Six-Month Longitudinal Patterns of Mental Health Treatment Utilization by Older Adults With Depressive Symptoms

Abstract

OBJECTIVE For community-dwelling older adults with depressive symptoms, aims were to: describe behavioral health service utilization patterns over a six-month period; and identify factors associated with service use, guided by a multidimensional, comprehensive theoretical model emphasizing the dynamic nature of service use patterns over time and social context. METHODS 144 participants with depressive symptoms completed an in-person baseline interview and six monthly telephone follow-up interviews. Outcomes included use of antidepressants or counseling at each follow-up. Covariates included individual (demographic, need, prior treatment experience, intentions) and social context (stigma, advice) variables. RESULTS Approximately half of participants received no formal service (antidepressant or counseling; n = 70, 48%). Service use or non-use did not change for most participants. More participants with severe symptoms received antidepressants (25–37%) than those with milder symptoms (10–14%), although more of the milder cases started (62% vs. 49%) and stopped antidepressants (77% vs. 26%) at least once. Fewer individuals received counseling overall, with no clear patterns by symptom severity. In multivariate longitudinal analyses, service use at follow-up was independently associated with younger age, current major depressive episode, baseline use of antidepressant, intention to begin a new service at baseline, and receipt of advice to use services over follow-up. CONCLUSIONS Over a six-month period, the majority of older adults with depressive symptoms in this study continued use or non-use of mental health services. Demographic, need, attitudinal and social variables were related to service use over time. Addressing intentions and providing advice may facilitate uptake of services.

Trajectories of depressive symptoms in community-dwelling older adults: A six-month longitudinal study with monthly assessment

“…Data for the current study were derived from a six-month longitudinal, convenience sample of 144 community-dwelling older adults with depressive symptoms (Gum et al, 2011).…”

“…Participants were recruited from a variety of community-based, health, and social service settings in six regions of Florida. Please see Gum et al (2011) for details.…”

“…Further, IGC is robust to missing data and unbalanced data (Sheck and Ma, 2011). We had a small amount of missing data (4.0%), largely due to participants missing a small number of interviews rather than withdrawing (Gum et al, 2011), and ICG includes all available data points.…”

“…Slope and intercept were allowed to vary across individuals in order to capture inter-individual differences in growth. Although the original study (Gum et al, 2011) measured participants' mental health service use patterns, no service use variables were included in the current analyses. As a naturalistic study, we did not attempt to control or influence service use in any way.…”

“…Our research team conducted a six-month longitudinal study with community-dwelling older adults who had mild to severe depressive symptoms at baseline, with seven waves of data collected over monthly intervals (N ¼144; Gum et al, 2011). In prior analyses, 31% of the variability in depressive symptoms over the course of the study was accounted for by month-to-month fluctuations within persons (Dautovich et al, 2014), suggesting the possibility of a variety of linear and non-linear trajectories.…”