Attitudes towards ageing and quality of life among older adults with depression and anxiety

Objectives: The thesis aims to synthesise studies on depression and attitudes towards ageing among older adults. Secondly, it aims to bridge the gap in the current literature by examining attitudes towards ageing and quality of life among older adults with late life anxiety. Design: The thesis is presented as a portfolio and includes: a systematic review on depression and attitudes towards ageing among older adults, a bridging chapter, an empirical paper examining attitudes towards ageing and quality of life among older adults with clinical anxiety compared to a non-clinical sample of older adults, an extended methodology chapter, an additional results chapter, and an overall discussion and critical evaluation chapter. Results: The systematic review synthesised the research on attitudes towards ageing and depression among older adults; it indicated that there is strong evidence that older adults who have depression, or more depressive symptoms, are more likely to have negative attitudes towards ageing. The empirical paper showed that older adults with clinical anxiety accessing mental health services have more negative attitudes towards ageing and a poorer quality of life compared to those older adults from a non-clinical setting, however, clinical anxiety was not a unique contributor of attitudes towards ageing and quality of life. Conclusions: Older adults who experience depression or anxiety are more likely to have negative attitudes towards ageing. Moreover, quality of life is poorer among those older adults within mental health settings who experience anxiety compared to those in the community. This thesis has clinical implications for the assessment and treatment of late life anxiety and depression among older adults. Findings have highlighted the need for future research in this area to concentrate on using clinical populations and longitudinal designs

The effect of a youth mental health service model on access to secondary mental healthcare for young people aged 14–25 years

Aims and method: The Norfolk Youth Service was created in 2012 in response to calls to redesign mental health services to better meet the needs of young people. The new service model transcends traditional boundaries by creating a single, ‘youth friendly’ service for young people aged 14–25 years. The aim of this study was to investigate the effect of the transition to this new model on patterns of referral, acceptance and service use. We analysed routinely collected data on young people aged 14–25 years referred for secondary mental healthcare in Norfolk before and after implementation of the youth mental health service. The number of referrals, their age and gender, proportion of referrals accepted and average number of service contacts per referral by age pre- and post-implementation were compared. Results: Referrals increased by 68% following implementation of the new service model, but the proportion of referrals accepted fell by 27 percentage points. Before implementation of the youth service, there was a clear discrepancy between the peak age of referral and the age of those seen by services. Following implementation, service contacts were more equitable across ages, with no marked discontinuity at age 18 years. Clinical implications: Our findings suggest that the transformation of services may have succeeded in reducing the ‘cliff edge’ in access to mental health services at the transition to adulthood. However, the sharp rise in referrals and reduction in the proportion of referrals accepted highlights the importance of considering possible unintended consequences of new service models. Declaration of interests: None