Barriers and facilitators to formal mental health help-seeking in individuals living with inflammatory bowel disease: A systematic review.

Background

Despite high rates of psychological comorbidity, research indicates low uptake of mental health services in inflammatory bowel disease (IBD) cohorts. With little known about factors influencing help-seeking in IBD, this review summarised existing knowledge regarding barriers and facilitators to formal mental health help-seeking in IBD.

Methods

Systematic search of six databases (PubMed, Scopus, Web of Science Core Collection, Medline, PsycINFO and CINAHL) was conducted in March 2026. Narrative synthesis was undertaken to summarise inferential and non-inferential findings across key help-seeking research domains: orientation, intention, actual engagement.

Results

Nineteen studies (N = 6285, Mage = 38.03, 58% female, 59% Crohn's disease) were identified, with studies assessed to have overall moderate quality (measured using the Mixed Methods Appraisal Tool [MMAT]). Rates of engagement ranged from 21%-64% (weighted average: 37.15%). Eighty factors were explored across included studies, with only psychosocial factors (health-related quality of life, IBD-related concerns, anxiety, depression) consistently and positively associated with help-seeking domains. Barriers spanned several categories: sociodemographics (e.g., busy lifestyles); clinical characteristics (e.g., disease duration); psychosocial factors (e.g., low perceived need); structural and systemic factors (e.g., cost, lack of IBD-specific therapists); treatment-related factors (e.g., stigma).

Conclusions

Barriers to formal mental health help-seeking may be more extensive and varied than factors facilitating help-seeking in IBD, indicating a wide range of potential intervention targets. Findings, however, highlight significant methodological limitations and a fragmented and underdeveloped evidence base, with recommendations provided to address past limitations and guide future research.