How, why, for whom and when do help-seeking interventions for anxiety and/or depression work among older adults: a realist review.

Problem

1-in-4 older adults (60+ years of age) in the UK experience a mental health problem each year. Only 1-in-6 with potential symptoms will seek help from a healthcare professional. Older adults may not seek help for a variety of reasons: feelings such as low mood or worry may not be understood as symptoms of a mental health problem; engagement with formal services may be perceived as a threat to independence or not offering acceptable support; services may be inaccessible due to physical disability or lack of transport. Stigmatised views linked to ageism and mental ill-health may also inform attitudes towards help-seeking.

This research aims to understand how, why, for whom and in what circumstances interventions to facilitate help-seeking for anxiety and/or depression work among community-dwelling older adults.

Approach

A realist review to identify and synthesise existing evidence of help-seeking interventions for anxiety and/or depression. Systematic search conducted in several databases including MEDLINE, EMBASE, Cochrane library. Protocol published on Prospero: crd.york.ac.uk/PROSPERO/display_record.php?RecordID=451756.

A patient/public advisory Group contributed to the study design and conduct. External topic experts from academia, clinical practice and voluntary sector contributed to an external advisory group.

Findings

1095 papers were reviewed against inclusion/exclusion criteria, 80 papers were identified for full text review. 25 papers have been analysed to refine an initial set of candidate theories.

Interventions identified include cognitive behavioural therapy, bibliotherapy, and befriending delivered by a diverse range of providers. Analysis indicates that help-seeking interventions are complex due to the interaction between attitudes, intentions, behaviours but also factors linked to inequalities (e.g. access to existing resources, education). Important aspects to consider in intervention design include: individual preferences, cultural backgrounds, co-morbidities, and personal resources. Interventions must have a theoretical basis in relevant social-psychological theory. Debates around what defines self-help and help-seeking also seem important but under-considered.

Consequences

Analysis is ongoing. The research will generate a programme theory to inform future help-seeking initiatives and interventions delivered in primary care and offer suggestions for initiatives that prove more sustainable and inclusive to patients and service users across primary care. Findings suggest that providers in the wider health and social care system could play important roles in offering alternative interventions to primary care which could be more accessible to more older adults with potential anxiety and/or depression.