Older adults' mental health before and during the COVID-19 pandemic: Evidence paper

Methods

Review of existing evidence

Search strategy

Three main strategies were used to identify relevant evidence. First, several databases^[8] were searched to identify relevant literature using various combinations of search terms (e.g., “older”, “elderly”, “geriatric”, “pensioner”, “later life”, “Scotland”, “Scottish”, “mental”, “lonely”). Further relevant sources were identified by manually searching reference and citation lists of previously identified reports, and by consulting and requesting evidence from stakeholders (e.g., third-sector organisations)^[9]. The evidence searching process was completed in November 2021.

Inclusion criteria

The review includes qualitative and quantitative evidence. The following criteria were applied to guide the inclusion of evidence in the review:

• A report of research, not including review articles
• Includes findings specific to Scotland’s population and older adults^[10]
• Includes assessment of mental health outcomes and/or access and delivery of older adult mental health services
• Regarding quantitative research into older adults’ mental health, evidence was included that involved one of the following three comparisons:
• Evidence reported in the last five years (since 2016)

In the identified reports, it was not typically clear whether statistical significance had been calculated for the quantitative findings. As such, differences reported in the text might not be at a statistically significant threshold, and should be interpreted with caution, but nevertheless may have useful learning to be applied/tested in the Scottish context.

Analysis of Scottish Health Survey data

The Scottish Health Survey (SHeS) is an annual survey of a representative sample of people living in private households in Scotland, and includes questions about mental health^[11]. Data from the four SHeS surveys conducted between 2016 and 2019 (SHeS 2016-2019) were analysed to provide more insights into the differences between older adults on the basis of age (e.g., those aged between 65 and 69 compared with those between 70 and 74) and other demographic characteristics (e.g., sex, Scottish Index of Multiple Deprivation quintile). The data from the 2016, 2017, 2018 and 2019 surveys were pooled for the dataset used for these analyses to increase the sample size to 4510 over-65 year olds and, in turn, to allow more robust statistical analyses to be conducted.

SHeS 2016-2019 mental health outcomes

For the purposes of this report, six mental health outcomes from SHeS 2016-2019 were focused on: mental wellbeing; a possible psychiatric disorder; depression symptoms; anxiety symptoms; a suicide attempt in the last 12 months; and an incidence of self-harm in the last 12 months. These were based on a key assessment measures included in SHeS.

Mental wellbeing was assessed with the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)^[12]. WEMWBS comprises 14 statements (e.g., 'I've been feeling relaxed') that respondents rate to indicate how often over the last two weeks they have felt that way, ranging from 'None of the time' (scored as 1) to 'All of the time' (scored as 5). The scores for all the items are then summed to give each participant a total score from 14 (lowest mental wellbeing) to 70 (highest mental wellbeing).

The General Health Questionnaire (GHQ-12)^[13] was used to assess whether a participant indicated a possible psychiatric disorder. The GHQ-12 comprises 12 questions relating to the respondents’ experiences over the previous two weeks in relation to issues such as sleep, stress, self-esteem and despair. If a respondent indicates that they have experienced four or more issues ‘more than usual’ or ‘much more than usual’ over the previous two weeks, their score is interpreted as indicating a possible psychiatric disorder.

Depression and anxiety symptoms were assessed with the Revised Clinical Interview Schedule (CIS-R)^[14]. In CIS-R sections relating to depression and anxiety, respondents are asked to indicate the presence of related symptoms. CIS-R scores are presented in this report separately for depression and anxiety symptoms; indicated by two or more of the respective symptoms.

Respondents were also asked separate questions about whether they had made an attempt to take their own life in the last 12 months or had had an incidence of self-harm without the intention of taking their own life. However, due to the small proportion of participants indicating these actions, these findings are not broken down by demographic characteristics.

All findings for the SHeS 2016-2019 mental health outcomes are presented as percentages of the samples that meet the specific thresholds. The exception for this is for findings relating to mental wellbeing (WEMWBS), which are reported as a mean score for the samples. All differences reported in the text that relate to the SHeS 2016-2019 analyses are statistically significant^[15].