Background <p>Depression, a highly prevalent mental health disorder, exerts profound global and economic impacts. In China, rapid industrialization, post-COVID-19 challenges, and evolving social structures have collectively increased depression incidence. Despite evidence-based therapies, substantial treatment gaps persist, particularly due to low utilization of mental health services among individuals with depressive symptoms. Notably, research on help-seeking intentions in Xizang Autonomous Region’s unique cultural context remains scarce. This gap hinders understanding of mechanisms underlying mental health service underutilization and the development of targeted interventions. Thus, this study aims to comprehensively explore factors influencing help-seeking intentions among Xizang residents.</p> Method <p>A cross-sectional study was carried out in October and December 2023. Using systematic random sampling, 1,374 residents from the Shannan, Nyingchi, and Qamdo regions of Xizang were surveyed. Data collection was achieved through face-to-face interviews with structured questionnaires, grounded in the Andersen Behavioral Health Services Use Model. Statistical analyses encompassed descriptive statistics, univariate analyses, and binary logistic regression to discern significant influencing factors.</p> Results <p>The results indicated that 748 (54.4%) of the participants manifested negative help-seeking intentions (i.e., a lower likelihood of seeking professional help for depression problems), while 626 (45.6%) exhibited positive intentions. Notably, among those meeting the Patient Health Questionnaire-9 (PHQ-9) criteria for moderate-to-severe depression (prevalence = 15.1%), only 34.3% (71/207) demonstrated help-seeking intentions. Multiple factors were significantly associated with help-seeking intentions. Predisposing factors included age (<i>p</i> &lt; 0.05), gender (β = 0.27, <i>p</i> = 0.041), education level (<i>p</i> &lt; 0.05), attitude towards depression (β = 0.13, <i>p</i> &lt; 0.001), and perceived stigma (β=-0.09, <i>p</i> = 0.020). Key enabling/hindering factors were subsistence allowances (β=-0.64, <i>p</i> = 0.008), access to higher-level healthcare facilities (β = 0.49, <i>p</i> = 0.010), received family physician services (β = 0.76, <i>p</i> &lt; 0.001), and geographical location (<i>p</i> &lt; 0.001). For needs factors, both insomnia symptoms (<i>p</i> &lt; 0.05) and depression symptoms (β=-0.06, <i>p</i> &lt; 0.001) were significant. Among these, enabling factors had the most robust association, followed by predisposing and needs factors.</p> Conclusions <p>These findings not only provide a comprehensive understanding of the determinants of depression help-seeking intentions among Xizang residents but also underscore the imperative for targeted interventions to surmount barriers to mental health service utilization in Xizang. Overall, this study accentuates the urgent necessity of formulating and implementing targeted interventions to dismantle the obstacles to mental health care access in Xizang, thereby contributing to the improvement of mental health outcomes in this region.</p>