(WITHDRAWN) A Scoping Review of Help Seeking Behaviors Among Middle to Old Age Adults with Suicide Ideation

Background and Purpose: Suicide is a major public health concern in many countries (Dey & Jorm, 2016). In the United States, the suicide rate has risen by 35% from 10.5 per 100,000 in 1999, to 14.2 in 2018 (CDC, 2020). While suicide is an outcome experienced across the age spectrum, suicide rate is highest among people in late middle age and in the oldest old (Arbore, 2019). Despite of these distressing numbers, evidence suggests that help-seeking for suicidality is low, with 55% of people who complete suicide having no contact with a primary care provider in the month before suicide and 68% having no contact with mental health services in the year before suicide (Calear, Batterham, & Christensen, 2014). However, very little research has been conducted on the process of help-seeking for suicide, and even less on individuals who are specifically middle and older aged adults. In light of the knowledge gap, this study aims to, through a scoping review, summarize the existing literature exploring and identifying help seeking behaviors, aid in understanding of the patterns and correlates of help-seeking behaviors, and suggest areas for further research to improve interventions for middle and old age adults with suicidal ideations.

Methods: This scoping review was conducted following the Arksey & O’Malley six-stage framework, including identifying research question, identifying relevant studies, study selection, charting data, summarizing and reporting data, and consultation (Arksey & O’Malley, 2005). A search of seven electronic databases, and manual review of reference lists and key suicide- and gerontology-focused journals was conducted. Articles were reviewed independently by two researchers to screen for eligibility based on title, abstract, and full-text. Results from the included studies were summarized qualitatively.

Results: A total of 4,394 articles were retrieved during the initial search, of which 43 articles were screened at full-text. A total of 25 articles were selected for analysis. To address the first research question, patterns of help-seeking behaviors (e.g. use of specialized care and alternative pathways of care) were identified and discussed. The review further identified the promoting factors (e.g. mental health literacy and safety planning) and barriers (e.g. stigma, attitude, shame, help negation, and access to help) to the use of help-seeking behaviors among middle and old age adults with suicidal ideations from the included studies.

Conclusions and Implications: This review provides a mapping of existing literature on the patterns and correlates of suicide help-seeking behaviors. Future research directions and practice implications were discussed to better understand and address this critical issue among the vulnerable population.