Stage 1- Research Question
As there was no review available on the barriers to mental healthcare faced by medical students, our goal was to conduct a scoping review to showcase the available research, describe recommendations, and identify potential for future research (19). Thus, we developed a broad research question “What are the barriers faced by medical students to seeking professional mental healthcare?”. We defined professional mental healthcare as that which is sought from a counsellor, therapist, or physician, as opposed to self-care and peer support. Although self-care and peer support can be effective in improving mental health, they may not have the same barriers and stigma as professional care. Our sub-questions included:
Are there any geographic trends in the barriers faced by medical students seeking mental healthcare?
Are there any recommendations for addressing barriers faced by medical students seeking mental healthcare in currently available literature?
Stage 2 - Identify Relevant Studies
To find studies that address our research question, we created a MeSH search and applied it to PubMed, Embase, and PsychINFO databases. We used these three databases as studies about mental health are likely to appear in databases that focus on medicine and psychology. The search terms used included variations of medical students, mental health and illness, counseling, healthcare, and therapy, as well as descriptions of barriers and help-seeking behaviours. For a full list of search terms see Appendix A. We did not impose publication year or country limits on our searches in order to assess for geographic variations in identified barriers. Our review included primary articles where barriers to mental healthcare was either the primary variable being investigated or one of multiple study results. We excluded relevant review articles, however, did include primary studies from their references if they were not included in our original search.
Stage 3- Literature Selection
Our literature search yielded 438 articles, and an additional 16 articles were extracted from literature reviews that were not yielded by the initial search. The resultant total of 454 articles were reviewed for title and abstract screening. Through title and abstract screening, we excluded 389 articles that were either duplicates, pilot projects, reviews, did not address barriers to mental healthcare faced by medical students, or focused on veterinary or dental students. A full-text screening performed on the remaining 65 articles excluded studies focusing on non-professional or self-care. 33 articles passed the screening process and were included in our final review [Figure 1].
Stage 4- Charting data
Data extraction was manually performed and documented using Microsoft Excel. Our data of interest were the barriers medical students faced in seeking mental healthcare noted in each article. Exact wording from each article was used when describing barriers. Data was extracted by all authors with oversight by lead author M.B.
Stage 5- Summarizing and Reporting
Data extracted from studies was organized to answer the research question and sub-questions.
We listed barriers from all articles and compiled them within two broader categories: systemic barriers and individual barriers. Systemic barriers included “policies, procedures, or practices that unfairly discriminate and can prevent individuals from participating fully in a situation” (20). Individual barriers were not directly linked to institutional practices and were dictated by a person’s life experiences, emotions, and prior knowledge. Papers were assigned to barrier categories based on which barriers were identified in the study results. Studies were also categorized by geographic location, including Asia, South America, Australia, Europe, and North America. Article suggestions for addressing the barriers to medical student mental health care were recorded and combined to formulate an overall recommendation most applicable in North America, as this is the context of our institution.