This study estimated the past and current prevalence of psychiatric illness and subsyndromal mental illness (both pre-relapse and new onset) in a sample of low-income, medically ill older adults.
Method:
A convenience sample of 95 public sector medical patients aged 55 and older were assessed for the presence of psychiatric diagnosis and symptoms using the Geriatric Depression Scale, Beck Anxiety Inventory, the Short Michigan Alcohol Screening Test, and the Computerized Diagnostic Interview Schedule (DIS-C).
Results:
Dysthymia and Major Depression were the most prevalent current disorders and Alcohol Dependence the most prevalent past disorder. Overall, 25 percent met criteria for at least one Axis I disorder. An additional 44 percent of patients had subsyndromal mental illness: 14 percent had subsyndromal depression, 17 percent were significantly anxious, and 30 percent were problem drinkers. A prior model predicting current Axis I disorder in younger people was found to be predictive of current Axis I but did not predict to subsyndromal disorder.
Conclusions:
The rates of psychiatric disorders and symptoms in this older, low-income population were similar to those in other samples of older medical patients. The findings from this research suggest the need for larger epidemiological studies of the prevalence of psychiatric disorders in this disadvantaged aging population. The complexities of this type of research are also discussed.
U.S. Bureau of the Census. Population projections of the United States by age, sex, race, and Hispanic origin: 1993–2050. Current Population Reports (P25–1104), Washington, DC: U.S. Government Printing Office, 1993.
2.
BlaneD. Social determinants of health-socioeconomic status, social class and ethnicity. American Journal of Public Health1995; 85: 903–905.
3.
National Institute of Health. Diagnosis and treatment of depression in late life. Journal of the American Medical Association1992; 268: 1018–1024.
4.
StarfieldB. Health systems' effects on health status-financing versus the organization of services. American Journal of Public Health1995; 85(10): 1350–1351.
5.
American Association of Homes and Services for the Aging. Aging demographics. AAHSA, 1998.
6.
KlermanGBreslauLHaugM. Depression and aging: Causes, care and consequences. BreslauL & HaugM, editors. New York: Springer Press, 1983.
7.
BelleD. Poverty and women's mental health. American Psychologist1995; 45: 385–389.
8.
AntonucciTCJacksonJS. Psychological health and self-esteem. Family and Community Health1994; 86: 1–9.
9.
MoultonHJ. The impact of crime and violence on lifestyle of elderyl living in mixed population housing: A pilot study. Physical and Occupational Therapy in Geriatrics1996; 14: 53–65.
10.
WooJHoSCLauJYuenYK. Age and marital status are major features associated with institutionalisation in elderly Hong Kong Chinese. Journal of Epidemiology and Community Health1994; 48: 306–309.
11.
BakerFMOkwumabuaJPhiliposeVWongS. Screening African-American elderly for the presence of depression symptoms: A preliminary investigation. Journal of Geriatric Psychiatry and Neurology1996; 9: 127–132.
12.
VoyerMVezinaJ. Contribution of hassles, appraisal, and coping to psychological distress among elderly widows. Canadian Journal of Language1995; 14: 498–510.
13.
PenninxWJBeekmanATFOrmelJKriegsmanDMWBoekeAJPVan EilkJTMDeegDJH. Psychological status among elderly people with chronic disease: Does type of disease play a part?Journal of Psychosomatic Research1996; 40: 521–534.
14.
BlazerDGHughersDCGeorgeLK. The epidemiology of depression in an elderly community population. The Gerontologist1987; 16: 118–124.
15.
KoenigHGBlazerDG. Epidemiology of geriatric affective disorders. Clinics in Geriatric Medicine1989; 4: 498–505.
16.
Perez-StableEMirandaJMMuñozRYingY. Depression in medical outpatients: Under recognition and misdiagnosis. Archives of Internal Medicine1990; 150: 1083–1088.
17.
MurphyJMOlivierDCMonsonRRSobolAMLeightonAH. Incidence of depression and anxiety: The Stirling County Study. American Journal of Public Health1988; 78(5): 534–540.
18.
HarrisREMionLCPattersonMBFrengleyJD. Severe illness in older patients: The association between depression disorders and functional dependency during the recovery phase. Journal of the American Geriatrics Society1988; 36: 890–896.
19.
KesslerRCMcGonagleKAZhaoSNelsonCBHughesMEshlemanSWittchenHUKendlerKS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry1994; 51: 8–19.
20.
AreánPAGallagher-ThompsonD. Issues and recommendations for the recruitment and retention of older ethnic minority adults into clinical research. Journal of Consulting and Clinical Psychology1996; 64(5): 875–880.
BeckATSteerRA. The Beck Anxiety Inventory Manual. San Antonio, TX: The Psychological Corporation, 1988.
23.
YesavageJABrinkTLRoseTLLumOHuangVAdeyMLeirerVO. Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research1982; 17(1): 37–49.
24.
RobinsLNHelzerJECrughanJRatcliffKS. National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics and validity. Archives of General Psychiatry1981; 38: 381–389.
25.
KoenigHGPappasPHolsingerTBacharJR. Assessing diagnostic approaches to depression in medically ill older adults: How reliably can mental health professionals make judgements about the cause of symptoms?Journal of the American Geriatrics Society1995; 43(5): 472–478.
26.
BrownDrAhmedFGaryLEMilburnNG. Major depression in a community sample of African Americans. American Journal of Psychiatry1995; 152(3): 373–378.
27.
HeithoffK. Does the ECA underestimate the prevalence of late-life depression?Journal of the American Geriatrics Society1995; 43: 2–6.
28.
WetherellJLAreánPA. Utility of the Beck Anxiety Inventory in older medical patients. Psychological Assessment1996; 9(2): 136–144.
29.
BrislinRW. Translations: Applications in Research. New York: Wiley/Halstead, 1976.
30.
KrauseN. Chronic financial strain, social support and depressive symptoms among older adults. Psychology and Aging1987; 2: 185–192.
31.
KrauseNLiangJYatomiN. Satisfaction with social support and depressive symptoms: A panel analysis. Psychology & Aging1989; 4(1): 88–97.
32.
GalloJJRabinsPVLyketsonCGTienAYAnthonyJC. Depression without sadness: Functional outcomes of nondysphoric depression in later life. Journal of the American Geriatrics Society1997; 45: 570–578.
33.
AreánPAMirandaJM. Utility of the CES-D in older and minority medical patients. Aging and Mental Health1997; 1: 47–56.
34.
AreánPARobinsonGHicksS. Help-seeking, referral and use of mental health services in public sector medical patients: An age comparison. Bethesda, MD: Annual NIMH Conference on Mental Health Services Research, 1997.
35.
LibertoJGOlsinDWRuskinPE. Alcoholism in older persons: A review of the literature. Hospital and Community Psychiatry1992; 43: 975–984.
36.
UnutzerJPatrickDLSimonGGrembowskiDWalkerERutterCKatonW. Depressive symptoms and the cost of services in HMO patients aged 65 years old and older: A 4-year prospective study. Journal of the American Medical Association1997; 277: 1618–1623.
37.
CurtisJRGellerGStokesEJLevineDMMooreRD. Characteristics, diagnosis and treatment of alcoholism in elderly patients. Journal of the American Geriatric Society1989; 37: 310–316.
38.
LebowitzBDPearsonJLSchneiderLSReynoldsCFAlexopoulosGSBruceMLConwellYKatzIRMeyersBSMorrisonMFMosseyJNiedereheGParmaleeP. Diagnosis and treatment of depression in late life. Consensus statement update. Journal of the American Medical Association1997; 278: 1186–1190.
39.
OkinRLBocellariAAzocarFShumwayMO'BrienKGelbAKohnMHardingPWachsmuthC. The effects of clinical case management on hospital service use among ED frequent users. American Journal of Emergency Medicine2000; 18: 603–608.
