title: Factors associated with help-seeking behaviors in Mexican older individuals with depressive symptoms: a cross-sectional study.
abstract: OBJECTIVE
  Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling "that something is wrong" and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms.
  
  
  METHODS
  A cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health.
  
  
  RESULTS
  A total of 2322 individuals were studied; from these, 67.14% (n = 1559) were women, and the mean age was 73.18 years (SD = 7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ(2) = 81.66, p < 0.0001), significant variables were female gender (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.511-0.958, p = 0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p = 0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant.
  
  
  CONCLUSIONS
  Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms.
authors.affiliation: Instituto Nacional de Geriatría, Secretaría de Salud, Mexico, DF, México.
authors.forename: Mario Ulises
authors.initials: MU
authors.lastname: Pérez-Zepeda
authors.forename: Victoria Eugenia
authors.initials: VE
authors.lastname: Arango-Lopera
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Wagner
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
authors.forename: Sergio
authors.initials: S
authors.lastname: Sánchez-García
authors.forename: Teresa
authors.initials: T
authors.lastname: Juárez-Cedillo
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Peña
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008800:Mexico; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors
keywords: help seeking; late life depression care; late life depressive symptoms; mental health services