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

Abstract

Background: 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 behavior among this population. Methods: 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 behavior for mental health reasons among older adults with anxiety. Results: 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 behavior was corroborated by both quantitative and qualitative evidence. The overarching theme is ‘coherence’ as a multilevel concept. Limitations: 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. Conclusions: There is no one model that can depict the complexity of help-seeking behavior among older adults with anxiety. A better understanding of the role of need factors and the multi-level concept of ‘coherence’ on help-seeking behavior is required.

Keywords

• Anxiety
• Older adults
• Help-seeking behavior
• Mental health service use