SHADOW – Seeking Help for Anxiety/Depression within cOmmunity-dWelling older adults

BACKGROUND

Mental ill-health is a leading cause of disability worldwide (Vos et al. 2012). One-in-four older adults experience symptoms of mental ill-health; however, fewer than one-in-six consult about these symptoms with a healthcare professional (AgeUK, 2016). Common barriers to help-seeking and treatment for mental health problems among older adults include stigma, perceived cost, mobility restrictions, the normalising of mental ill-health as a part of ageing and poor mental health literacy (Chew-Graham et al. 2012; Reavley et al. 2013; Titov et al. 2016; Rost et al., 2016; Elshaikh et al. 2021). Social inequalities linked to deprivation and rurality may also restrict access to primary care and mental health services (Milbourne & Kitchen,2014; Ford et al. 2015). Older adults continue to be under-represented in terms of engagement with Improving Access to Psychological Therapies (IAPT), as evidenced by lower rates of referral and access to treatment (Walters et al., 2018). In combination, these circumstances place older adults at a unique disadvantage when seeking to access appropriate help for mental health problems. Without adequate management, mental ill-health can negatively impact morbidity and mortality (World Health Organisation, 2017).

AIM

This research aims to understand how, why and for whom interventions that facilitate help-seeking for anxiety and/or depression among community-dwelling older adults (60+ years of age) work.

METHODS

Realist review to identify and synthesise existing evidence following a 5-stage approach (Pawson 2006). A realist programme theory will be developed that explains how, why, for whom and to what extent interventions that facilitate help-seeking among older adults for anxiety and/or depression work. The approach will be iterative and incorporate a broad range of evidence from documentary sources (including peer-review journals, grey literature, policy documents) and expert opinion (Wong, 2018). The review will be registered on PROSPERO and conducted using the Realist and Meta-narrative Synthesis: Evolving Standards (RAMESES).

DISSEMINATION AND IMPACT

Findings will be shared in multiple formats to reach different stakeholders including academics, clinicians, non-traditional providers, healthcare commissioners and the public. Findings will help us to raise awareness, enhance intervention design and service provision in the future.

PATIENT AND PUBLIC INVOLVEMENT AND ENGAGEMENT

A patient/public advisory group (PAG) of six people aged 50 years and over with experience of mental health problems (either personal experience or as a caregiver) met on 21st July 2022 to discuss this research question and contribute to the development of this application. The PAG members will be invited to continue this role and to provide advice and guidance on the study. CC-G and TK have expertise in PPIE and will be supported by the Impact Accelerator Unit at Keele University.