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Exploring older adults’ experiences seeking psychological services using the network episode model

Published online by Cambridge University Press:  22 June 2020

Brooke E. Beatie Open the ORCID record for Brooke E. Beatie [Opens in a new window] ,
Corey S. Mackenzie ,
Genevieve Thompson ,
Lesley Koven ,
Tyler Eschenwecker  and
John R. Walker
Brooke E. Beatie*
Affiliation:
Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
Corey S. Mackenzie
Affiliation:
Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
Genevieve Thompson
Affiliation:
College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
Lesley Koven
Affiliation:
Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
Tyler Eschenwecker
Affiliation:
Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
John R. Walker
Affiliation:
Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
*
*Corresponding author. Email: umbeatie@myumanitoba.ca
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Abstract

Older adults’ mental health problems are a growing public health concern, especially because their rate of mental health service use is particularly low. Decades of mental health service utilisation models have been developed, yet key assumptions from these models focus primarily on factors that facilitate or inhibit access into the treatment system without taking into considering the dynamics of how individuals respond to their mental health problems and engage in service utilisation. More recently, dynamic models like the Network Episode Model (NEM-II) have been developed to challenge the underlying, rational choice assumption of traditional utilisation models. Given the multifaceted and complex nature of older adults’ mental health problems, the objective of this study was to examine whether the NEM-II is a helpful and appropriate model for understanding the dynamic process of how older adults navigate the mental health system, including factors that advanced and delayed help-seeking. Our qualitative analyses from 15 interviews with older adults revealed that their backgrounds, social supports and treatment systems influence, and are influenced by, their illness careers. Factors that delayed help-seeking included: a lack of support, ‘inappropriate’ referrals/advice from treatment professionals and poor mental health literacy. This research suggests the NEM-II is a helpful and appropriate theory for understanding older adults’ pathways to treatment, and has implications to enhance older adults’ access to psychological services.

Keywords

mental healtholder adultsservice utilisationNetwork Episode Modelillness career
Type
Article
Information
Ageing & Society , Volume 42 , Issue 1 , January 2022 , pp. 48 - 71
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Alvidrez, J and Areán, PA (2002) Physician willingness to refer older depressed patients for psychotherapy. International Journal of Psychiatry in Medicine 32, 21–35.10.2190/J26T-YQMJ-BF83-M05DCrossRefGoogle ScholarPubMed
Andersen, RM (1995) Revisiting the behavioral model and access to care: does it matter? Journal of Health and Social Behavior 36, 1–10.10.2307/2137284CrossRefGoogle ScholarPubMed
Bartels, SJ and Drake, RE (2005) Evidence-based geriatric psychiatry: an overview. Psychiatric Clinics of North America 28, 763–784.CrossRefGoogle ScholarPubMed
Bartels, SJ and Naslund, JA (2013) The underside of the silver tsunami – older adults and mental health care. New England Journal of Medicine 368, 493–496.10.1056/NEJMp1211456CrossRefGoogle ScholarPubMed
Bartels, SJ, Coakley, EH, Zubritsky, C, Ware, JH, Miles, KM, Areán, PA, Chen, H, Oslin, DW, Llorente, MD, Costantino, G, Quijano, L, McIntyre, JS, Linkins, KW, Oxman, TE, Maxwell, J and Levkoff, SE (2004) Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. American Journal of Psychiatry 161, 1455–1462.10.1176/appi.ajp.161.8.1455CrossRefGoogle ScholarPubMed
Burroughs, H, Lovell, K, Morley, M, Baldwin, R, Burns, A and Chew-Graham, C (2006) ‘Justifiable depression’: how primary care professionals and patients view late-life depression. A qualitative study. Family Practice 23, 369–377.10.1093/fampra/cmi115CrossRefGoogle ScholarPubMed
Butler-Jones, D (2010) The Chief Public Health Officer's Report on the State of Public Health in Canada: Growing Older – Adding Life to Years. Public Health Agency of Canada. Available at https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/cphorsphc-respcacsp/2010/fr-rc/pdf/cpho_report_2010_e.pdf.Google Scholar
Byers, AL, Arean, PA and Yaffe, K (2012) Low use of mental health services among older Americans with mood and anxiety disorders. Psychiatric Services 63, 66–72.10.1176/appi.ps.201100121CrossRefGoogle ScholarPubMed
Cairney, J, Corna, LM and Streiner, DL (2010) Mental health care use in later life: results from a national survey of Canadians. Canadian Journal of Psychiatry 55, 157–164.10.1177/070674371005500307CrossRefGoogle ScholarPubMed
Choi, S, Morrow-Howell, N and Proctor, E (2006) Configuration of services used by depressed older adults. Aging & Mental Health 10, 240–249.10.1080/13607860500310591CrossRefGoogle ScholarPubMed
Creswell, JW (2014) Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, 4th Edn. Los Angeles, CA: Sage.Google Scholar
Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, Angermeyer, MC, Bernet, S, de Girolamo, G, Morosini, P, Polidori, G, Kikkawa, T, Kawakami, N, Ono, Y, Takeshima, T, Uda, H, Karam, EG, Fayyad, JA, Karam, AM, Mneimneh, ZN, Medina-Mora, ME, Borges, G, Lara, C, de Graaf, R, Ormel, J, Gureje, O, Shen, YC, Huang, YQ, Zhang, MY, Alonso, J, Haro, JM, Vilagut, G, Bromet, EJ, Gluzman, S, Webb, C, Kessler, RC, Merikangas, KR, Anthony, JC, Von Korff, MR, Wang, PS, Brugha, TS, Aguilar-Gaxiola, S, Lee, S, Heeringa, S, Pennell, BE, Zaslavsky, AM, Ustun, TB and Chatterji, S (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization world mental health surveys. JAMA: The Journal of the American Medical Association 291, 2581–2590.Google ScholarPubMed
El-Gabalawy, R, Mackenzie, CS, Shooshtari, S and Sareen, J (2011) Comorbid physical health conditions and anxiety disorders: a population-based exploration of prevalence and health outcomes among older adults. General Hospital Psychiatry 33, 556–564.CrossRefGoogle ScholarPubMed
Farrer, L, Leach, L, Griffiths, KM, Christensen, H and Jorm, AF (2008) Age differences in mental health literacy. BMC Public Health 8, 125.10.1186/1471-2458-8-125CrossRefGoogle ScholarPubMed
Fisher, LJ and Goldney, RD (2003) Differences in community mental health literacy in older and younger Australians. International Journal of Geriatric Psychiatry 18, 33–40.10.1002/gps.769CrossRefGoogle ScholarPubMed
Ghesquiere, A (2013) ‘I was just trying to stick it out until I realized that I couldn't’: a phenomenological investigation of support seeking among older adults with complicated grief. Omega: Journal of Death and Dying 68, 1–22.Google Scholar
Goldsmith, HF, Jackson, DJ and Hough, R (1988) Process model of seeking mental health services: proposed framework for organizing the research literature on help-seeking. In Goldsmith, HF, Lin, E, Bell, RA and Jackson, D (eds), Needs Assessment: Its Future. Washington, DC: Government Printing Office, pp. 49–64.Google Scholar
Gum, AM, Areán, PA, Hunkeler, E, Tang, L, Katon, W, Hitchcock, P, Steffens, DC, Dickens, J and Unützer, J (2006) Depression treatment preferences in older primary care patients. The Gerontologist 46, 14–22.10.1093/geront/46.1.14CrossRefGoogle ScholarPubMed
Jorm, AF (2012) Mental health literacy: empowering the community to take action for better mental health. American Psychologist 67, 231–243.10.1037/a0025957CrossRefGoogle ScholarPubMed
Jorm, AF, Korten, AE, Jacomb, PA, Christensen, H, Rodgers, B and Pollitt, P (1997) Mental health literacy: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia 166, 182–186.CrossRefGoogle ScholarPubMed
Kantor, V, Knefel, M and Lueger-Schuster, B (2017) Perceived barriers and facilitators of mental health service utilization in adult trauma survivors: a systematic review. Clinical Psychology Review 52, 52–68.10.1016/j.cpr.2016.12.001CrossRefGoogle ScholarPubMed
Karel, MJ, Gatz, M and Smyer, MA (2012) Aging and mental health in the decade ahead: what psychologists need to know. American Psychologist 67, 184–198.10.1037/a0025393CrossRefGoogle ScholarPubMed
Kessler, RC, Barker, PR, Colpe, LJ, Epstein, JF, Gfroerer, JC, Hiripi, E, Howes, MJ, Normand, ST, Manderscheid, RW, Walters, EE and Zaslavsky, AM (2003) Screening for serious mental illness in the general population. Archives of General Psychiatry 60, 184–189.10.1001/archpsyc.60.2.184CrossRefGoogle ScholarPubMed
Kinsella, K and He, W (2009) An Aging World: 2008: International Population Reports. Washington, DC: US Government Printing Office.Google Scholar
Klap, R, Unroe, KT and Unützer, J (2003) Caring for mental illness in the United States: a focus on older adults. American Journal of Geriatric Psychiatry 11, 517–524.10.1097/00019442-200309000-00006CrossRefGoogle ScholarPubMed
Lawrence, V, Banerjee, S, Bhugra, D, Sangha, K, Turner, S and Murray, J (2006) Coping with depression in later life: a qualitative study of help-seeking in three ethnic groups. Psychological Medicine 36, 1375–1383.10.1017/S0033291706008117CrossRefGoogle ScholarPubMed
Lincoln, YS, Lynham, SA and Guba, EG (2011) Paradigmatic controversies, contradictions, and emerging confluences revisited. In Denzin, NK and Lincoln, YS (eds), The Sage Handbook of Qualitative Research, 4th Edn. Thousand Oaks, CA: Sage, pp. 97–128.Google Scholar
Lippens, T and Mackenzie, CS (2011) Treatment satisfaction, perceived treatment effectiveness, and dropout among older users of mental health services. Journal of Clinical Psychology 67, 1197–1209.10.1002/jclp.20842CrossRefGoogle ScholarPubMed
Lyness, JM, Kim, J, Tu, X, Conwell, Y, King, DA and Caine, ED (2007) The clinical significance of subsyndromal depression in older primary care patients. American Journal of Geriatric Psychiatry 15, 214–223.10.1097/01.JGP.0000235763.50230.83CrossRefGoogle ScholarPubMed
Mackenzie, CS, Gekoski, WL and Knox, VJ (1999) Do family physicians treat older patients with mental disorders differently from younger patients? Canadian Family Physician 45, 1219–1224.Google ScholarPubMed
Mackenzie, CS, Pagura, J and Sareen, J (2010) Correlates of perceived need for and use of mental health services by older adults in the collaborative psychiatric epidemiology surveys. American Journal Geriatric Psychiatry 18, 1103–1115.10.1097/JGP.0b013e3181dd1c06CrossRefGoogle ScholarPubMed
Mackenzie, CS, Heath, PJ, Vogel, DL and Chekay, R (2019) Age differences in public stigma, self-stigma, and attitudes toward seeking help: a moderated mediation model. Journal of Clinical Psychology 75, 2259–2272.CrossRefGoogle ScholarPubMed
Maddux, JE and DuCharme, KA (1997) Behavioral intentions in theories of health behavior. In Gochman, DS (ed.), Handbook of Health Behavior Research I: Personal and Social Determinants. New York, NY: Plenum Press, pp. 133–152.Google Scholar
Mays, N and Pope, C (2000) Qualitative research in health care: assessing quality in qualitative research. British Medical Journal 320, 50–52.CrossRefGoogle ScholarPubMed
Mental Health Foundation (2016) What are mental health problems? Available at https://www.mentalhealth.org.uk/your-mental-health/about-mental-health/what-are-mental-health-problems.Google Scholar
Mosier, KE, Vasiliadis, H, Lepnurm, M, Puchala, C, Pekrul, C and Ternpier, R (2010) Prevalence of mental disorders and service utilization in seniors: results from the Canadian community health survey cycle 1.2. International Journal of Geriatric Psychiatry 25, 960–967.CrossRefGoogle ScholarPubMed
Moye, J, Karel, MJ, Stamm, KE, Qualls, SH, Segal, DL, Tazeau, YN and DiGilio, DA (2019) Workforce analysis of psychological practice with older adults: growing crisis requires urgent action. Training and Education in Professional Psychology 13, 46–55.CrossRefGoogle ScholarPubMed
O'Reilly, M and Parker, N (2013) ‘Unsatisfactory saturation’: a critical exploration of the notion of saturated sample sizes in qualitative research. Qualitative Research 13, 190–197.CrossRefGoogle Scholar
Parsons, T (1951) The Social System. Glencoe, IL: Free Press.Google Scholar
Payne, KA and Myhr, G (2010) Increasing access to cognitive-behavioural therapy (CBT) for the treatment of mental illness in Canada: a research framework and call for action. Healthcare Policy 5, 173–185.Google ScholarPubMed
Pepin, R, Segal, DL, Klebe, KJ, Coolidge, FL, Krakowiak, KM and Bartels, SJ (2015) The barriers to mental health services scale revised: psychometric analysis among older adults. Mental Health & Prevention 3, 178–184.10.1016/j.mhp.2015.09.001CrossRefGoogle ScholarPubMed
Perrucci, R and Targ, DB (1982) Network structure and reactions to primary deviance of mental patients. Journal of Health and Social Behavior 23, 2–17.10.2307/2136385CrossRefGoogle ScholarPubMed
Pescosolido, BA (1991) Illness careers and network ties: a conceptual model of utilization and compliance. Advances in Medical Sociology 2, 164–181.Google Scholar
Pescosolido, BA (1992) Beyond rational choice: the social dynamics of how people seek help. American Journal of Sociology 97, 1096–1138.10.1086/229863CrossRefGoogle Scholar
Pescosolido, BA (2011) Organizing the sociological landscape for the next decades of health and health care research: the network episode model III-R as cartographic subfield guide. In Pescosolido, BA, Martin, JK, McLeod, JD and Rogers, A (eds), Handbook of the Sociology of Health, Illness, and Healing. New York, NY: Springer, pp. 39–66.10.1007/978-1-4419-7261-3_3CrossRefGoogle Scholar
Pescosolido, BA and Boyer, CA (1999) How do people come to use mental health services? Current knowledge and changing perspectives. In Horwitz, AV and Sheid, TL (eds), A Handbook for the Study of Mental Health: Social Contexts, Theories and Systems. New York, NY: Cambridge University Press, pp. 392–411.Google Scholar
Pescosolido, BA and Boyer, CA (2010) Understanding the context and dynamic social processes of mental health treatment. In Sheid, TL and Brown, TN (eds), A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems, 2nd Edn. New York, NY: Cambridge University Press, pp. 420–438.Google Scholar
Pescosolido, BA, Boyer, CA and Medina, TR (2013) The social dynamics of responding to mental health problems. In Aneshensel, CS, Phelan, JC and Bierman, A (eds), Handbook of the Sociology of Mental Health. New York, NY: Springer, pp. 505–524.CrossRefGoogle Scholar
Pope, C, Ziebland, S and Mays, N (2000) Qualitative research in health care. Analysing qualitative data. British Medical Journal 320, 114–116.Google ScholarPubMed
Ritchie, J and Spencer, L (2002) Qualitative data analysis for applied policy research. In Huberman, AM and Miles, MB (eds), The Qualitative Researcher's Companion. Thousand Oaks, CA: Sage, pp. 305–329.Google Scholar
Romanow, RJ and Marchildon, GP (2003) Psychological services and the future of health care in Canada. Canadian Psychology 44, 283–295.10.1037/h0086954CrossRefGoogle Scholar
Schellander, R and Donnerer, J (2009) Antidepressants: clinically relevant drug interactions to be considered. Pharmacology 86, 203–215.CrossRefGoogle Scholar
Scott, KM, Von Korff, M, Alonso, J, Angermeyer, M, Bromet, EJ, Bruffaerts, R, de Girolamo, G, de Graaf, R, Fernandez, A, Gureje, O, He, Y, Kessler, RC, Kovess, V, Levinson, D, Medina-Mora, ME, Mneimneh, Z, Oakley Browne, MA, Posada-Villa, J, Tachimori, H and Williams, D (2008) Age patterns in the prevalence of DSM-IV depressive/anxiety disorders with and without physical co-morbidity. Psychological Medicine 38, 1659–1669.10.1017/S0033291708003413CrossRefGoogle ScholarPubMed
Sherbourne, CD (1988) The role of social support and life stress events in use of mental health services. Social Science & Medicine 27, 1393–1400.CrossRefGoogle ScholarPubMed
Strecher, VJ, Champion, VL and Rosenstock, IM (1997) The health belief model and health behavior. In Gochman, DS (ed.), The Handbook of Health Behavior Research I: Personal and Social Determinants. New York, NY: Plenum Press, pp. 71–92.Google Scholar
Thorne, S, Kirkham, SR and O'Flynn-Magee, K (2008) The analytic challenge in interpretive description. International Journal of Qualitative Methods 3, 1–11.10.1177/160940690400300101CrossRefGoogle Scholar
Vieweg, WVR, Wood, MA, Fernandez, A, Beatty-Brooks, M, Hasnain, M and Pandurangi, AK (2009) Proarrhythmic risk with antipsychotic and antidepressant drugs. Drugs & Aging 26, 997–1012.CrossRefGoogle ScholarPubMed
Vogel, DL, Wade, NG and Haake, S (2006 a) Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology 53, 325–337.CrossRefGoogle Scholar
Vogel, DL, Wester, SR, Larson, LM and Wade, NG (2006 b) An information-processing model of the decision to seek professional help. Professional Psychology: Research and Practice 37, 398–406.10.1037/0735-7028.37.4.398CrossRefGoogle Scholar
Volkert, J, Andreas, S, Härter, M, Dehoust, MC, Sehner, S, Suling, A, Ausín, B, Canuto, A, Crawford, MJ, Da Ronch, C, Grassi, L, Hershkovitz, Y, Muñoz, M, Quirk, A, Rotenstein, O, Santos-Olmo, AB, Shalev, AY, Strehle, J, Weber, K, Wegscheider, K, Wittchen, H and Schulz, H (2018) Predisposing, enabling, and need factors of service utilization in the elderly with mental health problems. International Psychogeriatrics 30, 1027–1037.10.1017/S1041610217002526CrossRefGoogle ScholarPubMed
Wang, PS, Aguilar-Gaxiola, S, Alonso, J, Angermeyer, MC, Borges, G, Bromet, EJ, Bruffaerts, R, de Girolamo, G, de Graaf, R, Gureje, O, Haro, JM, Karam, EG, Kessler, RC, Kovess, V, Lane, M, Lee, S, Levinson, D, Ono, Y, Petukhova, M, Posada-Villa, J, Seedat, S and Wells, JE (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. The Lancet 370, 841–850.CrossRefGoogle ScholarPubMed
Wetherell, JL, Kaplan, RM, Kallenberg, G, Dresselhaus, TR, Sieber, WJ and Lang, AJ (2004) Mental health treatment preference of older and younger primary care patients. International Journal of Psychiatry in Medicine 34, 219–233.CrossRefGoogle Scholar
Wetherell, JL, Petkus, AJ, McChesney, K, Stein, MB, Judd, PH, Rockwell, E, Sewell, DD and Patterson, TL (2009) Older adults are less accurate than younger adults at identifying symptoms of anxiety and depression. Journal of Nervous and Mental Disease 197, 623–626.10.1097/NMD.0b013e3181b0c081CrossRefGoogle ScholarPubMed
White, MM, Clough, BA and Casey, LM (2018) What do help-seeking measures assess? Building a conceptualization framework for help-seeking intentions through a systematic review of measure content. Clinical Psychology Review 59, 61–77.10.1016/j.cpr.2017.11.001CrossRefGoogle ScholarPubMed
Whiteford, HA, Degenhardt, L, Rehm, J, Baxter, AJ, Ferrari, AJ, Erskine, HE, Charlson, FJ, Norman, RE, Flaxman, AD, Johns, N, Burstein, R, Murray, CJL and Vos, T (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet 382, 1575–1586.CrossRefGoogle ScholarPubMed
Woodward, AT, Taylor, RJ, Bullard, KM, Neighbors, HW, Chatters, LM and Jackson, JS (2008) Use of professional and informal support by African Americans and Caribbean blacks with mental disorders. Psychiatric Services 59, 1292–1298.10.1176/ps.2008.59.11.1292CrossRefGoogle ScholarPubMed
World Health Organization (2015) World Report on Ageing and Health. Geneva: World Health Organization.Google Scholar
Wuthrich, VM and Frei, J (2015) Barriers to treatment for older adults seeking psychological therapy. International Psychogeriatrics 27, 1227–1236.CrossRefGoogle ScholarPubMed