Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-23T06:01:23.877Z Has data issue: false hasContentIssue false
  • English
  • Français

Barriers to treatment for older adults seeking psychological therapy

Published online by Cambridge University Press:  05 March 2015

Viviana M. Wuthrich Open the ORCID record for Viviana M. Wuthrich [Opens in a new window]  and
Jacqueline Frei
Viviana M. Wuthrich*
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
Jacqueline Frei
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
*
Correspondence should be addressed to: Viviana Wuthrich, Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia. Phone: +61-2-9850-4866; Fax: +61-2-9850-8062. Email: Viviana.Wuthrich@mq.edu.au.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Older adults with mental health disorders underutilize mental health services more than other adults. While there are well known general barriers to help seeking across the population, specific barriers for older adults include difficulties with transportation, beliefs that it is normal to be anxious and depressed in old age, and beliefs by referrers that psychological therapy is less likely to be effective. This study examined barriers related to identifying the need for help, seeking help and participating in therapy in a clinical population of older adults.

Method: Sixty older adults (aged 60–79 years) with comorbid anxiety and unipolar mood disorders completed barriers to treatment questionnaires before and after psychological group treatment, as well as measures of cognitive ability, anxiety, depression, and quality of life at baseline.

Results: The greatest barriers to help seeking related to difficulties identifying the need for help, with 50% of the sample reporting their belief that their symptoms were normal as a major barrier. Other major barriers identified were related to: self-reliance, cost of treatment, and fear of medication replicating previous findings. The main barriers reported for difficulties in continuing therapy included not finding therapy helpful, cost of treatment, and thinking that the therapist did not understand their issues.

Conclusions: The main barriers identified related to issues with identifying the need to seek help. More attention is needed to educate older adults and professionals about the need for, and effectiveness of, psychological therapies for older adults with anxiety and depression to reduce this barrier to help seeking.

Keywords

barriers to treatmentpsychological treatmentanxietydepression
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Special Issue 7: Late Life Anxiety , July 2015 , pp. 1227 - 1236
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1995). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Cameron, I. M., Lawton, K. and Reid, I. C. (2011). Recognition and subsequent treatment of patients with sub-threshold symptoms of depression in primary care. Journal of Affective Disorders, 130, 99–105. doi: 10.1016/j.jad.2010.10.010.Google Scholar
Chaplin, R., Farquharson, L., Clapp, M. and Crawford, M. (2015). Comparison of access, outcomes and experiences of older adults and working age adults in psychological therapy. International Journal of Geriatric Psychiatry, 30, 178–184.CrossRefGoogle ScholarPubMed
Christensen, H. et al. (1999). Age differences in depression and anxiety symptoms: a structural equation modelling analysis of data from a general population sample. Psychological Medicine, 29, 325–339. doi: 10.1017/S0033291798008150.Google Scholar
Crabb, R. and Hunsley, J. (2006). Utilization of mental health care services among older adults with depression. Journal of Clinical Psychology, 62, 299–312. doi: 10.1002/jclp.20231.Google Scholar
Cuijpers, P., van Straten, A. and Smit, F. (2006). Psychological treatment of late-life depression: a meta-analysis of randomised controlled trials. International Journal of Geriatric Psychiatry, 21, 1139–1149. doi: 10.1002/gps.1620.CrossRefGoogle Scholar
Currin, J. B., Hayslip, B. Jr, Schneider, L. J. and Kooken, R. A. (1998). Cohort differences in attitudes toward mental health services among older persons. Psychotherapy, 35, 506–518. doi: 10.1037/h0087857.CrossRefGoogle Scholar
Di Nardo, P. A., Brown, T. A. and Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV. Boston: Center for Stress and Anxiety Related Disorders, Boston University.Google Scholar
Gould, R. L., Coulson, M. C. and Howard, R. J. (2012). Efficacy of cognitive behavioral therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials. Journal of the American Geriatrics Society, 60, 218–229. doi: 10.1111/j.1532-5415.2011.03824.x.Google Scholar
Helmes, E. and Gee, S. (2003). Attitudes of Australian therapists toward older clients: educational and training imperatives. Educational Gerontology, 29, 657–670. doi: 10.1080/03601270390225640.CrossRefGoogle Scholar
Henderson, A. S. et al. (1997). The course of depression in the elderly: a longitudinal community-based study in Australia. Psychological Medicine, 27, 119–129. doi: 10.1017/S0033291796004199.CrossRefGoogle ScholarPubMed
Issakidis, C. and Andrews, G. (2002). Service utilisation for anxiety in an Australian community sample. Social Psychiatry and Psychiatric Epidemiology, 37, 153–163.Google Scholar
Johnco, C., Knight, A., Tadic, D. and Wuthrich, V. M. (2014). Psychometric properties of the geriatric anxiety inventory (GAI) and short-form (GAI-SF) in a clinical and non-clinical sample of older adults. International Psychogeriatrics, Published online 11 August 2014, doi: http://dx.doi.org/10.1017/S1041610214001586.Google Scholar
Jongenelis, K. et al. (2005). Diagnostic accuracy of the original 30-item and shortened versions of the geriatric depression scale in nursing home patients. International Journal of Geriatric Psychiatry, 20, 1067–1074. doi: 10.1002/gps.1398.CrossRefGoogle ScholarPubMed
Katon, W. J., Lin, E., Russo, J. and Unutzer, J. (2003). Increased medical costs of a population-based sample of depressed elderly patients. Archives of General Psychiatry, 60, 897–903. doi: 10.1001/archpsyc.60.9.897.Google Scholar
Keiffer, K. M. and Reeses, R. J. (2002). A reliability generalisation study of the geriatric depression scale. Education and Psychological Measurement, 62, 969–994. doi: 10.1177/0013164402238085.CrossRefGoogle Scholar
Mackenzie, C. S., Scott, T., Mather, A. and Sareen, J. (2008). Older Adults’ help-seeking attitudes and treatment beliefs concerning mental health problems. American Journal of Geriatric Psychiatry, 16, 1010–1019. doi: 10.1097/JGP.0b013e31818cd3be.Google Scholar
Mellor, D., Kiehne, M., McCabe, M. P., Davison, T. E., Karantzas, G. and George, K. (2010). An evaluation of the beyondblue depression training program for aged care workers. International Psychogeriatrics, 22, 927–937. doi: 10.1017/S1041610210000153.Google Scholar
Mioshi, E., Dawson, K., Mitchell, J., Arnold, R. and Hodges, J. R. (2006). The addenbrooke's cognitive examination revised (ACE-R): a brief cognitive test battery for dementia screening. International Journal of Geriatric Psychiatry, 21, 1078–1085. doi: 10.1002/gps.1610.Google Scholar
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E. and Arnold, E. (2007). Development and validation of the geriatric anxiety inventory. International Psychogeriatrics, 19, 103–114. doi: 10.1017/S1041610206003504.CrossRefGoogle ScholarPubMed
Pepin, R., Segal, D. L. and Coolidge, F. L. (2009). Intrinsic and extrinsic barriers to mental health care among community-dwelling younger and older adults. Aging & Mental Health, 13, 769–777. doi: 10.1080/13607860902918231.Google Scholar
Prina, A. M., Marioni, R. E., Hammond, G. C., Jones, P. B., Brayne, C. and Dening, T. (2014). Improving access to psychological therapies and older people: findings from the Eastern Region. Behaviour, Research and Therapy, 56, 75–61.Google Scholar
Robb, C., Haley, W. E., Becker, M. A., Polivka, L. A. and Chwa, H.-J. (2003). Attitudes towards mental health care in younger and older adults: similarities and differences. Aging & Mental Health, 7, 142–152. doi: 10.1080/1360786031000072321.Google Scholar
Sarkisian, C. A., Lee-Henderson, M. H. and Mangione, C. M. (2003). Do depressed older adults who attribute depression to “old age” believe it is important to seek care? Journal of General Internal Medicine, 18, 1001–1005. doi: 10.1111/j.1525-1497.2003.30215.x.CrossRefGoogle ScholarPubMed
Sarkisian, C. A., Liu, H. H., Ensrud, K. E., Stone, K. L. and Mangione, C. M. (2001). Correlates of attribution of new disability to “old age.” Journal of the American Geriatrics Society, 49, 134–141. doi: 10.1046/j.1532-5415.2001.49033.x.Google Scholar
Shah, R., McNiece, R. and Majeed, A. (2001). General practice consultation rates for psychiatric disorders in patients aged 65 and over: prospective cohort study. International Journal of Geriatric Psychiatry, 16, 57–63. doi: 10.1002/1099-1166(200101)16:1%3C57::AID-GPS273%3E3.0.CO;2-%23.Google Scholar
Thompson, A., Hunt, C. and Issakidis, C. (2004). Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample. Social Psychiatry and Psychiatric Epidemiology, 39, 810–817.Google Scholar
Uncapher, H. and Arean, P. A. (2000). Physicians are less willing to treat suicidal ideation in older patients. Journal of the American Geriatrics Society, 48, 188–192.Google Scholar
Watts, S. C. et al. (2002). Mental health in older adult recipients of primary care services: is depression the key issue? Identification, treatment and the general practitioner. International Journal of Geriatric Psychiatry, 17, 427–437. doi: 10.1002/gps.632.CrossRefGoogle ScholarPubMed
Wetherell, J. L., Lenze, E. J. and Stanley, M. A. (2005). Evidence-based treatment of geriatric anxiety disorders. Psychiatric Clinics of North America, 28, 871–896. doi: 10.1016/j.psc.2005.09.006.CrossRefGoogle ScholarPubMed
WHOQOL Group. (1995). The World Health Organisation Quality of Life Assessment (WHOQOL): position paper from the World Health Organisation. Social Science & Medicine, 41, 1403. doi: 10.1016/0277-9536(95)00112-K.CrossRefGoogle Scholar
Wuthrich, V. M., Kangas, M., Perini, S. and Rapee, R. (2014). Randomised Controlled Trial Comparing the Effectiveness of Group Cognitive Behavioural Therapy to a Discussion Group in Older Adults with Comorbid Anxiety and Depression. Sydney, Australia: Macquarie University.Google Scholar
Wuthrich, V. M. and Rapee, R. M. (2013). Randomized controlled trial of group cognitive behavioral therapy for comorbid anxiety and depression in older adults. Behaviour Research and Therapy, 51, 779–786. doi: 10.1016/j.brat.2013.09.002.Google Scholar
Yesavage, J. A. et al. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 1, 37–49. doi: 10.1016/0022-3956(82)90033-4.Google Scholar