Development and validation of the Barriers to Mental Health Service Utilization Scale (BMHSUS) in Bangladesh: an in-depth analysis of sociodemographic influences on access barriers – insights from the National Mental Health Survey

Background Mental health service utilisation (MHSU) in Bangladesh remains limited due to cultural, social and structural barriers, including stigma, reliance on traditional healing practices, concerns about medication and restricted access to care. This study aimed to develop and validate a culturally appropriate tool to assess barriers to MHSU and to examine sociodemographic, clinical and psychosocial factors associated with these barriers. Methods Data were drawn from the National Mental Health Survey of Bangladesh (August 2019–May 2020), a multicentre, community-based study using stratified cluster random sampling across 496 primary sampling units (PSUs). A total of 7238 adults were included. Exploratory and confirmatory factor analyses were conducted to validate the Barriers to Mental Health Service Utilization Scale (BMHSUS). Binary logistic regression identified predictors of perceived barriers. Results Confirmatory factor analysis validated a four-factor, eight-item BMHSUS with strong psychometric properties. Overall, nearly three-quarters of participants reported at least one barrier to mental health service utilisation, with social concerns (47%) and perceived stigma (39%) emerging as the most prevalent obstacles. Females had significantly lower odds of reporting barriers than males (adjusted OR (AOR)=0.49; 95% CI 0.38 to 0.61), and urban residents were less likely than rural residents to report barriers (AOR=0.84; 95% CI 0.75 to 0.94). Individuals with depressive (AOR=1.48; 95% CI 1.15 to 1.90) and anxiety disorders (AOR=1.75; 95% CI 1.28 to 2.39) were more likely to experience barriers. Higher stigma-related scores for relationship disruption, anxiety and hygiene concerns were associated with increased barriers, whereas favourable beliefs about treatability and recovery reduced the odds (AOR=0.89; 95% CI 0.88 to 0.90). Conclusions The BMHSUS is a reliable and culturally valid tool for assessing barriers to MHSU in Bangladesh. Addressing stigma, geographic inequities and disorder-specific vulnerabilities is essential to improving access to mental health services and informing evidence-based policy and intervention strategies.