Patterns of help-seeking behavior among people with mental illness in Ethiopia: a systematic review and meta-analysis

Abstract

Background: Despite the availability of evidence-based and effective treatments, significant numbers of people living with mental illness do not receive treatment or do not seek help from providers of formal modern treatment. Although numerous primary studies have been conducted on patterns of help-seeking behavior among individuals with mental illness with respect to modern therapy, the evidence has not been aggregated nationwide. Therefore, the aim of this review was to investigate pooled data on patterns of help-seeking behavior among individuals with mental illness in Ethiopia.

Methods: All available primary studies were searched via the Google Scholar, HINARI, and PubMed databases from June 22 to December 20, 2023; 912 articles were identified. Sixteen articles were included in the final review; data from them were extracted to an Excel spreadsheet and exported to Stata version 17 for analysis. The search terms used were: "Pattern of help-seeking behavior'' OR "Pattern of treatment-seeking behavior" OR "Health care-seeking behavior" OR "Help-seeking intention" OR "Help-seeking preferences" OR "Perceived need" OR "Pathways to psychiatric care", AND "Common mental disorders" OR "Mental illness" OR "Mental health problems" OR "Depression", AND "Predictors" OR "Determinate factors" OR "Associated factors", AND "Ethiopia". The quality of the studies included was critically appraised using the modified The Joanna Briggs Institute (JBI) Joanna Briggs Institute quality assessment tool, adapted for observational studies. During critical appraisal, disagreements between the two authors conducting the assessment were resolved by the involvement of a third author. Effect sizes were pooled using the random effects model, and the presence of publication bias was detected based on asymmetry of the funnel plot and a statistically significant result of Egger's test (p<0.05).

Results: The pooled rate of positive help-seeking behavior with respect to modern treatment among people living with mental illness was 42.21% (95% CI: 29.29, 55.12; I² = 99.37%, P=0.00). Factors significantly associated with a positive pattern of help-seeking behavior were: having a secondary education or above (AOR=5.47, 95% CI: 2.33, 12.86); believing that mental illness requires treatment (AOR=2.76, 95% CI: 2.02, 3.78); having strong social support (AOR=2.00, 95% CI: 1.64, 2.44); having a family history of mental illness (AOR=2.68, 95% CI: 1.38, 3.97); having awareness of the availability of treatment (AOR=2.92, 95% CI: 1.56, 5.46); having previously engaged in positive help-seeking behavior (AOR=3.28, 95% CI: 1.63, 6.60); having comorbid disorders (AOR=4.25, 95% CI: 1.69, 10.66); not using alcohol (AOR=3.29, 95% CI: 1.73, 6.27); and the perceived severity of mental illness (AOR=2.54, 95% CI: 1.490, 4.33).

Conclusions: The majority of people with mental illness in Ethiopia exhibited a poor pattern of help-seeking behavior with respect to modern treatment. Therefore, mobilization of the community should be encouraged via regular public awareness campaigns regarding mental illness and the availability of evidence-based and effective modern treatment in Ethiopia. Moreover, the design of effective community-based mental health interventions is recommended in order to improve public attitudes and rates of help-seeking behavior in relation to mental health problems.

Keywords: Ethiopia; help seeking behavior; mental illness; systematic review and meta-analysis; treatment.

Figure 1

PRISMA flow diagram showing the results of the literature search.

Figure 2

Forest plot showing the pooled rate of positive help-seeking behavior with respect to formal modern treatment among people with mental illness in Ethiopia, 2023.

Figure 3

Funnel plot showing publication bias in studies of help-seeking behavior among people with mental illness in Ethiopia (A) before and (B) after adjustment using trim-and-fill analysis.

Figure 4

Sensitivity analysis for the rate of positive help-seeking behavior with respect to formal modern treatment among people with mental illness in Ethiopia, 2023.

Figure 5

Forest plot showing subgroup analysis by region for rates of help-seeking behavior among people with mental illness in Ethiopia, 2023.

Figure 6

Forest plot showing the subgroup analysis by study setting for rates of help-seeking behavior among people with mental illness in Ethiopia, 2023.

Figure 7

Forest plot showing the subgroup analysis by sample size for rates of help-seeking behavior among people with mental illness in Ethiopia, 2023.

Figure 8

Forest plot showing the subgroup analysis by publication year for rates of help-seeking behavior with respect to formal modern treatment among people with mental illness in Ethiopia, 2023.

Figure 9

Forest plot showing the adjusted odds ratios obtained in different studies, with corresponding 95% CIs, for the association between having a secondary education or above and rates of positive help-seeking behavior with respect to medical treatment among people with mental illness. The midpoint and length of each segment indicate the AOR and 95% CI, respectively; the diamond shape represents the combined AOR over all studies.

Figure 10

Forest plot showing the adjusted odds ratios obtained in different studies, with corresponding 95% CIs, for the association between the belief that mental illness requires treatment and rates of positive help-seeking behavior with respect to medical treatment among people with mental illness. The midpoint and length of each segment indicate the AOR and 95% CI, respectively; the diamond shape represents the combined AOR over all studies.

Figure 11

Forest plot showing the adjusted odds ratios obtained in different studies, with corresponding 95% CIs, for the association between strong social support and rates of positive help-seeking behavior with respect to medical treatment among people with mental illness. The midpoint and the length of each segment indicate the AOR and 95% CI, respectively; the diamond shape represents the combined AOR over all studies.