How, why, for whom and when do help-seeking interventions for anxiety and depression work among older adults? A realist review

BACKGROUND: A quarter of older adults (aged ≥60 years) in the UK experience a mental health problem each year. Older adults may not seek help due to limited awareness of symptoms of mental ill-health; fear of losing independence; limited access to services. Stigmatised views linked to ageism may also influence help-seeking. AIM: 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. METHOD: 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. A patient/public advisory group (PAG) and expert advisory group contributed to the study design, analysis and conduct. RESULTS: 1095 papers reviewed against inclusion/exclusion criteria; 80 papers identified for full text review and 42 papers included. A variety of interventions were identified including cognitive behavioural therapy, bibliotherapy and befriending, delivered by a diverse range of providers. Help-seeking interventions are complex due to interactions between attitudes, intentions, behaviours but also factors linked to inequalities. Interventions perform better when they support older adults to recognise a problem exists, promote personal agency, include culturally sensitive resources, and adopt a salutogenesis perspective that builds on individual strengths. Interventions are generally under-theorised when it comes to help-seeking. CONCLUSION: The review will generate a programme theory to inform future help-seeking initiatives and suggestions for interventions that may be more accessible to older adults and service users experiencing mental health difficulties.