Mental distress and service utilization among help-seeking, community-dwelling older adults

Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
International Psychogeriatrics (Impact Factor: 1.89). 08/2010; 22(5):739-49. DOI: 10.1017/S104161021000058X
Source: PubMed

ABSTRACT This study aimed to characterize healthcare and human services utilization among mentally distressed and non-distressed clients receiving in-home care management assessment by aging services provider network (ASPN) agencies in the U.S.A.
A two-hour research interview was administered to 378 English-speaking ASPN clients aged 60+ years in Monroe County, NY. A modified Cornell Services Index measured service utilization for the 90 days prior to the ASPN assessment. Clients with clinically significant anxiety or depressive symptoms were considered distressed.
ASPN clients utilized a mean of 2.93 healthcare and 1.54 human services. The 42% of subjects who were distressed accessed more healthcare services (e.g. mental health, intensive medical services) and had more outpatient visits and days hospitalized than the non-distressed group. Contrary to expectations, distressed clients did not receive more human services. Among those who were distressed, over half had discussed their mental health with a medical professional in the past year, and half were currently taking a medication for their emotional state. A far smaller proportion had seen a mental health professional.
In the U.S.A., aging services providers serve a population with high medical illness burden and medical service utilization. Many clients also suffer from anxiety and depression, which they often have discussed with a medical professional and for which they are receiving medications. Few, however, have seen a mental health specialist preceding intake by the ASPN agency. Optimal care for this vulnerable, service intensive group would integrate primary medical and mental healthcare with delivery of community-based social services for older adults.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: There are disparities in mental health services (MHS) utilization within and between populations and several factors are studied as its potential correlates. Identifying those correlates would help health policy makers to adjust service provision with characteristics of their community. To evaluate demographic, socioeconomic and system correlates of MHS utilization among married women from Tehran, Iran. Methods: A household survey of 615 married women residents of 22 municipal districts of Tehran selected via a cluster sampling method. All subjects were asked about health services utilization during last one and 12 months as well as need and access for MHS, demographic and socioeconomic factors. Independent correlates of MHS use were determined with logistic regression analysis. Results: Total 615 women, mean±SE age and duration of marital life of 42.6±0.9 and 22±0.8 years, respectively were selected, rate of MHS utilization during last one and 12 months were 5.2% and 10.1% respectively. 23.6% of women reported having mental illness and 19.3% and 17.9% had need for MHS and access to outpatient health services, respectively. Logistic regression models showed that need for MHS (OR:5.25, 95%CI:2.7-10.1), access to outpatient services (OR:2.17, 95%CI:1.04-4.52), smoking (OR:3.4, 95%CI:1.16-10.2) and crowding index (OR:0.69, 95%CI:0.48-0.99). Conclusions: Rate of MHS utilization in women are low considering the near to estimated rate of perceived illness. Bridging the gap between perceived illness and need for services, then providing better access to services in areas with higher crowding index and higher rates of smoking in residents should considered in any mental health promotion programs. Declaration of interest: None.
    02/2013; 7(1):51-60. DOI:10.1016/S0924-9338(13)75783-3
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling that something is wrong and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms. MethodsA cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health. ResultsA total of 2322 individuals were studied; from these, 67.14% (n=1559) were women, and the mean age was 73.18years (SD=7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help ((2)=81.66, p<0.0001), significant variables were female gender (odds ratio (OR)=0.7, 95% confidence interval (CI) 0.511-0.958, p=0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p=0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant. Conclusions Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms. Copyright (c) 2013 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 12/2013; 28(12). DOI:10.1002/gps.3953 · 3.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although individuals with subjective memory impairment (SMI) tend to be at an increased risk for dementia and the majority of them have depressive symptoms, it remains unclear whether SMI with depression is associated with an increased or decreased risk of dementia. The purpose of this study was to investigate the relationship between depressive symptoms and hippocampal/amygdalar volume, a reliable biomarker in the prediction of progression to dementia in SMI. Ninety subjects with SMI participated in the study, and 28 healthy participants without memory complaints served as a normal control (NC) group. 3-D T1-weighted structural MRI scans were completed in all subjects. When the volumes of hippocampus and amygdala were compared among the groups, the SMI group showed significantly smaller volumes than the NC group. When multiple regression analysis was conducted in all subjects, neither hippocampal nor amygdalar volume showed significant interaction effect between group and Geriatric Depression Scale (GDS). However, when the analysis was conducted within each group, lower GDS score was associated with smaller hippocampal volume in the SMI group, and higher GDS score was associated with smaller amygdalar volume in the NC group. Thus, individuals with SMI and less depressive symptoms tend to have smaller hippocampus, which could be associated with more risk of dementia, than normal individuals.
    Archives of gerontology and geriatrics 02/2013; DOI:10.1016/j.archger.2013.01.005 · 1.53 Impact Factor

Full-text (2 Sources)

Available from
Dec 5, 2014