Low use of mental health services among older Americans with mood and anxiety disorders.
OBJECTIVE
It is unclear why late-life mood and anxiety disorders are highly undertreated, despite being common among older adults. Thus this study examined prevalence of and key factors associated with nonuse of mental health services among older community-dwelling adults with these disorders.


METHODS
The sample included 348 participants aged 55 years or older who met 12-month criteria for DSM-IV mood and anxiety disorders and responded to the National Comorbidity Survey Replication (NCS-R), a population-based probability sample. Analyses included frequency measures and logistic regression with weights and complex design-corrected statistical tests. Key factors associated with not using mental health services were determined in a final multivariable model based on a systematic approach that accounted for a comprehensive list of potential predictors.


RESULTS
Approximately 70% of older adults with mood and anxiety disorders did not use services. Those who were from racial-ethnic minority groups, were not comfortable with discussing personal problems, were married or cohabitating, and had middle- versus high-income status had increased odds of not using mental health services. In addition, respondents with mild versus serious disorders, no chronic pain complaints, and low versus high perceived cognitive impairment had greater odds of nonuse.


CONCLUSIONS
Results indicate that improvements are needed in the following areas to combat the very high number of mood and anxiety disorders that go untreated in older Americans: awareness of need, comfort in discussing personal problems with a health care professional, and screening and other prevention efforts.
Department of Psychiatry, University of California, San Francisco (UCSF), 4150 Clement St. (116H), San Francisco, CA 94121, USA. amy.byers@ucsf.edu
Amy L
AL
Byers
Patricia A
PA
Arean
Kristine
K
Yaffe
D000367:Age Factors; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004812:Epidemiologic Methods; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D006278:Medicare; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology* / Q000628:therapy; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology