Mental health services use: Baltimore epidemiologic catchment area follow-up.
OBJECTIVE
To examine the patterns of previous and current mental health services use among older adults in the Baltimore Epidemiologic Catchment Area Follow-up. Examination of a recent cohort of older adults is important because patterns of utilization may have changed due to treatment advances, changes in mental healthcare services, and greater mental health awareness.


METHODS
A population-based longitudinal survey.


METHODS
Continuing participants in a study of community-dwelling adults who were living in East Baltimore in 1981.


METHODS
In all, 1,067 adults for whom complete data were available.


METHODS
Separately, and before the mental health assessments were made, participants were asked about use of health services. Cognitive status and physical health were assessed using standardized instruments. Mental disorders were assessed using the Diagnostic Interview Schedule.


RESULTS
Compared with adults aged 40-59 years in 2004, adults aged 60 years and older were less likely to report specialty mental health services versus general medical care without a mental health component (adjusted odds ratio = 0.28, 95% confidence interval [0.14-0.56]). Multivariate models controlled for potentially influential characteristics including major depression or depression associated with recent bereavement, anxiety disorders, and past use of mental health services.


CONCLUSIONS
Adults aged 60 years and older are approximately one third as likely to consult a specialist in mental health compared with adults aged 40-59 years even accounting for other factors associated with differential use of services. Our study strengthens evidence that the primary care remains important for the treatment of psychiatric disorders in the elderly.
Bogner
Hillary R
HR
Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA. hillary.bogner@uphs.upenn.edu
de Vries
Heather F
HF
Maulik
Pallab K
PK
Unützer
Jürgen
J
D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D015142:Baltimore / Q000453:epidemiology; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D003863:Depression / Q000453:epidemiology* / Q000534:rehabilitation; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires