RPF 14/15 Mental health literacy, depression and older people: An exploratory study

Project: Other internal award

Project participant(s)

Department / unit(s)



This is a 3-linked phase mixed methods study. We recruited four volunteers >65 years to ensure that study methods and materials (e.g. interview questions) are appropriate to this population group.

Phase 1. Postal questionnaire

PARTICIPANTS: We recruited participants from the CASPER cohort. The people in this cohort are older adults (≥65 years) who have been assessed for depressive symptoms and were assessed as non-depressed. They have previously agreed to be contacted about mental health studies. Based on similar cohort studies, we anticipated a response rate around 50%. We sent out 722 questionnaires achieving a sample of 376 participants (52%).

DATA COLLECTION: We sent a questionnaire pack (cover letter, information sheet, questionnaire, freepost envelope). The questionnaire booklet comprised two Mental Health Literacy (MHL) measures and a measure of Health Literacy (HL). The MHL measures were a vignette to assess recognition of, and attitudes towards depression and interventions for depression [1] and questions exploring where to seek mental health information and attitudes towards mental health. [2] The measure of HL used was the Health Literacy Questionnaire (HLQ). [3] Participants indicated at the end of the questionnaire if they were willing to be contacted to participate in Phase 2.

DATA ANALYSIS: The data are currently being entered. Next, descriptive statistics will explore MHL scores. Men and women differ in their HL levels and HL declines with age. [4, 5] We will, therefore, compare MHL by gender and age (>65, >75) as well as non-depressed/at risk. We will also record completion rates of the measures to assess feasibility of using these tools with this population.

Phase 2. Interviews (in progress)
Older people: We have re-contacted 16 Phase 1 participants to be interviewed, achieving a mix of males, females, ≥65s, ≥75s. This maximum variation sampling approach facilitates collection of diverse views even within this small sample. [6]

Primary care health professionals: We have also recruited 5 primary care health professionals (GPs and nurses) from two GP practices participating in the CASPER study.

DATA COLLECTION: Semi-structured interviews are underway (n=9 completed to date). These explore the views of older adults about MHL (specifically the recognition of depressive symptoms, management and prevention of depression including help-seeking behaviour and access to mental health service). Health professionals are asked about their experiences of working with older adults in the context of MHL. Older adults are also asked to reflect on the MHL measures in the questionnaire (e.g. ease of completion). Interviews with older people are conducted face-to-face, interviews with health professionals are done face-to-face/telephone. All interviews are audio-recorded digitally and transcribed verbatim.

DATA ANALYSIS: Data from older people and health professionals will be analysed independently (synthesised in Phase 3) using the six phases of thematic analysis. [7] ATLAS-ti software will aid data handling. This will occur in August 2015.

Phase 3: Synthesis
Synthesis of the interview findings with the questionnaire data will be done using a “triangulation protocol”, [8] the data having previously been analysed independently. A matrix will be created to display both quantitative and qualitative findings namely MHL levels, feasibility of measurement and views about MHL. This will occur in September 2015.

1. Reavley NJ, Morgan AJ, Jorm AF. Development of scales to assess mental health literacy relating to recognition of and interventions for depression, anxiety disorders and schizophrenia/psychosis. The Australian and New Zealand journal of Psychiatry 2014;48(1):61-9
2. O'Connor, M., & Casey, L. The Mental Health Literacy Scale (MHLS): A new scale-based measure of mental health literacy. 2015 (Manuscript submitted for publication)
3. Osborne, RH, Batterham, RW, Elsworth, GR et al. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health 2013; 13: 658
4. Kobayashi, L., Wardle, J., Wolf, M.S., and von Wagner, C. Systematic review of ageing and health literacy. Proceedings of the Health Literacy: Healthy Living conference 29 June 2014, Keele University, Keele.
5. Doyle, G., Cafferkey, K. and Fullam, J. The European Health Literacy Survey: Results from Ireland. Dublin , Ireland : University College Dublin. 2012.
6. Patton M.Q. Qualitative evaluation and Research Methods. 2nd ed. Newbury Park, California: Sage; 1990.
7. Braun V. and Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006;3(2):77-101.
8. Farmer T., Robinson K., Elliott S.J. and Eyles J. Developing and implementing a triangulation protocol for qualitative health research. Qualitative health research 2006; 16(3): 377-94.

Layman's description

Mental health literacy (MHL) is “knowledge and beliefs about mental disorders which aid their recognition, management or prevention”. [9] Depression affects many older adults however it is under-recognised and under-treated. Improving MHL can improve recognition of depressive symptoms, increase help-seeking behaviour and access to mental health services. Little UK research has been done on MHL and older people.
We will measure levels of MHL in 350-400 older people and then interview up to 16 older people as well as 10 primary care health professionals to further understand MHL in this population. The findings will inform an application for a PhD fellowship.

9. Jorm, A.F. Mental health literacy: Public knowledge and beliefs about mental disorders. British Journal of Psychiatry 2000; 177, 396-401.

Key findings

Phase 1: 722 questionnaire packs were mailed out and 376 completed questionnaires were received (52% response rate).
Phase 2: Interviews are currently being undertaken. Data entry and analysis is ongoing and will be completed in September 2015.
Effective start/end date1/08/1431/07/15

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