Full CASP assessment on sixteen studies.

Background
Western literature has long explored help-seeking behaviours related to mental health issues. However, this has been relatively neglected in the Middle East despite an increase in mental health needs in the region. The purpose of this review was to conduct a systematic review and qualitative meta-synthesis exploring help-seeking behaviours related to mental health issues in the Middle East.
Methods
We conducted a systematic review and meta-synthesis to gain a comprehensive overview of what is known about mental health and help-seeking behaviours in the Middle East from published qualitative research in the Middle Eastern region. A search of electronic databases (MEDLINE, Embase, CINAHL, PsycINFO and QScience) was carried out from inception to July 2022. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool, and the review protocol was pre-registered with PROSPERO (Ref: CRD42022311494).
Results
We identified 16 qualitative studies exploring mental health-seeking behaviours in Middle East countries. Facilitators and barriers to help-seeking were captured under six overarching themes. Across all studies, we identified negative attitudes towards seeking help for mental health issues, economic and structural barriers to accessing mental healthcare, and misconceptions surrounding religious beliefs, all of which had a critical role in impacting decisions to seek mental healthcare services. Many sought help from alternative sources, such as traditional healers or family members before consulting a healthcare professional. The role of the family and cultural norms was also identified as key contributors to people’s help-seeking behaviours.
Conclusions
This meta-synthesis indicates the existence of many challenges surrounding mental health-seeking in the Middle East, including public and internalizing stigmas. This suggests an urgent need for an increase in psychoeducation and mental health awareness in the region.

背景
长期以来，西方学界已对与心理健康问题相关的求助行为开展了诸多探索。然而，尽管中东地区的心理健康需求持续增长，但该领域的相关研究却相对匮乏。本综述旨在针对中东地区与心理健康问题相关的求助行为，开展系统综述与定性元综合研究。
方法
本研究通过系统综述与元综合研究，全面梳理中东地区已发表的定性研究中关于心理健康及求助行为的现有研究成果。我们于2022年7月前，对MEDLINE、Embase、CINAHL、PsycINFO及QScience等电子数据库开展文献检索。采用临界评价技能项目（Critical Appraisal Skills Programme, CASP）工具对纳入研究的质量进行评价，本综述方案已在PROSPERO平台预注册（编号：CRD42022311494）。
结果
本研究共纳入16项针对中东国家心理健康求助行为的定性研究。研究将求助行为的促进因素与阻碍因素归纳为6个核心主题。综合所有纳入研究，我们发现针对心理健康问题的求助存在负面态度、获取精神卫生服务的经济与结构性障碍，以及围绕宗教信仰的认知误区，上述因素均对个体寻求精神卫生服务的决策产生关键影响。多数个体在咨询专业医护人员前，会先向传统治疗师或家人等非正规渠道求助。此外，家庭与文化规范的作用同样是影响个体求助行为的关键因素。
结论
本元综合研究表明，中东地区在心理健康求助方面面临诸多挑战，包括公众污名与个体内化污名。这提示该地区亟需加强心理教育与心理健康认知推广工作。