Mental health services are underutilized by older adults, particularly in relation to the prevalence of depressive and anxious symptoms among this population (see our earlier post on depression and older adults).
A study found that among older adults in their survey sample, around two-thirds of those meeting diagnostic criteria for major depressive disorder (MDD) and almost three-quarters of those meeting criteria for an anxiety disorder didn’t receive mental health care within the previous year. The authors then examined how individual perceptions, psychological health, physical illness, and alcohol use relate to the use of mental health care by older adults.
The article is based on secondary data analysis of the older adult sample within the Collaborative Psychiatric Epidemiology Surveys, a public-use survey of community-dwelling adults in the U.S. The analysis focused on determining the factors that influenced whether or not individuals visited a primary care provider or mental health specialist for mental health care in the previous year. Based on the survey, individuals were assessed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depressive disorder (MDD), dysthymia (a form of depressive disorder with less severe symptoms but longer duration than MDD), anxiety disorders (including PTSD and generalized anxiety disorder), and alcohol dependence or abuse. Individuals were also scored for physical health and function, their own perceived need for mental health services, sociodemographic characteristics, insurance status, attitudes toward mental health care, and, for individuals who indicated a need for care, any delay in seeking care.
Most older adults who met criteria for depression and anxiety did not receive care, which was due in part to not perceiving a need for care or for wanting to wait out such symptoms; however, 17% of those who identified a need for care did not receive it. Women, those with private insurance, and individuals with a history of chronic physical conditions were more likely to seek care. Greater mobility, a lifetime prevalence of anxious symptoms below clinical threshold, and ethnic minority status predicted delaying or avoiding care. Individuals with past symptoms of alcohol use or dependence were more likely to seek mental health care as well. Multivariate regression was also able to point to factors such as larger household size and age.
In sum, this survey of an older adult U.S. population showed a “greater amount of unmet need for formal care use than found in samples including younger adults.” In other words, “millions of older adults…are not receiving [mental health care] that they feel they need.” The authors note the high proportion of those receiving care through a primary care provider and suggest that older adults may be more likely to mention mental health symptoms to such a doctor—that attitude toward mental health care is a contributing factor as well. Further, anxiety and a lack of insurance also appear to be stumbling blocks. The authors did not speculate about the reasons for gender and ethnic differences.
The authors note that the cross-sectional nature of the data makes it impossible to explore how these categories influence one another. For instance, we cannot use these data to ask whether or not individuals who receive mental health treatment may be more likely to pathologize or otherwise selectively interpret their alcohol use or to what extent gender or ethnic identity influence perceptions of mental health care. These are by no means criticisms of this study, however. Cross-sectional survey data are vital in conceptualizing the bigger picture of mental health use among older adults and is the only way to draw such comparisons across groups that can draw attention to differences. This study identifies a gap between the utilization of and the need for (both as assessed by clinical standards and self-perception) mental health services. It points to the influence of perception and attitudes on health-seeking behavior and identifies some differences between those who seek care and those who do not.