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

Fisher, Tamsin; Chew-Graham, Carolyn; Corp, Nadia; Hider, Samantha; Southam, Jane; Wong, Geoffry; Kingstone, Tom

Abstract

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.

Citation

Fisher, T., Chew-Graham, C., Corp, N., Hider, S., Southam, J., Wong, G., & Kingstone, T. (2025, March). How, why, for whom and when do help-seeking interventions for anxiety and depression work among older adults? A realist review. Presented at BJGP Research and Publishing conference, The Lowry Hotel, Manchester, England

• Presentation Conference Type: Presentation / Talk
• Conference Name: BJGP Research and Publishing conference
• Start Date: Mar 21, 2025
• Acceptance Date: May 22, 2025
• Online Publication Date: May 22, 2025
• Publication Date: May 22, 2025
• Deposit Date: Jun 9, 2025
• Journal: British Journal of General Practice
• Print ISSN: 0960-1643
• Electronic ISSN: 1478-5242
• Publisher: Royal College of General Practitioners
• Peer Reviewed: Peer Reviewed
• Volume: 75
• Issue: suppl 1
• Article Number: bjgp25X741729
• DOI: https://doi.org/10.3399/bjgp25x741729
• Public URL: https://keele-repository.worktribe.com/output/1277415
• Publisher URL: https://bjgp.org/content/75/suppl_1/bjgp25X741729