Mental health literacy and help-seeking behaviour among older adults in Mysuru, India: a mixed methods study

Abstract

As populations age globally, mental health remains a frequently neglected aspect of healthy ageing. Older adults face biological, psychological, and social challenges that heighten their risk of mental health problems, yet professional service utilization remains low. In India, this treatment gap is worsened by limited mental health literacy, stigma, and socio-cultural barriers. This study assessed mental health literacy and help-seeking behaviour among older adults in Mysuru, examined their association, and explored barriers and facilitators influencing professional help-seeking. An explanatory sequential mixed-methods design was used. A community-based cross-sectional survey was conducted among 232 older adults (aged ≥ 60 years) selected through multistage stratified sampling from rural and urban Mysuru Taluk, Karnataka. Mental health literacy was measured using the Mental Health Literacy Scale (MHLS) and help-seeking behaviour using the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPH). Non-parametric tests and Spearman’s correlation were applied. Eight in-depth interviews followed, analyzed using Braun and Clarke’s thematic analysis and Lewin’s Force Field Analysis framework. Participants had a median MHLS score of 105 (IQR 12), representing a substantial proportion of the maximum possible score of 160, yet only 7.8% had sought professional help in the preceding 12 months, with most turning first to family or friends. A significant negative correlation existed between mental health literacy and help-seeking attitudes (ρ = -0.262, p  < 0.001). Education and family structure significantly influenced both outcomes. Five qualitative themes emerged: understanding of mental health, experiences of emotional distress, help-seeking and coping, barriers to care, and facilitators of support. Key barriers included stigma, emotional suppression, financial constraints, and misattribution of distress to normal ageing, while family support, awareness, and accessible services were key facilitators. Despite a comparatively favourable median mental health literacy score, professional help-seeking among older adults in Mysuru remains limited. Targeted awareness interventions, stigma reduction strategies, and strengthened community-based mental health services are needed. Not applicable.