Effect of medical school initiatives on help seeking for mental health problems among medical students: A Systematic Review and Meta-Analysis

Objectives:
Many medical students with mental health problems do not seek help. However, it is unclear what medical schools can do to promote help seeking. We sought to establish the effect of medical school initiatives on help seeking for mental health problems among medical students.

Design:
A systematic review and meta-analysis of studies published between 2013 and 2023.

Data sources:
MEDLINE Ovid, EMBASE Ovid, PsycINFO Ovid, Web of Science, ERIC, BEI and Education Abstracts.

Eligibility criteria:
Studies that assess the effect of an intervention delivered by a university or healthcare organisation on medical students’ attitudes towards help seeking or their help-seeking behaviour for mental health problems.

Data extraction and synthesis:
Two reviewers independently screened studies for inclusion and extracted data. Risk of bias was assessed using Cochrane Risk of Bias 2 (for randomised controlled trials (RCTs)) and Risk Of Bias In Non-randomized Studies of Interventions (for non-randomised studies). Studies were grouped according to intervention type. Meta-analysis was conducted using random-effects models. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluations.

Results:
The evidence from the meta-analyses was of very low to low certainty. Improvements in help seeking were noted in the meta-analyses of pre-post studies investigating the effect of interventions with a lived-experience component (five studies, n=492, standardised mean difference (SMD) 0.62, 95% CI 0.33 to 0.91, p<0.001); of educational interventions (two studies, n=260, SMD 0.38, 95% CI 0.01 to 0.74, p=0.04); and of interventions to improve access to services (two studies, n=1120, OR 1.80, 95% CI 1.12 to 2.88, p=0.02). Effects on help seeking diminished over time. The meta-analysis of three pre-post studies (n=677) evaluating the effect of clinical clerkships found no benefit on personal help-seeking attitudes (SMD 0.21, 95% CI −0.08 to 0.51, p=0.16). Meta-analysis of controlled studies comparing different approaches did not find superiority of face-to-face lived-experience interventions over active control interventions.

Conclusions:
Overall, the evidence is of very low to low certainty, due to the serious risk of bias in the included studies, most of which used uncontrolled pre-post designs. Interventions with a lived-experience component may improve medical students’ help-seeking attitudes. Standard clinical clerkships did not appear to impact personal help seeking, despite multiple previous studies suggesting they reduce stigma, suggesting barriers to help seeking extend beyond stigma and mental health literacy in this student population. Further high-quality research, particularly RCTs with long-term follow-up, is needed to firm up the evidence base in this area.

PROSPERO registration number:
CRD42024319771.