Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: A systematic review

Byrow, Yulisha; Pajak, Rosanna; Specker, Philippa; Nickerson, Angela

doi:10.1016/j.cpr.2019.101812

Cited by 345Migration, Health and TraumaMental Health Treatment and AccessMigration, Racism, and Human Rights

Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: A systematic review

Byrow, Yulisha, Pajak, Rosanna, Specker, Philippa, Nickerson, Angela·2020·Clinical Psychology Review

DOI 10.1016/j.cpr.2019.101812

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Abstract

Despite elevated rates of psychological disorders amongst individuals from a refugee background, levels of mental health help-seeking in these populations are low. There is an urgent need to understand the key barriers that prevent refugees and asylum-seekers from accessing help for psychological symptoms. This review synthesises literature examining perceptions of mental health and barriers to mental health help-seeking in individuals from a refugee background. Our analysis, which complies with PRISMA reporting guidelines, identified 62 relevant studies. Data extraction and thematic analytic techniques were used to synthesise findings from quantitative (n = 26) and qualitative (n = 40) studies. We found that the salient barriers to help-seeking were: (a) cultural barriers, including mental health stigma and knowledge of dominant models of mental health; (b) structural barriers, including financial strain, language proficiency, unstable accommodation, and a lack of understanding of how to access services, and (c) barriers specific to the refugee experience, including immigration status, a lack of trust in authority figures and concerns about confidentiality. We discuss and contextualise these key themes and consider how these findings can inform the development of policies and programs to increase treatment uptake and ultimately reduce the mental health burden amongst refugees and asylum-seekers.

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Uncertainty related to when they can continue their journeys safely, what their futures may hold, the possibility of reuniting with family members, the outcome of their asylum request, and the chance to integrate into society negatively impacts their psychological state.
“- Uncertainty related to when they can continue their journeys safely, what their futures may hold, the possibility of reuniting with family members, the outcome of their asylum request, and the chance to integrate into society. This state of 'not knowing' heavily influences their thoughts and feelings, negatively impacting their psychological state (Participant 7; Byrow et al., 2020).”
From Border Pushbacks in Greece: Human Rights Violations and Psychological Impacts (2024) · cites this paper as Byrow et al., 2020

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Cultural translation of refugee trauma: Cultural idioms of distress among Somali refugees in displacement
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Independent and Interdependent Self-construals and Socio-cultural Factors in 29 Nations
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Health and Social Needs of Traumatized Refugees and Asylum Seekers: An Exploratory Study
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Somali Refugees’ Perceptions of Mental Illness
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The Traumatogenic Dynamics of Internalized Stigma of Mental Illness Among Arab American, Muslim, and Refugee Clients
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U.S. Cambodian Refugees' Use of Complementary and Alternative Medicine for Mental Health Problems
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Pediatrician-experienced barriers in the medical care for refugee children in the Netherlands
Baauw, A., Rosiek, S. K., Slattery, B., Chinapaw, M. J. M., van Hensbroek, M. B., van Goudoever, J. B., & Holthe, J. K.-V. (2018) · European Journal of Pediatrics · doi:10.1007/s00431-018-3141-y · Cited by 30 · see citing works
Cognitive-Behavior Therapy for Vietnamese Refugees With PTSD and Comorbid Panic Attacks
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Changing the Face of Multicultural Counselling with Principles of Change
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Nursing students' experiences with refugees with mental health problems in Jordan: A qualitative content analysis
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State-sanctioned Violence and Mental Health: Implications for Learning and Treatment
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Flagged first, then by citations

4 of the 149 references couldn’t be matched to a known paper.

Sorted by citations

Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review
Spanhel, K., Balci, S., Feldhahn, F., Bengel, J., Baumeister, H., & Sander, L. B. (2021) · npj Digital Medicine · doi:10.1038/s41746-021-00498-1 · Cited by 178 · see citing works
The effectiveness of adapted psychological interventions for people from ethnic minority groups: A systematic review and conceptual typology
Arundell, L.-L., Barnett, P., Buckman, J. E. J., Saunders, R., & Pilling, S. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102063 · Cited by 137 · see citing works
Life and mental health in limbo of the Ukraine war: How can helpers assist civilians, asylum seekers and refugees affected by the war?
Anjum, G., Aziz, M., & Hamid, H. K. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1129299 · Cited by 137 · see citing works
Understanding experiences of mental health help-seeking in Arab populations around the world: a systematic review and narrative synthesis
(2023) · doi:10.1186/s12888-023-04827-4 · Cited by 89 · see citing works
Mental health problems and hypertension in the elderly: Review from the HOPE Asia Network
Turana, Y., Tengkawan, J., Chia, Y. C., Shin, J., Chen, C., Park, S., Tsoi, K. K. F., Buranakitjaroen, P., Soenarta, A. A., Siddique, S., et al. (2020) · Journal of Clinical Hypertension · doi:10.1111/jch.14121 · Cited by 83 · see citing works
The Artificial Third: A Broad View of the Effects of Introducing Generative Artificial Intelligence on Psychotherapy
Haber, Y., Levkovich, I., Hadar‐Shoval, D., & Elyoseph, Z. (2024) · JMIR Mental Health · doi:10.2196/54781 · Cited by 83 · see citing works
“Worldwide, numerous barriers, ranging from socioeconomic constraints and geographical distances to linguistic challenges and intricate cultural contexts, limit access to quality care [36,37].”
Background
Posttraumatic Stress Disorder in Refugees
Bryant, R. A., Nickerson, A., Morina, N., & Liddell, B. J. (2023) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-080921-080359 · Cited by 82 · see citing works
Self-citation
Parenting Interventions for Refugees and Forcibly Displaced Families: A Systematic Review
Gillespie, S., Banegas, J. M., Maxwell, J., Chan, A. C. Y., Darawshy, N. A., Wasil, A. R., Marsalis, S. E., & Gewirtz, A. H. (2022) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-021-00375-z · Cited by 80 · see citing works
Barriers to accessing mental health care for refugees and asylum seekers in high-income countries: A scoping review of reviews mapping demand and supply-side factors onto a conceptual framework
Dumke, L., Wilker, S., Hecker, T., & Neuner, F. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102491 · Cited by 71 · see citing works
A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD
Turrini, G., Tedeschi, F., Cuijpers, P. J., Giovane, C. D., Kip, A., Nexhmedin Morina, B., Nosè, M., Ostuzzi, G., Purgato, M., Ricciardi, C., et al. (2021) · BMJ Global Health · doi:10.1136/bmjgh-2021-005029 · Cited by 67 · see citing works
Spiritual Needs, Religious Coping and Mental Wellbeing: A Cross-Sectional Study among Migrants and Refugees in Germany
Maier, K., Konaszewski, K., Skalski‐Bednarz, S. B., Büssing, A., & Surżykiewicz, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063415 · Cited by 68 · see citing works
An Ethical Perspective on the Democratization of Mental Health With Generative AI
Elyoseph, Z., Gur, T., Haber, Y., Simon, T., Angert, T., Navon, Y., Tal, A., & Asman, O. (2024) · JMIR Mental Health · doi:10.2196/58011 · Cited by 64 · see citing works
“Factors such as socioeconomic status [14], geographical location [19], linguistic barriers [20], and cultural disparities [21] present significant hurdles to the accessibility of mental health services.”
Background
Problems faced by Syrian refugees and asylum seekers in Switzerland
Kiselev, N., Pfaltz, M. C., Schick, M., Bird, M., Hansen, P., Sijbrandij, M., de Graaff, A. M., Schnyder, U., & Morina, N. (2020) · Swiss Medical Weekly · doi:10.4414/smw.2020.20381 · Cited by 54 · see citing works
Predictors of not receiving mental health services among people at risk of suicide: A systematic review
Tang, S., Reily, N. M., Arena, A. F. A., Sheanoda, V., Han, J., Draper, B., Batterham, P. J., Mackinnon, A. J., & Christensen, H. M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.01.054 · Cited by 51 · see citing works
Experience of discrimination during COVID-19 pandemic: the impact of public health measures and psychological distress among refugees and other migrants in Europe
Marchi, M., Magarini, F. M., Chiarenza, A., Galeazzi, G. M., Paloma, V., Garrido, R., Ioannidi, E., Vassilikou, K., de Matos, M. G., Gaspar, T., et al. (2022) · BMC Public Health · doi:10.1186/s12889-022-13370-y · Cited by 51 · see citing works
“Previous research has identified migrants’ barriers in accessing both physical and mental health care, which likely worsened during the pandemic [3, 4].”
Background
Assessing Virtual Mental Health Access for Refugees during the COVID-19 Pandemic Using the Levesque Client-Centered Framework: What Have We Learned and How Will We Plan for the Future?
Hynie, M., Jaimes, A., Oda, A., Rivest‐Beauregard, M., Gonzalez, L. P., Ives, N. G., Ahmad, F., Kuo, B. C. H., Arya, N., Bokore, N., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095001 · Cited by 51 · see citing works
“Byrow and colleagues’ [12] pre-pandemic review showed that refugees seeking mental health support encountered important barriers of three sorts: (1) structural (financial strain, language, housing, lack of information); (2) cultural (perceptions of health, mental health, and appropriate care; stigma); and (3) specific…”
Background
Global research activity on mental health literacy
Sweileh, W. M. (2021) · Middle East Current Psychiatry · doi:10.1186/s43045-021-00125-5 · Cited by 45 · see citing works
“The poor health-seeking behaviors among people with mental health problems are related to a wide range of barriers including economic, social, psychological, and physical services [14, 15].”
Background
Lived experiences of transgender forced migrants and their mental health outcomes: systematic review and meta-ethnography
Hermaszewska, S., Sweeney, A., Camminga, B., Botelle, R., Elliott, K., & Sin, J. (2022) · BJPsych Open · doi:10.1192/bjo.2022.51 · Cited by 42 · see citing works
“Sometimes It Seems Easier to Push It Away”: A Study Into the Barriers to Help-Seeking for Victims of Sexual Violence
Pijlman, V., Eichelsheim, V., Pemberton, A., & de Waardt, M. (2023) · Journal of Interpersonal Violence · doi:10.1177/08862605221147064 · Cited by 40 · see citing works
“The representation of males and ethnic minorities in future sexual violence research is pivotal as they are likely to face additional barriers to help-seeking and are known to be less likely to seek help (Bach et al., 2021; Byrow et al., 2020; Ullman & Lorenz, 2020).”
Background
The gap between perceived mental health needs and actual service utilization in Australian adolescents
Islam, M. I., Yunus, F. M., Isha, S. N., Kabir, E., Khanam, R., & Martiniuk, A. L. C. (2022) · Scientific Reports · doi:10.1038/s41598-022-09352-0 · Cited by 39 · see citing works
Perceived barriers to care for migrant children and young people with mental health problems and/or neurodevelopmental differences in high-income countries: a meta-ethnography
Place, V., Nabb, B., Gubi, E., Assel, K. V., Åhlén, J., Hagström, A., Bäärnhielm, S., Dalman, C., & Hollander, A. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045923 · Cited by 38 · see citing works
The Economics of Treatment for Depression
Stecher, C. D., Cloonan, S., & Domino, M. E. (2023) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-061022-040533 · Cited by 42 · see citing works
Engaging Refugees With a Culturally Adapted Digital Intervention to Improve Sleep: A Randomized Controlled Pilot Trial
Spanhel, K., Hovestadt, E., Lehr, D., Spiegelhalder, K., Baumeister, H., Bengel, J., & Sander, L. B. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.832196 · Cited by 37 · see citing works
“, lack of treatment resources or financing opportunities) (18, 19) hinder refugees from seeking help for mental disorders.”
Background
Course and predictors of posttraumatic stress and depression longitudinal symptom profiles in refugees: A latent transition model
Lenferink, L. I. M., Liddell, B. J., Byrow, Y., O'Donnell, M. L., Bryant, R. A., Mau, V., McMahon, T., Benson, G., & Nickerson, A. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.12.009 · Cited by 39 · see citing works
“Furthermore, it is often challenging for resettled refugees to access mental health services due to various reasons, such as lack of knowledge about existing services, self-stigma, and distrust in health care system, which may result in long-term impaired mental health (Byrow et al., 2020).”
BackgroundSelf-citation
Barriers to the use of mental health services by Syrian refugees in Jordan: a qualitative study
Bawadi, H. A., Al‐Hamdan, Z. M., Khader, Y. S., & Aldalaykeh, M. (2022) · Eastern Mediterranean Health Journal · doi:10.26719/emhj.22.030 · Cited by 35 · see citing works
Mental health service use among migrant and Swedish-born children and youth: a register-based cohort study of 472,129 individuals in Stockholm
Gubi, E., Sjöqvist, H., Viksten-Assel, K., Bäärnhielm, S., Dalman, C., & Hollander, A.-C. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02145-2 · Cited by 34 · see citing works
“For example, negative perceptions about the social consequences of mental illness for the individual and the family [14, 15], internalized and treatment stigma [16, 17], parental perceptions of lack of cultural competency among providers [18], cultural differences in explanatory models of illness, and cultural variati…”
Background
Understanding mental health from the perception of Middle Eastern refugee women: A critical systematic review
Tahir, R., Due, C., Ward, P., & Ziersch, A. M. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100130 · Cited by 36 · see citing works
Access to Virtual Mental Healthcare and Support for Refugee and Immigrant Groups: A Scoping Review
Hynie, M., Oda, A., Calaresu, M., Kuo, B. C. H., Ives, N. G., Jaimes, A., Bokore, N., Beukeboom, C., Ahmad, F., Arya, N., et al. (2023) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-023-01521-1 · Cited by 31 · see citing works
Interdisciplinary perspectives on digital technologies for global mental health
Kuhn, E. M., Saleem, M., Klein, T., Köhler, C., Fuhr, D. C., Lahutina, S., Minarik, A., Musesengwa, R., Neubauer, K., Olisaeloka, L., et al. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0002867 · Cited by 31 · see citing works
“These advantages help to integrate vulnerable people into mental healthcare by reducing potential barriers, namely lack of treatment offers, high travel effort and costs, and the stigmatization of mental illness [8].”
Background
Beliefs About Causes and Cures of Prolonged Grief Disorder Among Arab and Sub-Saharan African Refugees
Lechner‐Meichsner, F., & Comteße, H. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.852714 · Cited by 29 · see citing works
Social Networks and Health Inequalities
Klärner, A., Gamper, M., Keim-Klärner, S., Moor, I., von der Lippe, H., & Vonneilich, N. (2022) · Springer eBooks · doi:10.1007/978-3-030-97722-1 · Cited by 33 · see citing works
Peer Mentoring Programs for Culturally and Linguistically Diverse Refugee and Migrant Women: An Integrative Review
Gower, S., Jeemi, Z., Forbes, D., Kebble, P. G., & Dantas, J. A. R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912845 · Cited by 29 · see citing works
“Concerns about stigma from community members, distrust of authority figures or health professionals from different cultural backgrounds, and socioeconomic factors such as income, language and transport may be barriers to accessing appropriate mental health services [12,19].”
BackgroundInfluential
Health system responsiveness to the mental health needs of Syrian refugees: mixed-methods rapid appraisals in eight host countries in Europe and the Middle East
Woodward, A., Fuhr, D. C., Barry, A. S., Balabanova, D., Sondorp, E., Dieleman, M. A., Pratley, P., Schoenberger, S. F., McKee, M., İlkkurşun, Z., et al. (2023) · Open Research Europe · doi:10.12688/openreseurope.15293.1 · Cited by 35 · see citing works
“Weaknesses in access and quality found in our study (e.g. stigma, language, cultural, knowledge/awareness, travel, costs, availability) are similar to those reported in reviews on access, barriers, and utilisation of MHPSS amongst refugees 13,15,116 .”
Which psychological characteristics influence therapists' readiness to work with refugees?
Schlechter, P., Hellmann, J. H., Wingbermühle, P. A. M., & Nexhmedin Morina, B. (2020) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2508 · Cited by 26 · see citing works
A narrative exploration of the importance of intersectionality in a Black trans woman’s mental health experiences
Shelton, S. A., & Lester, A. O. S. (2020) · International Journal of Transgender Health · doi:10.1080/26895269.2020.1838393 · Cited by 27 · see citing works
Mental Health Self-Stigma of Syrian Refugees With Posttraumatic Stress Symptoms: Investigating Sociodemographic and Psychopathological Correlates
Bär, J., Pabst, A., Röhr, S., Luppa, M., Renner, A., Nagl, M., Dams, J., Grochtdreis, T., Kersting, A., König, H., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.642618 · Cited by 26 · see citing works
Review: Cultural adaptations to psychosocial interventions for families with refugee/asylum‐seeker status in the United Kingdom – a systematic review
Taylor, A., Radford, G., & Calia, C. (2022) · Child and Adolescent Mental Health · doi:10.1111/camh.12547 · Cited by 25 · see citing works
How does context influence the delivery of mental health interventions for asylum seekers and refugees in low- and middle-income countries? A qualitative systematic review
Jannesari, S., Lotito, C., Turrini, G., Oram, S., & Barbui, C. (2021) · International Journal of Mental Health Systems · doi:10.1186/s13033-021-00501-y · Cited by 24 · see citing works
“Issues include a limited language ability, a lack of awareness of services, discrimination, unstable housing and immigration status [4, 5].”
Background
Professional Mental Health Help-Seeking Amongst Afghan and Iraqi Refugees in Australia: Understanding Predictors Five Years Post Resettlement
Tomasi, A., Slewa‐Younan, S., Narchal, R., & Rioseco, P. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19031896 · Cited by 24 · see citing works
“Refugees often arrive to the host country with poor mental health literacy and limited understanding of the new health care system, available services, the role of mental health professionals, and pathways to obtaining health care [20,21,28].”
BackgroundResultInfluential
Othering refugees: Psychotherapists’ attitudes toward patients with and without a refugee background
Dumke, L., & Neuner, F. (2022) · Psychotherapy Research · doi:10.1080/10503307.2022.2150097 · Cited by 24 · see citing works
“…specifically related to refugee experiences (e.g., lack of trust in others due to experiences of interpersonal trauma), eroding helpful perceptions of formal treatment and further reducing the already low rates of professional help-seeking among refugees (Byrow et al., 2020; Satinsky et al., 2019).”
Background
Patients' perspectives of barriers and facilitators to accessing support through primary care for common mental health problems in England: A systematic review
Tunks, A., Berry, C., Strauss, C., Nyikavaranda, P., & Ford, E. M. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.035 · Cited by 24 · see citing works
Scalable interventions for refugees
Bryant, R. A. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.59 · Cited by 23 · see citing works
“Many refugees also have negative beliefs about receiving help for mental health problems, which limits their motivation for seeking help that may be available (Byrow et al., 2020).”
Low access and inadequate treatment in mental health care for asylum seekers and refugees in Germany—A prospective follow‐up study over 12 months and a nationwide cross‐sectional study
Dumke, L., Schmidt, T. L., Wittmann, J., Neldner, S., Weitkämper, A., Catani, C., Neuner, F., & Wilker, S. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12523 · Cited by 22 · see citing works
Improving access to evidence‐based interventions for trauma‐exposed adults in low‐ and middle‐income countries
Kaminer, D., Booysen, D. D., Ellis, K., Kristensen, C. H., Patel, A., Robjant, K., & Sardana, S. M. (2024) · Journal of Traumatic Stress · doi:10.1002/jts.23031 · Cited by 21 · see citing works
Access to mental healthcare for refugees, asylum seekers and migrants: an umbrella review of barriers
Bilican, S., Irfan, M., Cox, A., Salaets, H., Sabbe, M. B., & Schoenmakers, B. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-096267 · Cited by 21 · see citing works
Navigating Support Networks: A Somali Woman’s Experience of Social Alignment to Overcome Isolation During Pregnancy and Early Motherhood
Nagesh, D., Ip, H. L., Li, K. K. W., Wong, H. S. L., & Chai, J. Y. H. (2025) · International Journal of Social and Psychological Aspects of Healthcare · doi:10.51847/ijophqpxav · Cited by 21 · see citing works
Mental health conditions and help-seeking among Ukrainian war refugees in Czechia: A cross-sectional study
Guerrero, Z., Melicharová, H., Kavanová, M., Prokop, D., Škvrňák, M., Kunc, M., Leontiyeva, Y., Vitíková, J., Spurný, M., Pilnáček, M., et al. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115552 · Cited by 23 · see citing works
“The reported barriers to accessing treatment by respondents in our study were similar to those reported in other studies, indicating the need for education on different types of help available and when to seek it (Byrow et al., 2020).”
Result
Call to action: Addressing sleep disturbances, a hallmark symptom of PTSD, for refugees, asylum seekers, and internally displaced persons
Jou, Y. C., & Pace-Schott, E. F. (2022) · Sleep Health · doi:10.1016/j.sleh.2022.09.003 · Cited by 20 · see citing works
Association between interpersonal resources and mental health professional help-seeking among Chinese adolescents with probable depression: mediations via personal resources and active coping
Lu, H., Yu, Y.-Q., Wang, D. B., Wu, A. M. S., Chen, J. H., Zhang, G., Wu, Y., & Lau, J. T. F. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06271-4 · Cited by 19 · see citing works
“…with the low level of BI-PHSMHP among adolescents having depression included low availability of services [19], worry about stigma [20], low perceived efficacy and negative attitude regarding professional services [20], poor family economic status [21], and low mental health literacy [10].”
A Scoping Review of Needs and Barriers to Achieving A Livable Life among Refugees with Disabilities: Implications for Future Research, Practice, and Policy
Rfat, M., Zeng, Y., Yang, Y., Adhikari, K., & Zhu, Y. (2022) · Journal of Evidence-Based Social Work · doi:10.1080/26408066.2022.2162357 · Cited by 20 · see citing works
Mental illness stigma and associated factors among Arabic-speaking refugee and migrant populations in Australia
Chimoriya, R., Mohammad, Y., Thomson, R. J., Webster, C., Dunne, R., Aibangbee, M., Ip, D., & Slewa‐Younan, S. (2023) · International Journal of Mental Health Systems · doi:10.1186/s13033-023-00580-z · Cited by 20 · see citing works
“While evidence suggests low levels of professional help-seeking behaviours and attitudes among Arabic-speaking refugee and migrant populations [15, 17, 18], this could be also attributed to their preference for seeking help for mental health difficulties from informal sources such as family, friends, and religious lea…”
Background
Effectiveness of trauma-focused treatments for refugee children: a systematic review and meta-analyses
Velu, M. E., Kuiper, R. M., Schok, M., Sleijpen, M., de Roos, C., & Mooren, T. T. M. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2494362 · Cited by 19 · see citing works
“…include mental health stigma, unstable living conditions, ﬁ nancial di ﬃ culties, language barriers, concerns about con ﬁ dentiality, and lack of awareness regarding the available options and the procedures for accessing services (Byrow et al., 2020; Heidi et al., 2011; van Es et al., 2019).”
Individuals of refugee background resettled in regional and rural Australia: A systematic review of mental health research
Hawkes, C., Norris, K., Joyce, J., & Paton, D. (2021) · Australian Journal of Rural Health · doi:10.1111/ajr.12785 · Cited by 19 · see citing works
Access to Healthcare Among US Adult Refugees: A Systematic Qualitative Review
Ho, C. H., Denton, A. H., Blackstone, S. R., Saif, N. T., MacIntyre, K., Ozkaynak, M., Valdez, R. S., & Hauck, F. R. (2023) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-023-01477-2 · Cited by 19 · see citing works
“We also excluded studies addressing mental health, as there are several recent systematic reviews that have explored refugees’ barriers and facilitators to accessing and utilizing mental health services [17, 23–27].”
Background
Mental health problems and help-seeking behaviours of Syrian refugee adolescents: mediating role of self-stigma
Özaslan, A., Yıldırım, M., Güney, E., ILHAN, M. N., & Vostanis, P. (2023) · Psychological Medicine · doi:10.1017/s0033291723002416 · Cited by 19 · see citing works
“The embarrassment that people feel about their mental problems can lead to self-stigmatization, which can prevent help-seeking behaviours (Byrow, Pajak, Specker, & Nickerson, 2020).”
Current Status and Future Directions of Artificial Intelligence in Post-Traumatic Stress Disorder: A Literature Measurement Analysis
Wan, R., Wan, R., Xie, Q., Hu, A., Xie, W., Chen, J., & Liu, Y. (2024) · Behavioral Sciences · doi:10.3390/bs15010027 · Cited by 19 · see citing works
“…collection, storage, and management require specialized information technology infrastructure and professionals, which poses difficulties, especially in remote and technologically underdeveloped regions where inadequate hardware and software facilities hinder data collection (Byrow et al., 2020).”
Common Life Stressors as Risk Markers for Intimate Partner Violence: A Meta-analysis
Keilholtz, B. M., Spencer, C. M., & Stith, S. M. (2022) · Contemporary Family Therapy · doi:10.1007/s10591-022-09633-w · Cited by 18 · see citing works
Exploring the Use of Hospital and Community Mental Health Services Among Newly Resettled Refugees
Mazumdar, S., Chong, S., Eagar, S. C., Fletcher, S., Jalaludin, B. B., & Smith, M. M. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.12449 · Cited by 18 · see citing works
Barriers and Facilitators of Mental Health Service Utilisation among Bhutanese Refugees in the USA: Findings from a Mixed-Methods Study
Soukenik, E., Haran, H., Kirsch, J., Pyakurel, S., & Maleku, A. (2021) · The British Journal of Social Work · doi:10.1093/bjsw/bcab123 · Cited by 17 · see citing works
“The lack of understanding of the formal health care system limits refugees’ access to services (Byrow et al., 2020).”
Background
Conceptualisations of mental illness and stigma in Congolese, Arabic-speaking and Mandarin-speaking communities: a qualitative study
Slewa‐Younan, S., Krstanoska-Blazeska, K., Blignault, I., Li, B., Reavley, N. J., & Renzaho, A. M. N. (2022) · BMC Public Health · doi:10.1186/s12889-022-14849-4 · Cited by 17 · see citing works
“Notably, mental illness related stigma has been postulated to play a significant role in CaLD communities engagement with mental health services [19, 22, 23].”
Background
Mental Illness Stigma and Associated Factors among Arabic-Speaking Religious and Community Leaders
Krstanoska-Blazeska, K., Thomson, R. J., & Slewa‐Younan, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18157991 · Cited by 17 · see citing works
“Previous studies have resulted in conclusions of low MHL among culturally diverse populations including Arabic-speaking individuals despite lacking consideration of cultural perspectives on beliefs and treatment knowledge [12].”
BackgroundResult
Refugee mental health: Culturally relevant considerations
Mattar, S., & Gellatly, R. (2022) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2022.101429 · Cited by 17 · see citing works
The impact of trauma, flight and protracted displacement on the mental health of Eritrean refugees living in Israel: An exploratory study of coping strategies
Fennig, M., & Denov, M. S. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100102 · Cited by 16 · see citing works
Lay-Led Intervention for War and Refugee Trauma
Zoellner, L. A., Bentley, J. A., Musa, K., Mohamed, F., Ahmed, L. B., King, K. M., Feeny, N. C., Ali, H., Ibrahim, Y., Ismail, A., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.29661 · Cited by 16 · see citing works
“If you don’t actually care for somebody, how can you help them?”: Exploring Young People’s Core Needs in Mental Healthcare—Directions for Improving Service Provision
Lynch, L., Moorhead, A., Long, M., & Hawthorne-Steele, I. (2024) · Community Mental Health Journal · doi:10.1007/s10597-024-01237-y · Cited by 15 · see citing works
“…et al., 2017; Persson et al., 2017) as well as inadequate support for young people from migrant or refugee backgrounds (DeAnstiss & Ziaian, 2010; Byrow et al., 2020) or for those who identify as LGBTI + (Fish, 2020), all of which can discourage them and others they know from seeking help in the…”
Background
Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial
Turrini, G., Purgato, M., Tedeschi, F., Acartürk, C., Anttila, M., Au, T. M., Carswell, K., Churchill, R. C., Cuijpers, P. J., Friedrich, F., et al. (2022) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796022000269 · Cited by 16 · see citing works
“…the type of population included, who were participants without a mental disorder, given the preventative aim, but at risk of developing one, with several social and everyday life priorities and potentially poorer recognition or less time to make their mental health a priority (Byrow et al., 2020).”
Background
Skills Training in Affective and Interpersonal Regulation for Refugees Integrated With Narrative Exposure Therapy: A Case Study on the Treatment of PTSD and Emotion Dysregulation for Refugees and Asylum-Seekers
Tissue, A., Specker, P., Hoffman, J., Uppal, S., Cloître, M., Neuner, F., O'Donnell, M. L., & Nickerson, A. (2022) · Clinical Case Studies · doi:10.1177/15346501221133315 · Cited by 15 · see citing works
“Many individuals from a refugee and asylum-seeker background face significant barriers when attempting to access treatment for psychological health issues (Byrow et al., 2020).”
BackgroundSelf-citation
Psychological well-being, mental distress, metabolic syndrome, and associated factors among people living in a refugee camp in Greece: a cross-sectional study
Knappe, F., Filippou, K., Hatzigeorgiadis, A., Morres, I. D., Tzormpatzakis, E., Havas, E., Seelig, H., Colledge, F., Ludyga, S., Meier, M., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1179756 · Cited by 15 · see citing works
A mixed methods systematic review of mental health self-care strategies for Arabic-speaking refugees and migrants
Mehjabeen, D., Blignault, I., Taha, P. H., Reavley, N. J., & Slewa‐Younan, S. (2023) · BMC Public Health · doi:10.1186/s12889-023-17395-9 · Cited by 17 · see citing works
“…and timely treatment-seeking include language limitations, low mental health literacy, healthcare costs, uncertain migration status, unstable housing, limited transportation, poor understanding of healthcare services, discrimination from healthcare professionals and distrust of authority [27–34].”
Background
Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis
Webb, R., Ford, E. M., Shakespeare, J., Easter, A., Alderdice, F. A., Holly, J., Coates, R., Hogg, S., Cheyne, H., McMullen, S., et al. (2024) · Health and Social Care Delivery Research · doi:10.3310/kqfe0107 · Cited by 18 · see citing works
Bridging the Gap: A Systematic Review and Meta-Analysis of Interventions to Address Barriers in Migrant Mental Health Care Access
Marchi, M., Laquatra, G., Yaaqovy, A. D., Pingani, L., Ferrari, S., & Galeazzi, G. (2024) · Psychiatry International · doi:10.3390/psychiatryint5040060 · Cited by 15 · see citing works
A Walk-In Clinic for Newly Arrived Mentally Burdened Refugees: The Patient Perspective
Zehetmair, C., Zeyher, V., Cranz, A., Ditzen, B., Herpertz, S. C., Kohl, R. M., & Nikendei, C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052275 · Cited by 15 · see citing works
“While the positive perception of psychopharmacological treatment found in our study is consistent with previous findings [61], biological components of mental health disorders were not explicitly represented in their theories of their mental illness.”
Result
Integration Is Correlated With Mental Health Help-Seeking From the General Practitioner: Syrian Refugees' Preferences and Perceived Barriers
Harris, S., Sandal, G. M., Bye, H. H., Palinkas, L. A., & Binder, P. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.777582 · Cited by 18 · see citing works
Affective Mechanisms of Moral Injury in Trauma Recovery Among Asylum Seekers: Exploring the Protective Effects of Mindfulness and Compassion Training
Bernstein, A., Aizik-Reebs, A., Phung, Y., Yuval, K., Gebremariam, S. G., & Vujanovic, A. A. (2026) · Clinical Psychological Science · doi:10.1177/21677026251344148 · Cited by 14 · see citing works
“Worse yet, FDP often experience barriers to seeking and receiving mental-health care after displacement, further maintaining MI and its sequelae (Asgary & Segar, 2011; Byrow et al., 2020).”
Are we on the same page? Mental health literacy and access to care: a qualitative study in young Hazara refugees in Melbourne
Saberi, S., Wachtler, C., & Lau, P. M.-Y. (2021) · Australian Journal of Primary Health · doi:10.1071/py21017 · Cited by 14 · see citing works
Adaptation and implementation of a parenting curriculum in a refugee/immigrant community using a task-shifting approach: a study protocol
Whitaker, D. J., Self‐Brown, S., Weeks, E. A., O’Connor, M. H., Lyons, M., Willging, C. E., Lee, N. H., Kumar, J. L., Joseph, H. L., Reidy, D. E., et al. (2021) · BMC Public Health · doi:10.1186/s12889-021-11148-2 · Cited by 14 · see citing works
The cultural perceptions on mental health and post-resettlement challenges among Rwandan refugees in the U.S.
Tonui, B. C. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114642 · Cited by 14 · see citing works
Pathways to care: IDPs seeking health support and justice for sexual and gender-based violence through social connections in Garowe and Kismayo, Somalia and South Kivu, DRC
Boeyink, C., Ali-Salad, M. A., Baruti, E. W., Bile, A. S., Falisse, J., Kazamwali, L. M., Mohamoud, S. A., Muganza, H. N., Mukwege, D. M., & Mahmud, A. J. (2022) · Journal of Migration and Health · doi:10.1016/j.jmh.2022.100129 · Cited by 13 · see citing works
Refugees' and asylum seekers' experiences of individual psychological therapy: A qualitative meta‐synthesis
Khairat, M., Hodge, S., & Duxbury, A. (2023) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12470 · Cited by 14 · see citing works
Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden
Woodward, A., Burchert, S., Barry, A. S., Broerse, J. E. W., Sondorp, E., Bold, A., Ruberl, A., Hessling, J. M., Knaevelsrud, C., Roberts, B., et al. (2023) · SSM - Mental Health · doi:10.1016/j.ssmmh.2023.100231 · Cited by 15 · see citing works
“…and considerations may help overcome some of the reported barriers refugees experience in accessing MHPSS services in host countries like stigma, language barriers, loss of trust, and sociocultural obstacles (Byrow et al., 2020; Hendrickx et al., 2020; Satinsky et al., 2019; Woodward et al., 2023).”
Background
Barriers to 12-month treatment of common anxiety, mood, and substance use disorders in the World Mental Health (WMH) surveys
Viana, M. C., Kazdin, A. E., Harris, M., Stein, D. J., Vigo, D., Hwang, I. H., Manoukian, S. M., Sampson, N. A., Alonso, J., Andrade, L. H., et al. (2025) · International Journal of Mental Health Systems · doi:10.1186/s13033-024-00658-2 · Cited by 13 · see citing works
“Several frameworks have been used in prior studies to organize the investigation of barriers to treatment among individuals with mental disorders [20–22].”
The association between persistent low parental income during preschool age and mental disorder in adolescence and early adulthood: a Norwegian register-based study of migrants and non-migrants
Hynek, K. A., Abebe, D., Hollander, A., Liefbroer, A. C., Hauge, L. J., & Straiton, M. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03859-6 · Cited by 13 · see citing works
“These findings could be a result of generally low OPMH service use among migrants [34] due to greater barriers in help-seeking for mental disorders [35], especially those with PLI.”
Background
Preventing suicide in refugees and asylum seekers: a rapid literature review examining the role of suicide prevention training for health and support staff
Ingram, J., Lyford, B., McAtamney, A., & Fitzpatrick, S. (2022) · International Journal of Mental Health Systems · doi:10.1186/s13033-022-00534-x · Cited by 13 · see citing works
“addresses the importance of trauma informed and culturally appropriate approaches when working with refugees and asylum seekers [9, 28, 31, 34].”
Background
An online tiered screening procedure to identify mental health problems among refugees
Meurling, J., Rondung, E., Leiler, A., Wasteson, E., Andersson, G., Richards, D., Shahnavaz, S., & Bjärtå, A. (2023) · BMC Psychiatry · doi:10.1186/s12888-022-04481-2 · Cited by 12 · see citing works
“Refugees also report other substantial barriers to seeking and receiving mental health care, such as fear of stigma and issues relating to transportation, financial challenges and difficulties locating services [27].”
Background
Group-Based Intervention Models in Treating Refugee Mental Health in High-Income Countries: A Systematic Review
Kirsch, J., Kitchens, K., Kerr, K., & Sivakumaran, S. (2024) · Trauma Violence & Abuse · doi:10.1177/15248380241270039 · Cited by 12 · see citing works
“There is evidence that these structural barriers and post-migration difficulties exacerbate previous trauma and mental health symptoms (Byrow et al., 2020; DeSa et al., 2022).”
Practitioners’ Perspectives on Barriers and Benefits of Telemental Health Services: The Unique Impact of COVID-19 on Resettled U.S. Refugees and Asylees
Weith, J., Fondacaro, K. M., & Khin, P. P. (2022) · Community Mental Health Journal · doi:10.1007/s10597-022-01025-6 · Cited by 11 · see citing works
“They also identified barriers specific to the refugee experience, such as lack of trust in authority figures (Byrow et al., 2020).”
Background
How to measure barriers in accessing mental healthcare? Psychometric evaluation of a screening tool in parents of children with intellectual and developmental disabilities
Xiong, T., Kaltenbach, E., Yakovenko, I., Lebsack, J., & McGrath, P. J. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08762-0 · Cited by 12 · see citing works
“As mental healthcare barrier is a broad concept with limited solid framework [44], the detection of strong correlates of PHBS was not available.”
Background
Development and validation of a risk perception scale of medical help-seeking behavior in Chinese adults
Lyu, X., Liu, Y., Yu, H., Mi, M., Shang, L., Zhong, Y., & Xie, D. (2020) · Annals of Translational Medicine · doi:10.21037/atm-20-1656 · Cited by 12 · see citing works
“However, previous studies mainly focused on the investigation of potential barriers for specific groups, such as African Americans, refugees, sexual and gender minority members, mental illness sufferers, and other disadvantaged groups (30-34).”
Background
“Let’s manage the stressor today” exploring the mental health response to forced migrants in Johannesburg, South Africa
Walker, R., & Vearey, J. (2022) · International Journal of Migration Health and Social Care · doi:10.1108/ijmhsc-11-2021-0103 · Cited by 14 · see citing works
Cultural adaptation of an internet-based self-help app for grieving Syrian refugees in Switzerland
Aeschlimann, A., Heim, E., Hoxha, A., Triantafyllidou, V., Killikelly, C., Haji, F., Stoeckli, R. T., Aebersold, M., & Maercker, A. R. A. (2024) · BMC Public Health · doi:10.1186/s12889-024-20507-8 · Cited by 11 · see citing works
“A further barrier identified in this study is concerns about data privacy and mistrust in healthcare providers and government institutions, influenced by the political climate in Syria and experiences as refugees, consistent with previous research [66–68].”
Result
Scalability of a task-sharing psychological intervention for refugees: A qualitative study in the Netherlands
Woodward, A., de Graaff, A. M., Dieleman, M. A., Roberts, B., Fuhr, D. C., Broerse, J. E. W., Sijbrandij, M., Cuijpers, P. J., Ventevogel, P., Gerretsen, B., et al. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100171 · Cited by 11 · see citing works
An Ethical Perspective on The Democratization of Mental Health with Generative Artificial Intelligence (Preprint)Preprint
Elyoseph, Z., Gur, T., Haber, Y., Simon, T., Angert, T., Navon, Y., Tal, A., & Asman, O. (2024) · doi:10.2196/preprints.58011 · Cited by 11 · see citing works
What mental illness means in different cultures: Perceptions of mental health among refugees from various countries of origin
Moses, S., & Holmes, D. (2022) · Mental Health Global Challenges Journal · doi:10.56508/mhgcj.v5i2.126 · Cited by 11 · see citing works
“Mental health perceptions differ between different cultures, with diverse explanations and beliefs behind them (Byrow et al., 2020).”
BackgroundInfluential
Exploring Young Adults' Reluctance to Engage With Psychiatric Hospitals in Erbil, Iraq: Identifying Barriers to Psychiatric Care
Ahmed, S. M., Saber, A. F., Naif, A. A., Hamad, A. H., Ahmed, S. K., Abdullah, A. Y., Qurbani, K., & Hussein, S. H. (2024) · Cureus · doi:10.7759/cureus.62164 · Cited by 10 · see citing works
“The limited availability of mental health experts from the participants' own cultural or ethnic backgrounds was a significant concern, underscoring the importance of provider diversity and cultural competence in mental health service delivery [33].”
Background
Challenges and strategies for navigating Australian healthcare access: experience from Chinese international students
Men, Q., Li, W., Khan, A., & Gillies, R. M. (2024) · International Journal for Equity in Health · doi:10.1186/s12939-024-02273-6 · Cited by 10 · see citing works
“Drawing on prior research [6, 15, 32], we crafted five key interview questions for the interviews via team discussions.”
Method
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Selim, A., Newby, C., Almutairy, A., Aldossari, A., Alkabba, F., Arabi, S., Zoromba, M. A., Atta, M. H. R., & Ibrahim, N. (2025) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2025.01.005 · Cited by 10 · see citing works
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Wigley, I. L. C. M., Nazzari, S., Pastore, M., Provenzi, L., & Barello, S. (2025) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2025.102541 · Cited by 10 · see citing works
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Dardas, L. A., Al-leimon, O., Gladstone, T. R. G., Dabbas, A. A., Alammouri, I., & Voorhees, B. W. V. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1529006 · Cited by 9 · see citing works
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Hawkes, C., Norris, K., Joyce, J., & Paton, D. (2021) · BMC Public Health · doi:10.1186/s12889-021-11934-y · Cited by 10 · see citing works
“Further, in studies which have focused on refugee populations, it has been identified that stigma is a prominent barrier to help seeking due to fears surrounding the consequences for the self (‘being taken to a crazy place’), and family unit (due to seeking support being identified as shameful for the family unit) [32…”
Background
Post-migration living difficulties, discrimination, and mental health of traumatized refugees in Germany: data from the <i>refuKey</i> project for timely and need-adapted treatment in a stepped-care setting
Graef-Calliess, I. T., Erdmann, L., Mohwinkel, V., Özkan, I., Finkelstein, D., Loos, K., Penteker, G., & Trilesnik, B. (2023) · International Review of Psychiatry · doi:10.1080/09540261.2022.2164181 · Cited by 9 · see citing works
“, 2020) as well as sociocultural barriers like divergent models of mental health and a lack of clinicians’ cultural sensitivity and awareness (Byrow et al., 2020; SchoulerOcak et al., 2015) hinder ASR from receiving adequate mental health care.”
BackgroundInfluential

Perceived barriers to access mental health services for refugees and asylum seekers: a systematic review of qualitative studies
Thiel, R., Kreis, L. G., Schneider, S., König, H., & Brettschneider, C. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-07802-x · Cited by 1 · see citing works
Barriers to Mental Health Help-Seeking Amongst Refugee Men
Byrow, Y., Pajak, R., McMahon, T., Rajouria, A., & Nickerson, A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16152634 · Cited by 76 · see citing works
Self-citation
Access to mental healthcare for refugees, asylum seekers and migrants: an umbrella review of barriers
Bilican, S., Irfan, M., Cox, A., Salaets, H., Sabbe, M. B., & Schoenmakers, B. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-096267 · Cited by 21 · see citing works
Barriers to accessing mental health care for refugees and asylum seekers in high-income countries: A scoping review of reviews mapping demand and supply-side factors onto a conceptual framework
Dumke, L., Wilker, S., Hecker, T., & Neuner, F. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102491 · Cited by 71 · see citing works
Exploring Factors Influencing Refugees' Mental Health Help-Seeking
Ndikumana, F. (2019) · Digital Commons - ACU (Abilene Christian University)

Authors: Byrow, Y., Pajak, R., Specker, P., & Nickerson, A.
Affiliations: UNSW Sydney (AU)
Corresponding author: Byrow, Yulisha
ORCID: Byrow, Yulisha
Specker, Philippa
Nickerson, Angela
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2020-02
Volume: 75
Pages: 101812
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2019.101812
OpenAlex: W2997387113
Cited by: 345
References: 149
Citations by year: 2026: 34 · 2025: 60 · 2024: 88 · 2023: 56 · 2022: 66 · 2021: 35 · 2020: 6
FWCI: 4.24
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
Funders: BeyondBlue research grant (CLT:7237)
Topics: Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Health › Migration, Racism, and Human Rights
Keywords: refugees, asylum seekers, mental health help-seeking, help-seeking barriers, mental health stigma, cultural barriers, structural barriers, financial stress, language barriers, immigration status, confidentiality concerns, mental health perceptions, mental illness
MeSH terms: Mental Disorders, Health Services Accessibility, Humans, Health Knowledge, Attitudes, Practice, Mental Health, Patient Acceptance of Health Care, Refugees, Social Stigma

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Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: A systematic review

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