Development and Validation of the Barriers to Mental Health Service Utilization Scale (BMHSUS) in Bangladesh: An In-Depth Analysis of Sociodemographic Influences on Access Barriers – Insights from the National Mental Health Survey

<b>Background</b>: Mental Health Service Utilization (MHSU) in Bangladesh remains low due to cultural, societal, and structural barriers, including stigma, fear of ostracization, reliance on traditional healers, medication concerns, limited access, and sociodemographic factors such as age, gender, and location. This study aims to develop and validate a tool for assessing barriers to MHSU in Bangladesh and explore the influence of sociodemographic factors on these barriers.<b>Methods</b>: The National Mental Health Survey, conducted from July 2019 to May 2020, was a multicentric, community-based study using stratified cluster random sampling from 496 primary sampling units (PSUs) across Bangladesh. After addressing missing data, 7,238 completed datasets were analyzed. The survey included sections on sociodemographic information, mental health screening, stigma, and attitudes toward mental health service utilization.<b>Conclusions</b>: The BMHSUS is a reliable and culturally appropriate tool for assessing barriers to MHSU in Bangladesh. The findings highlight the importance of addressing structural, cultural, and demographic factors to improve access to mental health services. Public health interventions should reduce stigma, improve access, tailor strategies targeting specific demographic groups, and use the BMHSUS for future research and policy development.

研究背景：孟加拉国的心理健康服务利用（Mental Health Service Utilization, MHSU）率长期处于低位，这一现状源于多维度的文化、社会与结构性障碍，包括病耻感、对被排斥的恐惧、对传统治疗师的依赖、药物相关顾虑、服务可及性不足，以及年龄、性别、居住地等社会人口学因素。本研究旨在开发并验证一款用于评估孟加拉国心理健康服务利用障碍的工具，并探究社会人口学因素对这些障碍的影响。
研究方法：2019年7月至2020年5月开展的全国心理健康调查为多中心社区研究，采用分层整群随机抽样方法，从孟加拉国全境的496个初级抽样单元（Primary Sampling Units, PSUs）中抽取研究样本。完成缺失数据处理后，最终纳入7238份完整数据集开展分析。该调查涵盖社会人口学信息、心理健康筛查、病耻感以及对心理健康服务利用的态度等多个调研模块。
研究结论：BMHSUS是一款可靠且具备文化适配性的工具，可用于评估孟加拉国心理健康服务利用障碍。本研究结果凸显了针对结构性、文化性及人口学因素开展干预以提升心理健康服务可及性的重要意义。公共卫生干预举措应着力降低病耻感、改善服务可及性、针对特定人口群体制定个性化策略，并将BMHSUS应用于未来的研究与政策制定工作中。