Older men's mental health and emotional wellbeing: Exploring factors associated with the use of community support groups using a UK-based population survey.

The University of Bristol requires the Adult Psychiatric Morbidity Survey (APMS) 2014 data to investigate the use of community support group services by older men living in the UK.

Mental health in older people is a social care area that requires more attention as there is an existing long-held assumption that mental ill-health is an inevitable consequence of ‘old age’. The APMS (2014) found that prevalence rates of common mental disorders (CMDs) (comprising of depression and different anxiety disorders) in those aged 75+ was half the rate of that of working age adults. Yet given the increasing social isolation and poorer physical health that ageing may bring this seems surprising. One British study has shown that only a quarter of community-based older people with depression consult their GP and only a sixth receive treatment. Another study further noted that older people with CMDs had the lowest rates of psychological therapy and unmet treatment requests. This could suggest that older people may find it difficult to ask for what they need or may not even be aware of what mental health support is available to them.

In addition, older men with common mental disorders (such as anxiety and depression) are less likely than women to be using treatment. This is in part due to the longstanding stigma or reluctance to talk about mental health or to seek mental health help.

To explore older men’s psychiatric distress, help seeking and use of community services, the University of Bristol requires the APMS 2014 to examine the question: Under what circumstances do older men use community support groups for mental health difficulties? The aim is to investigate associations between different social and demographic factors and older men’s use of support group services.

The APMS is a representative sample of the whole population and is the primary source of information on treated and untreated psychiatric problems and their associations, as well as the level and nature of treatment and support service use, among adults in England. The research project at the University of Bristol, requiring access to APMS data, is particularly interested in the use of community support services by older men who may or may not have been diagnosed with a common mental health problem.

Defined in the APMS, “CMDs, also known as neurotic disorders, cause marked emotional stress and interfere with daily function, although they do not usually affect insight and cognition”. CMDs cover different types of depression and anxiety, for example, low mood and loss of interest and enjoyment in things, generalised anxiety disorder, panic disorder, phobias and obsessive-compulsive disorder. The survey also included information on the extent of use of health care services for a mental health reason (GP, inpatient and outpatient health care) as well as day and community service use.

In addition, the APMS includes responses from older adults. Importantly, the two most recent APMS’ (2007 and 2014) had no upper age limit for participation. Using the APMS data, the University of Bristol will assess the social contexts that are significantly associated with older men’s use of community support group services. If the numbers of older men in the 2014 dataset are low, then the dataset will be combined with the 2007 dataset which this project group already has access to.

Participants have freely participated in the APMS and were aware that their data would be used for research purposes.

This research will be undertaken as part of an Academic National Institute for Health Research (NIHR) School for Social Care (SSCR) early career, post-doctoral social care fellowship. Older men’s use of community support groups will be focused on and considered in relation to other forms of formal and informal support that older men might access for help with mental health difficulties. This secondary analysis is one phase of a mixed-methods study that will assess trends and patterns of older men’s use of community services for mental health difficulties. The second phase of the study will be a qualitative, cross-sectional element that uses in-depth, semi-structured interviews with older men. Data from the APMS will not be linked in any way to the data collected in the qualitative phase of the study.

The data subjects for this study are UK (male residents) residents aged over 55 years living in private households who have completed the APMS. The level of data required is pseudonymised and there will be no further data linkage and no attempt to identify individuals. When the UK Data Service (UKDS) supply the dataset, they provide the whole dataset as there is no facility to select individual variables. The UKDS holds the data on behalf of NHS Digital and, once a Data Sharing Agreement is active with NHS Digital, access to the data will be provided by the UKDS. No data will be shared with third parties. The data is requested for 3 years to allow time for submission to academic journals and revision of data at the request of peer reviewers.

The University of Bristol is the sole Data Controller will also process the data.

NIHR SSCR are funding the early career, post-doctoral fellowship for which this project is being conducted. The University of Bristol have provided NHS Digital with evidence of this funding award. NIHR will only get notified of a publication output and do not request or require any data before that. NIHR does not control the scope or conduct of the research. They are therefore not listed as a data controller or data processor in this Agreement.

The data will be processed in line with GDPR Article 6(1)(e) “for the performance of a task carried out in the public interest” and GDPR Article 9(2)(j) “Processing is necessary for archiving purposes in the public interest, or scientific and historical research purposes or statistical purposes in accordance with Article 89 (1)”.

Article 6(1)(e) can be relied upon because the University of Bristol is a public authority as described under Schedule 1 of the Freedom of Information Act 2000. University of Bristol is also founded and regulated by its Charter of Incorporation which states that “the University shall have all the powers of a natural person to do anything within the law which promotes or helps to promote the Objects including, but not limited to, power…to promote or carry out research and disseminate knowledge”.

Article 9(2)(j) can be relied upon as research into the mental health and emotional wellbeing of older men is in the public interest. Mental health in older people is a neglected area of research as there is an assumption that mental ill-health is an inevitable consequence of ‘old age’.

All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract i.e. employees, agents and contractors of the Data Recipient who may have access to that data).

In order to protect patient confidentiality in publications resulting from analysis of APMS data users must:

- guarantee that any outputs made available to anyone other than those with whom this agreement is made, will meet required standards, including the guarantee, methods and standards contained in the Code of Practice for Official Statistics and the ONS Statistical Disclosure Control for tables produced from surveys;

- apply methods and standards specified in the Microdata Handling and Security Guide to Good Practice for disclosure control for statistical outputs.

The request is for the APMS 2014 dataset. The APMS is carried out by NatCen, in collaboration with the University of Leicester, on behalf of NHS Digital. Once this agreement is active the actual flow of data will be from the UK Data Service (UKDS) (www.ukdataservice.ac.uk) who are the data processors on behalf of NHS Digital. UKDS will grant system access to pseudonymised APMS 2014 data to the research team at the University of Bristol. There will be no subsequent flows of data and there will be no to attempt to re-identify individuals or link the dataset to any other healthcare data. It is not possible to obtain individual variables from this dataset.

The University of Bristol will be able to download the dataset from UKDS for the period specific within the data sharing agreement (DSA). The University of Bristol must securely destroy all local copies of the dataset upon expiration of the DSA and notify the Data Access Request Service (DARS) in line with standard procedures.

Data will be stored and upheld in line with the University of Bristol’s Data Security and Protection Policy. It will be marked as highly confidential and will only be accessed by the principal research team through the University of Bristol Safe Haven source. The Safe Haven source is encrypted at rest on the server, accessed only by a controlled username, has access logs kept for audit reports and is not backed up, to comply with data destruction notices. The principal research team consists of an academic NIHR SSCR Research Fellow, a senior lecturer and an associate professor from the School of Policy Studies at the University of Bristol. The NIHR SSCR Research Fellow is substantively employed by the University of Bristol as a Senior Research Associate. They are identified as an NIHR SSCR Research Fellow as this research project comprises part of a post-doctoral fellowship which the NIHR SSCR is funding. All members of the principal research team are therefore substantive employees of the University of Bristol. All members of the research team have undergone data protection training with the University of Bristol.

Women and respondents under 55 years of age will be excluded from the sample before analyses take place. There are two potential variables in APMS 2014 that can be used to measure support service use in the proposed analysis, and these could be used as the dependent variable (DV) in chi-square tests and the binary logistic regression model. A chi-square test is used to explore the relationship between two categorical variables e.g. is there an association between a man's marital status and their attendance at a support service. Binary logistic regression is used to determine the relationship between features and the probability of a particular outcome, e.g. what factors predict the likelihood that respondents would report that they had used a community support service?

Survey participants were asked to report use of community and day-care services in the past year. Community care services included use of the following in the past year: a psychiatrist, psychologist, community psychiatric nurse, community learning difficulty nurse, other nursing services, social worker, self-help/support group, home help/homecare worker or outreach worker. Day care service use included use of a community mental health centre, day activity centre, sheltered workshop and other nursing services in the past year. ‘Self-help/support group’ and ‘Used a day activity centre’ within the last year are two potential dependent variables to be used in the analysis.

Descriptive statistics and chi-square tests will initially be carried to investigate associations between socio-demographics (e.g. ethnicity, sexuality, socio-economic status), other contextual factors and community support use. Descriptive statistics are used to describe the characteristics of the sample and to check the variables will be appropriate for the chosen statistical techniques that will be used. Most current research in the social care field has applied logistic regression models in analysis of large datasets, in particular to rank the relative importance of independents on predicting the dependent variable. The University of Bristol will use binary logistic regression to examine what social factors (independents) predict older men’s community service use in the past year. The University of Bristol are interested in exploring factors that appear to influence community support service use by older men with and without a common mental disorder (CMD) present.

The selection of predictor (independent) variables will be informed by previous research and what is known about older men’s service use and mental health experiences. Examples of variables from APMS 2014 that could be explored in models as potential predictors are: socio-economic status; age; sexual orientation; ethnicity; religion; marital status; physical health conditions; previous mental health service use; alcohol or drug dependence; financial and housing circumstances; social functioning; stressful life events experienced; social support and social capital and participation. Only variables that show an association with support group service use will be used in the binary logistic regression analysis.

The research hopes to provide outputs to support secondary community support group services and to older men’s mental health awareness, and guidance for working with older men experiencing distress. The outputs may provide support for both community mental health and adult social care professionals as well as people working in the voluntary, community and social enterprise (VCSE) sector in the context of mental health distress to facilitate support service use.

The output reports will only include figures based on aggregated data. In line with the minimum requirements of the NIHR SSCR contract, an end-of-project report will be produced comprising:

- A short academic and administrative report.

- The pre-submission manuscript form of a peer reviewed paper that communicates the main findings of the project.

- A brief, accessible ‘findings’ document indicating key messages from the project to be placed on the NIHR SSCR website. The University of Bristol will ensure that this document is aimed at a variety of audiences, especially those who can help to improve practice.

A research paper will be produced and submitted to an academic peer-reviewed journal, specialising in health and social care and community services, for example the journal, Ageing & Mental Health. The aim of this paper will be to highlight the value of using large scale datasets for secondary analysis in social research and specifically the relevance of the APMS to UK adult social care practice. As Hussien’s (2011) SSCR methods review highlights, using existing large datasets relating to the social care sector can offer a great deal of potential value to users, practitioners, commissioners, providers and policy makers.

Results will also be broadcast through Twitter (https://twitter.com/ayvickery). If outputs are of public health interest, information hopes to also be made available for local community mental health teams to advise regarding the importance of community support groups for older men experiencing mental health difficulties.

Outputs to be included in the peer-review journal are expected to be submitted by April 2023. Findings will be presented at the NIHR SSCR conference, which will likely be April 2023.

Any paper or poster submitted for publication or review will involve acknowledgement of and review by the original authors of APMS 2014. Where possible, research outputs hope to be published to open access journals, for example, Health & Social Care in the Community and Ageing & Mental Health. The University of Bristol has an open access team to allow open access for a publication to, where possible, increase dissemination of research outputs.

The outputs hope to identify socio-demographics and social contexts (including if they have clinical diagnosis of CMD) which are associated with older men being likely to attend a community support group service. The data may be able to support health and social care providers and the voluntary, community and social enterprise (VCSE) sector working with people, specifically older men, experiencing mental health difficulties.

1) Findings from this project aim to highlight the social demographics and contexts that might influence an older man’s use of community support services. The findings could be used by support services to target support interventions and community groups at specific (social) groups of older men.

2) Outcomes of this project hope to demonstrate the need for support groups targeted at specific groups or men, or men who have experienced certain social contexts and situations.

3) The associations found between social factors and older men’s community support group use may identify areas where new research focusing specifically on men’s or older people’s mental health should be explored further.

4) Using the APMS data as part of a post-doctoral fellowship plans to highlight the benefits of using large datasets in adult social care research. Specifically, this research wishes to demonstrate ways in which APMS can be used within social care and indicate its uses to other social care researchers.

In a recent NIHR SSCR Review, it was indicated that older people are a group potentially facing more disadvantage and in need of more research about their use of social care. Furthermore, older people’s mental health is a social care area that deserves more focus. This project hopes to address this gap in research by focusing specifically on older men’s mental health, a subgroup of the population that might have distinct gendered experiences, needs and/or disadvantages. The Community Mental Health Framework for Adults and Older Adults (2019) (https://www.england.nhs.uk/publication/the-community-mental-health-framework-for-adults-and-older-adults/), set out as part of the NHS Long Term Plan, points to the need for effective links with community assets to support and enable people to become more embedded in their community and to use these assets, such as specific support groups (e.g. older adult groups, depression groups), to support their mental health. Specifically, this Framework locates community mental health services in the centre of the community, allowing all other services in the mental health care system to function more effectively (p.4). This project aims to advance this priority in highlighting how community support groups can support older men to manage and maintain good mental health.

Yielded Benefits is not a requirement for new applications.