Common mental health problems in later life: considering new approaches to meet the challenges of an ageing population
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Provisional Question for the thesis to address: Indicated and selective prevention of common mental health problems in later life: Is there a theoretical rationale for an Acceptance and Commitment Therapy approach? Background The burden of late life depression and anxiety is significant. Even subthreshold symptoms result in great individual, community, economic and societal cost. However, common mental health problems in later life are under‐recognised and under‐treated despite evidence in support of pharmacological and psychological intervention. Previous research regarding psychological therapy for late life mental health problems has been dominated by cognitive behavioural therapy. However, the effectiveness of this approach has been questioned, leading researchers to explore alternative approaches. Acceptance and Commitment Therapy has received increasing attention from researchers keen to explore an alternative and some have argued that this approach is particularly suited to older people. In the context of demographic change and a significant increase in the proportion of community dwelling elderly there is a need to provide evidence to support the use of alternative management strategies for late life mental health problems, for example, focusing on prevention. Methods A systematic review will evaluate the current evidence for the use of ‘indicated’ and ‘selective’ prevention interventions for older people at risk of developing a major depressive or anxiety disorder due to the experience of subsyndromal symptoms or the presence of significant physical, socioeconomic, and psychosocial risk factors. This paper will be followed by an empirical article in which the relationship between psychological processes and ageing will be explored. Specifically, this study will explore psychological flexibility, the use of Selection, Optimisation and Compensation strategies, and the presence of psychopathology in a non clinical sample of community dwelling older people. Results Findings of the systematic review provide preliminary evidence for indicated and selective prevention of late life depression, however there is no clear evidence of benefits of these interventions in late life anxiety. The relationships between variables in the empirical study were explored using descriptive statistics, correlation analysis, and conditional process modelling. Although the study did not find age to be a specific predictor of variance in psychological variables explored, the study did provide empirical support for the potential to use Acceptance and Commitment Therapy with older people. Discussion The systematic review article provided preliminary evidence for the efficacy of selective and indicated prevention interventions for late life depression. However, further research is required to consolidate these findings. The empirical paper found significant relationships between the perception of positive health, reduced psychopathology and theoretical variables including cognitive fusion, engagement in valued living, and the use of Selection, Optimisation, and Compensation strategies. Cognitive fusion was found to mediate these relationships and as such, findings provide support for the use of an Acceptance and Commitment Therapy approach with older people. The theoretical and clinical implications of these findings are discussed in detail.