Gadgil Mukta K, Darak Shrinivas, Jadhav Snehal, Rakshase Bal
State Health System Resource Centre (SHSRC), Pune, Maharashtra, India.
Prayas Health Group, Pune, Maharashtra, India.
Indian J Community Med. 2025 Aug;50(Suppl 1):S22-S29. doi: 10.4103/ijcm.ijcm_307_24. Epub 2025 Mar 31.
Mental health issues among adolescents are a significant public health concern globally. Overall, the unmet need for mental health care is high across the globe in different socio-demographic and ethnic populations. There have been efforts to understand the barriers to reducing the treatment gap globally and in India. It is evident that in different populations and countries, there are variations in barriers to accessing mental health care. A systematic understanding of barriers and facilitators to accessing care would be the first step toward bridging the gap in mental healthcare needs. This systematic review seeks to identify the factors that either enable or hinder adolescents in accessing care for their mental health concerns in India.
The electronic search was conducted in March 2023 on two databases: PubMed and Google Scholar. A detailed search strategy with relevant search terms was developed. The search yielded 1402 articles, which were further screened using inclusion and exclusion criteria. A total of 242 such articles were thus screened for abstract, of which 26 articles were screened for full paper, and finally, five articles were included in the review.
Barriers and facilitators to access to care are represented using the ecological model of behavior change. Facilitators at each level of this model help a person move closer to accessing health care, while barriers at each level take a person away from accessing health care. At the individual and interpersonal level, factors such as knowledge, awareness, and willingness to seek care, and treatment are predominant factors. At the institutional level, i.e., at the school level, awareness among teachers is an important facilitator, whereas stigma is a crucial community-level barrier to accessing health care. Most facilitators and barriers identified during this systematic review are related to policy-level issues such as quality of health care and Human Resource (availability, training, etc.), healthcare setup, Health Care Funding, etc.
Evidence for access to mental healthcare-related barriers and facilitators for adolescents in India is very scanty. More research is needed to understand these aspects from varying socio-cultural and demographic backgrounds.
青少年心理健康问题是全球重大的公共卫生问题。总体而言，全球不同社会人口和种族群体对心理健康护理的未满足需求很高。人们一直在努力了解全球和印度减少治疗差距的障碍。显然，在不同人群和国家中，获得心理健康护理的障碍存在差异。系统地了解获得护理的障碍和促进因素将是弥合心理健康护理需求差距的第一步。本系统评价旨在确定在印度促使或阻碍青少年获得心理健康护理的因素。
2023年3月在两个数据库进行了电子检索：PubMed和谷歌学术。制定了带有相关检索词的详细检索策略。检索共得到1402篇文章，使用纳入和排除标准对其进行进一步筛选。因此，共筛选了242篇此类文章的摘要，其中26篇文章进行了全文筛选，最终5篇文章纳入了本评价。
使用行为改变生态模型来呈现获得护理的障碍和促进因素。该模型每个层面的促进因素有助于一个人更接近获得医疗保健，而每个层面的障碍则使一个人远离获得医疗保健。在个人和人际层面，知识、意识以及寻求护理和治疗的意愿等因素是主要因素。在机构层面，即在学校层面，教师的意识是一个重要的促进因素，而耻辱感是获得医疗保健的一个关键社区层面障碍。在本次系统评价中确定的大多数促进因素和障碍都与政策层面的问题有关，如医疗保健质量和人力资源（可用性、培训等）、医疗保健设置、医疗保健资金等。
关于印度青少年获得心理健康护理相关障碍和促进因素的证据非常匮乏。需要更多研究从不同社会文化和人口背景来了解这些方面。
