https://www.sciencedirect.com/science/article/pii/S0738399125006718?dgcid=rss_sd_all
Family/friend carers are the “invisible backbone” of our healthcare systems, providing essential support to people with chronic physical health conditions. Yet many face significant unmet needs, burdens and psychosocial concerns. Psychological interventions can help carers to manage these impacts, however, carers often demonstrate low engagement with psychological support services. This systematic review aimed to provide a meta-synthesis of qualitative studies to determine the attitudinal barriers to seeking formal psychological support services among carers of people with a chronic physical health condition.
Following PRISMA guidelines, we systematically searched PsycINFO, MEDLINE, CINAHL and EMBASE for qualitative peer-reviewed articles published in English from 2005 to 2025 reporting on adult carers of people with a chronic physical health condition seeking psychological support for themselves. We conducted an inductive qualitative meta-synthesis and assessed study quality using the Critical Appraisal Skills Programme (CASP) qualitative checklist and Mixed Methods Appraisal Tool (MMAT).
Twenty-six qualitative and five mixed methods studies were included for analysis. Attitudinal barriers were synthesised into three interrelated themes. We found that carers held pre-existing beliefs about the validity of accessing support for themselves, often devaluing their personal needs to prioritise the patient. Stigmatised mental health beliefs meant that psychological support was not only seen as a luxury by some, but also contradictory to carers’ perceived role as pillars of emotional stability and strength. These beliefs were shaped and reinforced in patient-centric healthcare systems where there was a perceived lack of carer recognition and carer-informed support and services.
This review emphasises the importance of acknowledging carers, validating their needs and facilitating access to timely and appropriate psychological support.
Our results suggest a two-pronged approach is necessary to increase carer engagement with psychological support services, where attitudinal barriers are addressed at both an individual and health system/service level.
Fig. 1. PRISMA Flowchart for screening process. Note. Based on updated search from January 2025.
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