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.