Help-seeking for mental health problems among older adults with chronic diseases: An evaluation and intervention

Older adults have high rates of chronic diseases, leaving them more vulnerable to associated mental health declines. Nevertheless, the intentions of older adults with chronic diseases to seek help from mental health support systems are low. Couched in the Theory of Planned Behaviour (TPB), this thesis aimed to 1) identify antecedents to help-seeking for mental health problems in older adults with chronic diseases, and 2) to design, develop and test a behaviour change intervention, promoting mental health help-seeking among older adults with chronic diseases in Australia. An overview of this thesis is presented in Chapter 1. A literature review on the relationship between mental health problems, chronic diseases, and help-seeking in older adulthood is then provided (Chapter 2). A scoping review was conducted, which mapped 49 articles that applied the TPB to mental health help-seeking in adults aged \u3e18 years (Chapter 3). A considerable evidence base was found on the TPB for predicting mental health help-seeking intentions, and to a lesser extent behaviour. A survey instrument, to measure mental health help-seeking intentions among older adults (MHHS-OA), was developed and piloted with a sample of 54 adults aged 65 to 94 years living in metropolitan Perth, Western Australia (Chapter 4). The MHHS-OA demonstrated acceptable reliability and validity for measuring the TPB constructs of attitudes, subjective norms, and behavioural intention (Cronbach alphas .64 to .82). Modifications were made to improve the measurement of perceived behavioural control. The modified MHHS-OA was utilised in a cross-sectional study with 108 adults aged 65 to 93 years, living in metropolitan Perth, diagnosed with cardiovascular diseases, respiratory diseases, and/or type 2 diabetes (Chapter 5 and 6). The cross-sectional study sought to identify factors associated with intentions to seeking help, and barriers to seeking help, among older adults with chronic diseases. Using multiple linear regressions, the TPB was found to be a suitable model for understanding mental health help-seeking intentions in older adults with chronic diseases, accounting for 69.7% of the variance in intentions (Chapter 5). Attitudes and perceived behavioural control had the strongest association with help-seeking intentions, followed by subjective norms. Two common barriers to help-seeking were identified: ‘wondering whether the mental health problem is significant enough to warrant treatment’ (endorsed by 51.9% of participants), and ‘not having a regular primary health care provider to speak with’ (endorsed by 39.6% of participants). Multiple linear regressions revealed past use of mental health services had the strongest association with both barriers; past help-seeking behaviour was associated with less endorsement of barriers to help-seeking (Chapter 6). Identifying factors associated with intentions to seek help (attitudes, perceived behavioural control, and subjective norms), and barriers to seeking help, the first aim of this thesis was achieved. To achieve the second aim of this thesis, an intervention aimed at promoting mental health help-seeking was developed and tested in a pilot randomised controlled trial (RCT) (Chapter 7). The intervention was designed to address the antecedents to help-seeking that were identified (Chapters 5 and 6). Nine stakeholders were interviewed to inform the design and development of the intervention and 241 adults aged 66 to 90 years were randomised to receive the intervention or control materials. The intervention consisted of a TPB-based brochure, aimed at promoting mental health help-seeking. Results indicated the intervention is an acceptable and feasible method for improving mental health help-seeking in older adults with and without chronic diseases. Repeated measures ANOVAs, regarding the effectiveness of the intervention, indicated the intervention is effective in improving attitudes and intentions towards seeking help for mental health problems. Finally, Chapter 8 summarises, concludes, and proposes future research directions. This thesis helps to delineate factors associated with intentions as well as barriers to help-seeking and provides researchers and health professionals with an empirically based intervention aimed at increasing the likelihood of help-seeking intentions and behaviour among older adults with chronic diseases