Anna Szücs ^1,2,3* Rachel Hui Xin Lam ⁴ Wymann Shao Wen Tang ⁴ Lifan Zhou ^1,5 Monica Lazarus ¹ Andrea B Maier ^2,6,7 Jose Maria Valderas ^1,3,8

• ¹ Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
• ² Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands, Netherlands
• ³ Department of Family Medicine, National University Health System, Singapore, Singapore
• ⁴ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
• ⁵ Department of Statistics and Data Science, Faculty of Science, National University of Singapore, Singapore, Singapore
• ⁶ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
• ⁷ Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
• ⁸ Centre for Research in Health Systems Performance, National University of Singapore, Singapore, Singapore

The effective management of depression, anxiety, and other forms of psychological distress depends on individuals' readiness to seek and accept help for their mental suffering. Understanding which personality traits relate to help-seeking can help better tailor mental healthcare to individual needs. However, findings regarding associations of personality determinants of help-seeking have been inconsistent. This systematic review and meta-analysis focused on English-language research reports on the association of personality (encompassing personality disorders, Five Factor -Big Five- dimensions, and other measures of personality) with depression, anxiety, or unspecified psychological distress in adults aged 18 years and older. Procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy included two concepts: personality and help-seeking and was carried out on PubMed, Embase, Web of Science, and PsycINFO. Reference tracking and searches on Google Scholar were additionally performed. Sufficiently homogeneous subsections were analyzed by meta-analysis. A total of 48 studies described in 47 records reported on the association between personality and help-seeking. Nine assessed personality disorders, 29 Five Factor dimensions, and 13 other personality constructs. Twenty-three studies investigated attitudes towards help-seeking while 25 studies investigated help-seeking behaviors. Of the studies investigating behavior, three used external observations, the rest relied on self-reports/clinician-administered questionnaires. Evidence highlighted a dissociation between attitudes and behavior for schizotypal and borderline personality disorders, and neuroticism, which displayed negative help-seeking attitudes but more help-seeking behavior. By contrast, paranoid, schizoid and obsessivecompulsive personality disorders related to both negative help-seeking attitudes and behavior across studies. Limited evidence linked extraversion to social support seeking and conscientiousness to care seeking behaviors. Meta-analyses on the Five Factor dimensions and help-seeking attitudes supported robust negative associations with neuroticism, as well as positive associations with agreeableness, albeit less reliably. Other personality traits mostly corroborated the above relationships, while also contributing new perspectives, such as helpseeking behavior's negative associations with reality weakness and cynicism, and positive associations with abasement and rigidity. Future research should investigate help-seeking behavior using external observations and longitudinal designs. Assessing personality in clinical settings can help identify populations atrisk of keeping to themselves when mentally distressed.