{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T08:03:11Z","timestamp":1780041791880,"version":"3.53.1"},"reference-count":45,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Trauma, Violence, &amp; Abuse"],"abstract":"<jats:p>In exploring survivors\u2019 experiences of the wide range of services across settings that they sought for mental health support, this review synthesises experiences, facilitators and barriers encountered to help-seeking in adult survivors of complex trauma. We searched multiple databases including Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, EMBASE, Applied Social Sciences Index, Web of Science, and PROQUEST. In total, 23,129 records were retrieved and screened, out of which 108 records were eligible for inclusion. Following a narrative synthesis, seven themes representing facilitators and barriers to seeking help were identified at individual, organisational and societal levels: internal and external stigma, peer support, staff attitude, service flexibility, therapeutic relationship, skills and training. Our synthesis resulted in a conceptual model with three interconnected overarching themes: feeling safe, embarking on a journey, and achieving connectedness, all of which contribute to the development of post-traumatic self. Offering a comprehensive understanding of the obstacles involved in seeking support for complex trauma is essential. A large number of studies highlighted a need for greater public awareness to reduce stigma, trauma-informed training for staff in statutory and non-statutory settings, peer support, funding and better links between services to offer a more holistic approach. Political and practical interventions could help improve accessing support, hence further research to redress this balance is therefore warranted.<\/jats:p>","DOI":"10.1177\/15248380261429514","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T12:04:03Z","timestamp":1779797043000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Complex Trauma Survivors\u2019 Experiences of Services and Support for Mental Health: A Qualitative Thematic Synthesis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1948-5007","authenticated-orcid":false,"given":"Charlotte","family":"Rowe","sequence":"first","affiliation":[{"name":"City St George\u2019s, University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda C. M.","family":"Li","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9686-2232","authenticated-orcid":false,"given":"Steve","family":"Gillard","sequence":"additional","affiliation":[{"name":"City St George\u2019s, University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2036-5344","authenticated-orcid":false,"given":"Vasana","family":"Attanayake","sequence":"additional","affiliation":[{"name":"City St George\u2019s, University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7367-0195","authenticated-orcid":false,"given":"Sabrina","family":"Desai","sequence":"additional","affiliation":[{"name":"City St George\u2019s, University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Howell","sequence":"additional","affiliation":[{"name":"City St George\u2019s, University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1372-2363","authenticated-orcid":false,"given":"Siofra","family":"Peeren","sequence":"additional","affiliation":[{"name":"King\u2019s College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Sweeney","sequence":"additional","affiliation":[{"name":"King\u2019s College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roz","family":"Etwaria","sequence":"additional","affiliation":[{"name":"Little Ro for Survivors of Abuse, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Alyce","sequence":"additional","affiliation":[{"name":"PATHWAY Systematic Review-LEAG, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nell","family":"Hardy","sequence":"additional","affiliation":[{"name":"Response Ability Theatre (RATS), London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Quinn-Walker","sequence":"additional","affiliation":[{"name":"Birmingham City University, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Chevous","sequence":"additional","affiliation":[{"name":"King\u2019s College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0590-7165","authenticated-orcid":false,"given":"Jacqueline","family":"Sin","sequence":"additional","affiliation":[{"name":"City St George\u2019s, University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_3_4_2_1","unstructured":"Alyce S. (2023). Trust trusting and trustworthiness in the words of survivors of child sexual abuse [Dissertation University of Essex]."},{"key":"e_1_3_4_3_1","doi-asserted-by":"crossref","unstructured":"Bell V. Robinson B. Katona C. Fett A.-K. Shergill S. (2019). When trust is lost: The impact of interpersonal trauma on social interactions. Psychological Medicine 49(6) 1041\u20131046. https:\/\/doi.org\/10.1017\/S0033291718001800","DOI":"10.1017\/S0033291718001800"},{"key":"e_1_3_4_4_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2022.1.53674"},{"key":"e_1_3_4_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13033-017-0137-3"},{"key":"e_1_3_4_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003262"},{"key":"e_1_3_4_7_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.55.2.157"},{"key":"e_1_3_4_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2018.01.043"},{"key":"e_1_3_4_9_1","doi-asserted-by":"publisher","DOI":"10.1057\/9781137304667_14"},{"key":"e_1_3_4_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcop.20063"},{"key":"e_1_3_4_11_1","doi-asserted-by":"publisher","DOI":"10.1037\/men0000313"},{"key":"e_1_3_4_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2004.00463.x"},{"key":"e_1_3_4_13_1","doi-asserted-by":"publisher","DOI":"10.1037\/10595-009"},{"key":"e_1_3_4_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-018-1201-9"},{"key":"e_1_3_4_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10464-007-9134-z"},{"key":"e_1_3_4_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1524838007309805"},{"key":"e_1_3_4_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jts.2490050305"},{"key":"e_1_3_4_18_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1819.1998.0520s5S145.x"},{"key":"e_1_3_4_19_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2022.51"},{"key":"e_1_3_4_20_1","unstructured":"Huang L. N. Flatow R. Biggs T. Afayee S. Smith K. Clark T. Blake M. (2014). SAMHSA\u2019s concept of trauma and guidance for a trauma-informed approach. Substance Abuse and Mental Health Services Administration."},{"key":"e_1_3_4_21_1","doi-asserted-by":"publisher","DOI":"10.1037\/tra0000908"},{"key":"e_1_3_4_22_1","doi-asserted-by":"publisher","DOI":"10.4324\/9781315126401-15"},{"key":"e_1_3_4_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/15248380211068136"},{"key":"e_1_3_4_24_1","first-page":"1","article-title":"Online tools supporting the conduct and reporting of systematic reviews and systematic maps: A case study on CADIMA and review of existing tools","volume":"7","author":"Kohl C.","year":"2018","unstructured":"Kohl C., McIntosh E. J., Unger S., Haddaway N. R., Kecke S., Schiemann J., Wilhelm R. (2018). Online tools supporting the conduct and reporting of systematic reviews and systematic maps: A case study on CADIMA and review of existing tools. Environmental Evidence, 7, 1\u201317.","journal-title":"Environmental Evidence"},{"key":"e_1_3_4_25_1","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/4475114"},{"key":"e_1_3_4_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000062"},{"key":"e_1_3_4_27_1","doi-asserted-by":"publisher","DOI":"10.3402\/ejpt.v4i0.19985"},{"key":"e_1_3_4_28_1","unstructured":"Miles M.B. Huberman A.M. Saldana J. (2014). Qualitative data analysis: A methods sourcebook (3rd Edition). Sage."},{"key":"e_1_3_4_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-006-0094-7"},{"key":"e_1_3_4_30_1","doi-asserted-by":"publisher","DOI":"10.1037\/0735-7028.35.4.389"},{"key":"e_1_3_4_31_1","doi-asserted-by":"crossref","unstructured":"Moustakas C. (1994) Phenomenological research methods. Sage.","DOI":"10.4135\/9781412995658"},{"key":"e_1_3_4_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12012"},{"key":"e_1_3_4_33_1","article-title":"PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page M. J.","year":"2021","unstructured":"Page M. J., Moher D., Bossuyt P. M., Boutron I., Hoffmann T. C., Mulrow C. D., Shamseer L., Tetzlaff J. M., Akl E. A., Brennan S. E., Chou R., Glanville J., Grimshaw J. M., Hr\u00f3bjartsson A., Lalu M. M., Li T., Loder E. W., Mayo-Wilson E., McDonald S., . . . McKenzie J. E. (2021). PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ, 372, n160.","journal-title":"BMJ"},{"key":"e_1_3_4_34_1","unstructured":"Peeren S. Gillard S. Sweeney A. Rowe C. Sin J. (2023) Complex trauma survivors\u2019 experiences of services and support for mental health \u2013 A qualitative thematic synthesis. PROSPERO 2023 CRD42023398011 https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42023398011"},{"key":"e_1_3_4_35_1","unstructured":"Popay J. Roberts H. Sowden A. Petticrew M. Arai L. Rodgers M. Britten N. Roen K. Duffy S. (2006). Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC Methods Programme Version 1 b92."},{"key":"e_1_3_4_36_1","doi-asserted-by":"crossref","unstructured":"San Juan N. Clark S. E. Camilleri M. Jeans J. P. Monkhouse A. Chisnall G. Vindrola-Padros C. (2022). Training and redeployment of healthcare workers to intensive care units (ICUs) during the COVID-19 pandemic: A systematic review. BMJ Open 12 e050038. https:\/\/doi.org\/10.1136\/bmjopen-2021-050038","DOI":"10.1136\/bmjopen-2021-050038"},{"key":"e_1_3_4_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(17)30104-4"},{"key":"e_1_3_4_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbm069"},{"key":"e_1_3_4_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2463-1"},{"key":"e_1_3_4_40_1","doi-asserted-by":"publisher","DOI":"10.1080\/17482631.2022.2103934"},{"key":"e_1_3_4_41_1","doi-asserted-by":"publisher","DOI":"10.1192\/bja.2018.29"},{"key":"e_1_3_4_42_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638237.2018.1520973"},{"key":"e_1_3_4_43_1","doi-asserted-by":"publisher","DOI":"10.15252\/embr.201642951"},{"key":"e_1_3_4_44_1","doi-asserted-by":"publisher","DOI":"10.3109\/09540261.2014.924095"},{"key":"e_1_3_4_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12344"},{"key":"e_1_3_4_46_1","volume-title":"International Statistical Classification of Diseases and Related Health Problems","author":"World Health Organization","year":"2019","unstructured":"World Health Organization. (2019). International Statistical Classification of Diseases and Related Health Problems (11th ed.). World Health Organization.","edition":"11"}],"container-title":["Trauma, Violence, &amp; Abuse"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15248380261429514","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15248380261429514","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15248380261429514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T07:20:24Z","timestamp":1780039224000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15248380261429514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":45,"alternative-id":["10.1177\/15248380261429514"],"URL":"https:\/\/doi.org\/10.1177\/15248380261429514","relation":{},"ISSN":["1524-8380","1552-8324"],"issn-type":[{"value":"1524-8380","type":"print"},{"value":"1552-8324","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"article-number":"15248380261429514"}}