The Impact of Psychosocial Factors on Experience of Illness and Mental Health Service Use

Mental illness in psychiatry is a world of diseases, symptoms, and treatment. When conducting clinical interventions with older adults who have a mental illness, clinicians strive to provide adequate pharmacologic and psychotherapeutic interventions to alleviate suffering and promote recovery. Yet we are frequently faced with the duel challenges of underutilization of mental health services by older adults and nonadherence to the interventions offered. It is these challenges that spur us to look beyond symptoms and the need for treatments to the broader context of the individual. Psychosocial factors influence whether older adults seek and accept mental health interventions. These factors play a powerful role in adherence to interventions, and ultimately, depression outcomes. Similarly, attitudes and beliefs about mental illness can promote resilience or exacerbate symptoms in a suffering individual. In an overview of the priorities for the National Institute of Mental Health there is evidence of a renewed interest in the individual perspective and the impact of psychosocial factors. The clinical vision offered by National Institute of Mental Health outlines the four “Ps” of medical research; they are prediction, preemption, personalize, and participation (http:// www.nimh.nih.gov/about/strategic-planning-reports/ index.shtml). To personalize research is to highlight “the individual biological, environment, and social factors”. This new emphasis may path the way for greater attention to the personal and psychological perspectives on mental illness. When we consider older persons’ access and use (or lack thereof) of services or treatments, we can view their choices as driven in part by social-psychological factors that either facilitate or hinder quality care. Much is learned about the individual psychological perspective of older adults with depression by conducting research out in community settings. When you speak with older adults outside mental health settings, they openly talk about their reluctance to seek mental health care. They do not perceive the need for treatment, either because they attribute their difficulties to aging or medical illness, or perceive the “cost” of treatment too high. The “cost” goes beyond the finances of health care. It is the anticipated social costs of stigma and isolation. For many of these elders, mental illness is not like pneumonia with symptoms such as shortness of breath that cause distress, are readily identifiable as “abnormal” and precipitate seeking care. Instead, many depressed older persons struggle to get moving, take care of themselves and their families, and manage their day to day affairs (from their perspectives). They do not perceive themselves as suffering from a mental illness (our term). As a natural consequence, these older persons do not see that their difficulties could be ameliorated by seeking and participating in care. Many elders perceive their distress as an intractable part of the aging process. If depression, medical illness, and losses are a normal part of aging, why would one think to seek help? The Anderson Behavioral Model of Health Service Use is an explanatory model for the use of health