|dc.description.abstract||Background: Older adults are less likely to access mental health services than younger
adults despite experiencing similar rates of mental health problems. Older adults
experiencing mental health problems are more likely to be offered medication than
psychological interventions compared with younger adults. There is a recognized need
to increase access to early, psychological intervention and preventative mental
healthcare for older adults globally. Improving access to mental health services in rural
areas is a national priority. The combined risks of an ageing population, inadequate
service preparedness and comparatively poor mental health service utilisation by older
adults, increases the likelihood of a large-scale mental health crisis. Mental health
literacy (MHL) is associated with the recognition of mental health needs, service
utilisation and improved mental health outcomes. Psychoeducation is often an integral
part of low-intensity psychological intervention and receiving it is arguably linked to
mental health literacy. Older adults have been found to have lower MHL and are more
likely to use avoidance based coping strategies than younger adults. Little is known
about the factors within older adults that perpetuate, ameliorate or confound these
associations, particularly in a rural context.
Objectives: A systematic review ‘The Effectiveness of Low-intensity Psychological
Interventions on the Well-being of Older Adults’ synthesised the evidence for
effectiveness and acceptability of low-intensity psychological interventions (self-help,
psychoeducation, bibliotherapy, internet cognitive-behavioural therapy: iCBT) for older
adults with mild-to-moderate mental health problems.
A cross-sectional questionnaire-based survey ‘An Exploration into the Relationships
between Mental Health Literacy, Experiential Avoidance and Mental Health in Older
Adults in a Rural Scottish Region’ was used to explore the level of MHL, and the
relationships between MHL, mental health, experiential avoidance, willingness to use
mental health services and demographic variables in community-dwelling older adults in
a rural Scottish region.
Methods: The systematic review protocol was registered on Prospero prior to data
extraction. Ovid, EBSCOhost and ProQuest were searched for articles describing low-intensity
psychological interventions. Pre and post outcome measures and a mean age
of at least 50 (age range ≥40) were required for inclusion.
One hundred and fifty two respondents (aged ≥65, M = 71.9) took part in the
questionnaire study. The MHL Scale, Acceptance in Action Questionnaire-II
(experiential avoidance) and Clinical Outcomes in Routine Evaluation-10 (mental health
status) measured the variables of interest.
Results: The 26 articles describing 23 studies included in the systematic review
described (guided) iCBT, bibliotherapy, self-help, psychoeducation and audio
interventions. The majority of studies were of good quality and reported improvements in
participant’s mental health scores post intervention. Participants were more likely to be
female, aged 60-70 and to have obtained further education. Eight studies reported
obtaining participant satisfaction ratings. Three studies reported collecting data from
both rural and urban areas.
The empirical study found that respondents had good MHL. Half of the respondents
reported being aware of local mental health services for older adults. Older age (r (146)
= -.32, p < .001) and lower educational attainment (F (1,145) = 5.34, p = .020) were
associated with poorer MHL in our sample. MHL was not significantly correlated with
mental health problem severity or experiential avoidance. Self-reported willingness to
use mental health services was associated with lower experiential avoidance (ρ (146) =
-.266, p = .001), better mental health (ρ (146) = -.193, p = .018) and better MHL (ρ (146)
= .467, p ≤ .001). However, the single-item measure of willingness to use mental health
services was unreliable due to its significant negative skew and narrow range of data
points. Those who had used mental health services had higher MHL, higher experiential
avoidance and poorer mental health than those who had not.
Conclusions: The findings from the systematic review provide tentative evidence to
support the use of guided, low-intensity psychological interventions for mild-to-moderate
mental health problems in older adults. Guided iCBT and bibliotherapy may be beneficial
for older adults in their 60s and 70s experiencing mild-to-moderate levels of depression.
iCBT may also be beneficial for reducing symptoms of mild-to-moderate anxiety.
Providing the option of low-intensity psychological intervention, particularly iCBT, may
help to increase participant engagement with treatment. Given difficulties in mental
health service accessibility (both face-to-face and online) for those living in rural areas,
future research should strive to specify whether participants are from rural or urban
areas and explore any differences in outcomes. Improving rural-dwelling, older adults’
MHL and their awareness of locally available services and supports may help to
increase their willingness to seek mental health support.||en