Low Use of Mental Health Services Among Older Americans With Mood and Anxiety Disorders

Abstract

Objective It is unclear why late-life mood and anxiety disorders are highly undertreated, despite being common in older adults. Thus, this study determined the prevalence and key factors associated with non-use of mental health services among older community-dwelling adults with mood and anxiety disorders. Methods The study examined 348 participants aged 55 years and older who met criteria for prevalent DSM-IV mood and anxiety disorders from the National Comorbidity Survey Replication (NCS-R), a population-based probability sample. Analyses included frequency measures and logistic regression using weights and complex design-corrected statistical tests. Key factors associated with not using mental health services were determined in a final multivariable model using a systematic approach accounting for a comprehensive list of potential predictors. Results Approximately 70% of older adults with prevalent mood and anxiety disorders did not use services. Those who were from minority race/ethnic groups, not comfortable with discussing personal problems, who were married or cohabitating, and middle versus high income status had increased odds of not using mental health services. In addition, respondents with mild versus serious disorders, no chronic pain complaints, and low versus high perceived cognitive impairment had greater odds of non-use. Conclusions The results support improving perception of need and comfort to seek help, as well as increased screening and other prevention efforts, in order to combat the very high number of mood and anxiety disorders that go untreated in older Americans.

Late-Life Mental Health Disorders. Data from a Population-Based Study

“…These figures are controversial because the prevalence rates of DSM-IV mood and anxiety disorders in late life were found tending to decline with age. Nevertheless these disorders were found as very common, especially in women [23], and our findings are in line, with dementia and GAD significantly more frequently found in women than in male, as well as Cognitive Impairment No Dementia.…”

“…Two or more disorders occurred in 11.6% of participants and three or more in the 5.3% [21]. Since services dedicated to older psychiatric patients have claimed to be not fully effective [22] and improvements are needed in the screening and prevention of 'Common Mental Health Disorders' [23] more research is needed to provide informative figures of mental disorders occurrence in late-life.…”

The impact of Medicaid expansion on utilization of mental health services in west Louisville, Kentucky.

“…Barriers to treatment also include stigma and discrimination, whether real or perceived, such as worry and embarrassment regarding what others would think in the event that mental health services were used (Barry, 2004;Byers, Arean, & Yaffe, 2012).…”

“…Additionally, individuals have expressed beliefs about treatment effectiveness or a mistrust of providers that impact their willingness to seek care (Alegria et al, 2008;Byers et al, 2012;Eisenberg et al, 2011).…”

“…Integration of mental health and primary care services also promotes use of mental health services, especially when co-location of providers results in a personal introduction by the referring provider (Horevitz, Organista, & Arean, 2015). Likewise, a significant other can positively influence the use of mental health services; despite a high prevalence of non-use overall in adults over 55 year old, having a partner increased an individual's motivation to seek professional help (Byers et al, 2012). Support from family members is also associated with higher medication adherence (Ramirez Garcia, Chang, Young, Lopez, & Jenkins,…”