Psychosocial Factors in Help-Seeking Among Older Adults During the COVID-19 Pandemic: A Qualitative Analysis of Calls to India’s National Psychosocial Support and Mental Health Services Helpline

Background: Older adults faced significant psychosocial challenges during the COVID-19 pandemic, yet evidence on help-seeking behavior in low- and middle-income countries remains limited. This study aimed to identify the psychosocial factors prompting help-seeking among older Indian adults and family members who contacted the National Psychosocial Support and Mental Health Services Helpline during the COVID-19 pandemic. Methods: A secondary reflexive thematic analysis was conducted on 82 de-identified helpline call summaries (March 2020-October 2021). Data were analyzed using Braun and Clarke's six-phase analytic framework. Age-stratified, caller-type, and gender-differentiated analyses were used to examine demographic patterns within the dataset. Results: The sample comprised predominantly male (89.0%) older adults with a mean age of 69.3 years (SD: 7.6). Approximately 52.4% (n=43) were proxy calls initiated by family members (primarily sons), while 47.6% (n=39) were direct calls from older adults. Six major themes emerged, including psychological distress and emotional vulnerability (39.0%, n=32), pandemic-related isolation (22.0%, n=18), health anxieties (26.8%, n=22), cognitive concerns (18.3%, n=15), vaccination-related concerns (22.0%, n=18), and family relationship and caregiver issues (17.1%, n=14). Older adults aged ≥80 years showed higher prevalence of isolation (36.4%, n=4) and cognitive concerns (36.4%, n=4). Direct callers more frequently reported psychological distress (46.2%, n=18), whereas proxy callers more often reported cognitive concerns (25.6%, n=11) and family relationship strain (25.6%, n=11). Conclusions: Helpline interactions provided insight into the psychosocial concerns prompting older adults and their families to seek support during the COVID-19 pandemic. The findings highlight the importance of age-responsive, linguistically accessible, and family-inclusive mental health services during public health emergencies in low- and middle-income country contexts.