Barriers and enablers to help-seeking behaviour for mental health reasons among community dwelling older adults with anxiety: Mixed-methods systematic review

Abstract

• There is no one model that can depict the complexity of help-seeking behaviour. • Help-seeking is affected by contextual, interpersonal and individual factors. • Help-seeking represents a dynamic self-regulatory system. • Individual need factors play an important role in help-seeking. • Coherence between representations of illness, actions, immediate and higher-order goals is important. Despite their high prevalence and negative consequences, anxiety disorders in older adults remain underdiagnosed and undertreated, creating an ‘anxiety treatment gap’. To address this treatment gap, it is essential to identify barriers and enablers to help-seeking behaviour among this population. This mixed-methods systematic review used Andersen's Model and Leventhal's’ Common Sense Model (CSM) in a “best-fit” framework synthesis to explore barriers and enablers to help-seeking behaviour for mental health reasons among older adults with anxiety. A comprehensive search of six databases, last updated on 6 April 2022, led to the inclusion of thirteen records published 2011-2022. Quantitative data were synthesised using Andersen's Model, summarised using vote counting based on direction of effect, and focused mainly on factors at the individual level. Qualitative synthesis generated an extended conceptual model which includes a priori themes derived from Andersen's Model and Leventhal's CSM and new themes identified via inductive analysis. The role of individual need factors on help-seeking behaviour was corroborated by both quantitative and qualitative evidence. The overarching theme is ‘coherence’ as a multilevel concept. It was not possible to aggregate effect estimates extracted from quantitative records. The internal validity of the review is affected by scant evidence, quality of the qualitative records and lack of triangulation of evidence. There is no one model that can depict the complexity of help-seeking behaviour among older adults with anxiety. A better understanding of the role of need factors and the multi-level concept of ‘coherence’ on help-seeking behaviour is required. Conceptual Model representing the elements, phases and processes underlying illness-seeking behaviour among older adults with anxiety (print in colour)