Mental Health Disparities and Trauma across the Lifespan: A Mixed Methods Approach to Understanding Treatment Attitudes Among Urban Dwelling Middle and Older Aged Adult Trauma Survivors

Background and Purpose: Trauma exposed older adults in public care systems are often less likely than younger populations to seek out and receive mental health services when in need.  There is a need for research on how to support individuals entering late life in managing distress associated with trauma across the lifespan to increase positive coping and service use. This study uses a mixed-methods approach to examine attitudes towards mental health in managing psychological distress and service use among a racially/ethnically diverse community-based sample of trauma exposed middle-aged and older adults (50-years and older).

Methods: Cross-sectional data collected from a community mental health agency was analyzed that included 165 older adults ages 50 to 78 years (M = 56.3, S.D. = 5.53).  Semi-structured in-depth qualitative interviews were also conducted in English with a sub-sample recruited from the collected agency data (n=15) to understand complexities in seeking treatment and managing trauma related distress with increased age.  Quantitative analysis examined direct effects of trauma history and symptoms, functioning (Sheehan Disability Scale (SDS) and Brief Symptom Inventory), and quality of life (QOL; WHO-QOL BREF) on attitudes towards mental health treatment (Attitudes toward Seeking Professional Psychological Help-Short Form scale) using hierarchical linear regression.  Study investigators conducted qualitative data analysis rooted in grounded theory using interview data transcribed verbatim and coded thematically with NVivo qualitative software.

Results: Regression analysis revealed identification as non-Hispanic White (t= -2.50, p=.014, β=0.058) and QOL domains of increased psychological (t=2.04, p=.045, β=.225) and environmental well-being (t=3.81, p=.000, β=.453) as associated with improved attitudes about mental health treatment. Reporting higher QOL relating to social relationships (t= -2.22, p=.029, β=-.256) was associated with lower attitudes towards mental health treatment.  Themes emerged from the qualitative interview data relating to age related differences in perceptions about seeking services.  Respondents compared the impact of their lifelong traumas noting increased difficulty with the ability to work, maintain healthy personal relationships, and engaging in services with increased age.  Stigma as a barrier to seeking care to manage mental health needs was highly reported as relevant for older populations, especially around decisions to delay treatment seeking.  Participant recommendations for services included community education to combat stigma and multi-level therapeutic interventions that account for the functional daily care needs of older adults. Aligned with the quantitative findings (QOL-environment), safety and financial well-being were prioritized in managing mental health. 

Conclusion and Implications: Emphasizing resources to help manage the impact of psychological distress on independent activities of daily living is essential to this trauma-exposed population as they age. Enhancing capacity to provide self-care should align with individual treatment priorities and intervention strategies. Profiling such factors in the care experience can influence the degree individuals engage and remain in treatment.  Understanding the role of reported social supports is also import to account for preferences in managing trauma related distress with peer based models or formal clinical treatment for those least likely to seek services independently as needs increase with age.