Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes.

The objectives of this study were to explore age and gender differences in attitudes toward seeking professional psychological help, and to examine whether attitudes negatively influence intentions to seek help among older adults and men, whose mental health needs are underserved. To achieve these objectives 206 community-dwelling adults completed questionnaires measuring help-seeking attitudes, psychiatric symptomatology, prior help-seeking, and intentions to seek help. Older age and female gender were associated with more positive help-seeking attitudes in this sample, although age and gender interacted with marital status and education, and had varying influences on different attitude components. Age and gender also influenced intentions to seek professional psychological help. Women exhibited more favourable intentions to seek help from mental health professionals than men, likely due to their positive attitudes concerning psychological openness. Older adults exhibited more favourable intentions to seek help from primary care physicians than younger adults, a finding that was not explained by age differences in attitudes. Results from this study suggest that negative attitudes related to psychological openness might contribute to men's underutilization of mental health services. Help-seeking attitudes do not appear to be a barrier to seeking professional help among older adults, although their intentions to visit primary care physicians might be. These findings suggest the need for education to improve men's help-seeking attitudes and to enhance older adults' willingness to seek specialty mental health services.

Do family physicians treat older patients with mental disorders differently from younger patients?

OBJECTIVE: To determine whether there are differences between family physicians' beliefs and treatment intentions regarding older patients with mental disorders and younger patients with similar disorders. Such differences might contribute to older adults' lower rates of mental health service use. DESIGN: Mailed survey. SETTING: Primary care practices in and around Kingston, Ont. PARTICIPANTS: Questionnaires were mailed to 294 general practitioners listed in the 42nd Annual Canadian Medical Directory. Of the 285 eligible physicians, 115 (40%) completed and returned questionnaires. MAIN OUTCOME MEASURES: Physicians' ratings of preparedness to identify and treat, likelihood of treating, likelihood of using each of five different treatment methods, likelihood of referral, preferences for six referral options, and treatment effectiveness with respect to hypothetical older and younger patients with panic disorder or dysthymia. RESULTS: Physicians reported being less prepared to identify and treat older patients than younger patients. In addition, physicians reported being significantly less likely to treat and to refer older patients than younger patients. Finally, physicians reported that both psychotherapy alone, and in combination with pharmacotherapy, were less effective for older patients than for younger patients. CONCLUSIONS: In addition to other possible reasons for older adults' low rates of mental health service use, this study suggests that family physicians' beliefs and treatment intentions could be contributing factors. Changes in medical education aimed at replacing inaccurate beliefs with accurate information regarding older patients might be one way to increase rates of use in this underserved age group, because family physicians play a key role in the mental health care of older adults.

The Age Group Evaluation and Description (AGED) Inventory: a new instrument for assessing stereotypes of and attitudes toward age groups.

The AGED Inventory was designed to overcome shortcomings identified in the Aging Semantic Differential, a frequently used measure of how age groups are perceived. The new instrument was developed to allow assessment both of age stereotypes and of attitudes toward age-specified targets. The Inventory was developed with data from 300 male and 300 female respondents. Two seven-item evaluative factors (the Goodness and Positiveness dimensions) resulted from a series of factor analyses used to reduce an initial set of thirty-five evaluative adjective pairs. Two seven-item descriptive factors (the Vitality and Maturity dimensions) resulted from a separate series of factor analyses used to reduce an initial set of fifty adjective pairs judged to differentiate age groups. Using confirmatory factor analyses and coefficients of congruence on data from an additional 800 respondents, the factor structures of the two evaluative factors and of the two descriptive factors were found to be replicable for young, middle-aged, and old targets assessed in either between or within subject designs. Its ease of administration, multidimensionality, flexibility of targets specification, and capability for assessing attitude and/or stereotype in a manner congruent with current conceptualizations of these constructs make the AGED Inventory useful in a variety of contexts.

Confounding as a problem in relating life events to health status in elderly individuals.

Explored two types of confounding relevant to research relating major life events to physical illness in elderly individuals: (a) contamination of life events lists by health-related and subjective items; and (b) failure to control for illness existing prior to the life event assessment period. Community-residing elderly individuals (M = 70.4 years) completed two measures of health status in each of two waves of testing. During the second wave, participants also completed a life events list. Independent judges categorized the life events as health-related or not and further categorized non-health-related events as subjective or objective. Results indicated that life events-illness correlations were influenced by the presence of confounded items and that when illness present prior to the life event assessment period was controlled the relationship between confounded life events and illness decreased. These results underscore the importance of assessing possible sources of confounding when conducting life event illness research with elderly individuals.