Article

Prevalence of Mood, Anxiety, and Substance-Abuse Disorders for Older Americans in the National Comorbidity Survey-Replication

Department of Aging and Mental Health Disparities, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa, FL, USA.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry (Impact Factor: 4.24). 10/2009; 17(9):769-81. DOI: 10.1097/JGP.0b013e3181ad4f5a
Source: PubMed

ABSTRACT

Current information on the prevalence of psychiatric disorders among older adults in the United States is lacking. Prevalence of anxiety, mood, and substance disorders was examined by age (18-44, 45-64, 65-74, and 75 years and older) and sex. Covariates of disorders for older adults (65 years and older) were explored.
Cross-sectional epidemiologic study, using data from the National Comorbidity Survey-Replication.
Community-based epidemiologic survey.
Representative national sample of community-dwelling adults in the United States.
The World Health Organization Composite International Diagnostic Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders.
Prevalence of 12-month and lifetime mood, anxiety, and substance-use disorders was lower for older adults (65 years and older) than younger age groups: 2.6% for mood disorder, 7.0% for anxiety disorder, 0 for any substance-use disorder, and 8.5% for any of these disorders (for any disorder, 18-44 years = 27.6%, 45-64 years = 22.4%). Among older adults, presence of a 12-month anxiety disorder was associated with female sex, lower education, being unmarried, and three or more chronic conditions. Presence of a 12-month mood disorder was associated with disability. Similar patterns were noted for lifetime disorders (any disorder: 18-44 years = 46.4%, 45-64 years = 43.7%, and 65 years and older = 20.9%).
This study documents the continued pattern of lower rates of formal diagnoses for elders. These rates likely underestimate the burden of late-life psychiatric disorders, given the potential for underdiagnosis, clinical significance of subthreshold symptoms, and lack of representation from high-risk older adults (e.g., medically ill, long-term care residents).

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    • "Late-life depression is relatively common, yet difficult to treat given the range of physical, emotional, and cognitive symptoms (Fiske et al., 2009). While the 12-month prevalence for depression in the general late-life community is 5% (Byers, Yaffe, Covinsky, Friedman, & Bruce, 2010), an estimated 6-9% of older adults in the primary-care setting meet criteria for major depressive disorder (MDD) (Gum et al., 2009). An estimated 19% of older adults suffer from clinically significant depressive symptoms (Cole and Dendukuri, 2004). "
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    ABSTRACT: Objective: Supportive behaviors (both instrumental and emotional) from spouses and close family members can impact the trajectory of older adults' depressive symptoms. Interventions that target both the patient and support person may be more effective than interventions that target the patient only, in terms of alleviating mood symptoms in the identified patient. The purpose of this paper was to review the characteristics and findings of dyadic and family-oriented interventions for late-life mood disorders to determine if they are effective and beneficial. Methods: Following PRISMA guidelines, we conducted a systematic review of reports in the literature on dyadic or family-oriented interventions for late-life mood disorders. We searched PubMed, OVID PsycINFO, and EMBASE for peer-reviewed journal articles in English through October 2014. Results: We identified 13 articles, representing a total of 10 independent investigations. Identified studies focused on spouses and close family members as support persons. Effect sizes for dyadic interventions that treated major depressive disorder were, on average, moderately strong, while effect sizes for dyadic interventions that reduced depressive symptoms were generally small. We did not identify any dyadic studies that treated bipolar disorder. Conclusions: This review showed that dyadic interventions are feasible and that these interventions can decrease symptomatology in individuals who have major depressive disorder. Research is needed to understand the relative efficacy of a dyadic approach over a single-target approach in treating depression. Copyright © 2016 John Wiley & Sons, Ltd.
    Full-text · Article · Jan 2016 · International Journal of Geriatric Psychiatry
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    • "However, all disorders (except for antisocial personality disorder) were assessed on a 12-month time frame, limiting those biases. In addition, the prevalence rates found in this study are consistent with those of prior studies (Donnellan and Lucas, 2008; Gum et al., 2009; Hasin et al., 2005; Hoertel et al., 2013; Jorm, 2000; Kessler et al., 2005a; Manetti et al., 2013; Schuster et al., 2013a; Seitz et al., 2010; Sunderland et al., 2014; Weissman et al., 1985), including studies conducted among institutionalized individuals. Secondly, the lifetime assessment of antisocial personality disorder may have favored the invariance across age groups. "
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    ABSTRACT: Recent theories have proposed a metastructure that organizes related mental disorders into broad dimensions of psychopathology (i.e., internalizing and externalizing dimensions). Prevalence rates of most mental disorders, when examined independently, are substantially lower in older than in younger adults, which may affect this metastructure. Within a nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093), we developed a dimensional liability model of common psychiatric disorders to clarify whether aging affects specific disorders or general dimensions of psychopathology. Significant age differences existed across age groups (18-24, 25-34, 35-44, 45-54, 55-64, 65-75 and 75+), such that older adults showed lower prevalence rates of most disorders compared to younger adults. We next investigated patterns of disorder comorbidity for past-year psychiatric disorders and found that a distress-fear-externalizing liability model fit the data well. This model was age-group invariant and indicated that the observed lower prevalence of mental disorders with advancing age originates from lower average means on externalizing and internalizing liability dimensions. This unifying dimensional liability model of age and mental disorder comorbidity can help inform the role of aging on mental disorder prevalence for research and intervention efforts, and service planning for the impending crisis in geriatric mental health. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Mar 2015 · Journal of Psychiatric Research
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    • "Epidemiological surveys indicate that the rates of anxiety and depression tend to be lower in older adults. However, these surveys also indicate that approximately 8% and 3% of adults over 65 years of age still meet formal diagnostic criteria for depression and anxiety disorders, respectively (Byers et al., 2010; Gum et al., 2009; Pirkis et al., 2009). This is significant given that the number of adults over 65 is projected to increase in the coming decades and given these conditions compound the effects of physical comorbidities (Katon et al., 2007; Braam et al., 2005). "
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    ABSTRACT: Self-guided internet-delivered cognitive behavior therapy (iCBT) has considerable public health potential for treating anxiety and depression. However, no research has examined the use of self-guided iCBT, that is, treatment without contact with a clinician, specifically for older adults. The aim of the present study was to undertake a preliminary examination of the acceptability, efficacy and health economic impact of two entirely self-guided iCBT programs for adults over 60 years of age with anxiety and depression. Two separate single-group feasibility open trials of self-guided iCBT were conducted, the Anxiety Trial (n = 27) and the Depression Trial (n = 20), using the control groups of two randomized controlled trials. The online treatment packages consisted of five online educational lessons, which were delivered over 8 weeks without clinical contact. Participants rated the interventions as acceptable with more than 90% reporting the course was worth their time and more than 70% of participants completing at least 3 of the 5 lessons within the eight weeks. Significant reductions on measures of anxiety (Generalized Anxiety Disorder 7-item; GAD-7) and depression (Patient Health Questionnaire 9-item; PHQ-9) were observed from pre-treatment to post-treatment in both the Anxiety Trial (GAD-7 Cohen's d = 1.17; 95% CI: 0.55 to 1.75) and the Depression Trial (PHQ-9 Cohen's d = 1.06; 95% CI: 0.33 to 1.73). The economic analyses indicated that there was statistically significant improvement in health-related quality of life compared to baseline and marginally higher costs associated with treatment for both the Anxiety Trial ($69.84; 95% CI: $4.24 to $135.45) and the Depression Trial ($54.98; 95% CI: $3.84 to $106.12). The results provide preliminary support for the potential of entirely self-guided iCBT for older adults with anxiety and depression and indicate larger scale and controlled research trials are warranted.
    Full-text · Article · Nov 2014 · Internet Interventions
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