with health professional (36.8%); being afraid that other people discover I attend psychology and / or psychiatric appointments (33.3%)

Knowledge barriers: do not know if my problems are a reason to ask for help (76%); do not know what the best treatment options is (96.2%), do not know where to seek treatment (39.2%)

Higher age; single/divorced; history of psychiatric problems and treatment^a

Fonseca 2018 [37]

For women with significant psychological symptoms: women’s more insecure attachment representations (anxiety and avoidance) were associated with lower intentions to seek professional help^f

Ford 2019 [38]

Logistics of attending appointment; logistics of getting an appointment ^c

Fear of stigma; willingness to seek help ^c

Interpersonal relationship with healthcare professionals

(healthcare professionals being empathetic and non-judgemental, having my voice heard in discussions and decisions about treatment, opportunity to build trust and respect with healthcare professionals); support from friends and family (partners who encourage women to seek help)^d

Goodman 2009 [39]

Cost (22.6%); no time (64.7%), no childcare (33.2%); if there were a charge, I might not be able to afford it (18.8%)

Stigma (42.5%); would not know where to find such services (26.2%)

Goodman 2013 [40]

Cost^e

Belief that prayer would be sufficient to help prevent depression^e

Severity of illness (33%), pragmatics (e.g., cost, location), (29%); knowledge; social support (19%), professional encouragement (7%)

Holt 2017 [42]

I thought I would be able to manage on my own (11.1%); I felt I should be able to manage on my own (11.1%); I did not think I needed help; (6.7%); I did not want people to know I wasn’t coping (6.1%)

antenatal anxiety, previous history of depression; self-esteem^a

Kim 2010 [43]

Patient level: Lack of time (25%); Used other support (25%); spontaneous improvement of symptoms (13%)

Provider level: provider unavailability (56%); unresponsive provider (25%)

Patient / provider interaction: Poor match to patient need (31%); patient provider fit (31%); phone tag (31%),

System level: Cost/insurance mismatch (56%); geographic mismatch (19%)

Patient level: recognition of one’s own need for treatment (14%)

Provider level: treatment availability (21%)

System level: Cost/insurance mismatch (21%)

Additional factors: referrals tailored to patient needs; (29%); specific encouragement to engage in treatment; (21%); geographic match (21%), active facilitation of the referral process (14%)

Logsdon 2018a [45]

Attitudes towards help-seeking: seeking psychological help carries a social stigma (34.8%); people will see them in a less favourable way if they were receiving mental health treatment (23.9%); people who seek psychological treatment are generally liked less by others (34.8%); people should work out their own problems with psychological counselling as the last resort (30.4%)

More positive attitudes towards seeking professional psychological help, less social support; less perceived control^a

O’Mahen 2008 [48]

1.Structural Barriers (1. insurance; 2. inability to pay; 3. transportation; 4. inadequate childcare)^g

2. Knowledge (1. not sure who to contact; 2. Do not know what treatment might be best for me)

3.Attitudes (1. lack of expressed motivation; 2. hopelessness about treatment working)^g

O’Mahen 2009 [49]

Belief that symptoms would last a long time^a

Prevatt 2018 [59]^l

Time constraints (18%)

Stigma (19%); lack of motivation (16%)

Social support, stress^a

Ride 2016 [52]

Cost^m

High social support; high levels of education; childcare; higher efficacy, past experience of treatment^m

Wenze 2018 [58]

Lack of time (16.6%)

Zittel-Palamara 2008 [59]

Tried to find assistance but was unable to find resources (15.6%); PPD symptoms made it difficult to take action (13.3%), comments from health care professional that ‘this is normal’ (13.3%)

Not being sure who to speak to (15.6%), lack of PPD education (13.3%); pressure from family and friends (e.g., ‘it is normal, you are fine’) (13.3%)