Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
School of Psychology, University of Sussex, United Kingdom; Sussex Partnership NHS Foundation Trust, United Kingdom.
J Affect Disord. 2023 Oct 1;338:329-340. doi: 10.1016/j.jad.2023.06.035. Epub 2023 Jun 20.
Common mental disorders (CMDs) are prevalent throughout the population. Psychological therapy is often sought via primary care; however, equitable access is not commonplace. This review aims to investigate the barriers and facilitators adults experiencing CMDs perceive when accessing evidence-based psychological treatment in England.
A qualitative systematic review with meta-synthesis was conducted (PROSPERO CRD42020227039). Seven electronic databases were searched for papers from 2008 to October 2022.
Searches identified 30 studies from which three themes were developed with seven subthemes. Stigma and patients' perceptions and understandings of CMDs impacted their help-seeking decision-making and engagement with services. This meant that services were not used as a first resort for help-seeking. Upon reaching services, patients appeared to perceive primary care as not prioritising mental health problems, nor as being the place where they would be supported, particularly as healthcare professionals did not appear to know about CMDs and therapy was seen as difficult to access. The interaction between healthcare professional and patients was seen as pivotal to whether patients accessed support or not.
The review is limited to research conducted within England. Additionally, it only explores access barriers prior to treatment experiences.
Knowledge, attitudinal, systemic and relational barriers and facilitators were identified. Future research should focus on developing stigma reduction initiatives. Clinical implications include provision of standardised training across primary care HCP (healthcare professionals).
常见精神障碍（CMD）在人群中普遍存在。心理治疗通常通过初级保健寻求，但公平获得并不常见。本综述旨在调查英格兰成年人在获得基于证据的心理治疗时，感知到的障碍和促进因素。
进行了定性系统评价和元综合（PROSPERO CRD42020227039）。从 2008 年至 2022 年 10 月，在七个电子数据库中搜索了论文。
搜索结果确定了 30 项研究，从中发展出三个主题，七个子主题。污名和患者对 CMD 的认知和理解影响了他们的求助决策和对服务的参与。这意味着服务并不是求助的首选。一旦到达服务机构，患者似乎认为初级保健机构不重视心理健康问题，也不认为那里是他们会得到支持的地方，尤其是因为医疗保健专业人员似乎不了解 CMD，而且治疗似乎难以获得。医疗保健专业人员和患者之间的互动被认为是患者是否接受支持的关键。
该综述仅限于在英格兰进行的研究。此外，它仅探讨了治疗前的障碍。
确定了知识、态度、系统和关系方面的障碍和促进因素。未来的研究应集中于减少污名的举措。临床意义包括在初级保健医疗保健专业人员中提供标准化培训。
