Key Stakeholder Perspectives on Help-Seeking for Psychosis in South and Southeast Asia: A Systematic Mixed-Studies...

Globally, in 2020, less than one-third of individuals with psychosis accessed mental health services. These services are essential for reducing distress and burden, improving symptoms, and preventing adverse outcomes. However, people may not benefit from these services if they do not seek help. Factors contributing to the help-seeking remain poorly understood in South and Southeast Asia, regions with a majority of low- and middle-income countries. We aimed to synthesise evidence reporting the views and experiences of key stakeholders towards help-seeking for psychosis in these regions. This is the first review in this topic area to employ a multiple-perspective approach and to focus on the understudied regions. The PRISMA checklist guided reporting. We systematically searched primary qualitative, quantitative, and mixed-method research in bibliographic databases (CINAHL, MEDLINE, PsycINFO, Embase, ASSIA, Scopus, and PQDT Global), from inception to March 2025. Each article was independently screened by two reviewers. Eligible articles were extracted and synthesised using narrative synthesis, with JBI checklists utilised for methodological quality assessments. We included 57 studies published across 62 articles, 80% of which were rated as moderate or low quality. We inductively developed five themes, comprising 11 subthemes, which highlighted factors influencing and experiences of help-seeking across multiple stakeholders, including perceptions of problems, service quality, stigma, structural circumstances, and social support. Carers' perspectives were dominant and differed slightly from those of service users in their perceptions of problems, suggesting the value of more widely adopting a multiple-perspective approach in help-seeking research.