Regular Research Article
Caring for Mental Illness in the United States: A Focus on Older Adults

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Objective

The authors compared rates of common mental disorders and the use of primary care and specialty mental health services among younger and older adults.

Methods

They used data from 9,585 respondents to the HealthCare for Communities (HCC) Household Telephone Survey. Mental disorders during the past year, including depression, dysthymia, and generalized anxiety disorder, were identified with a short questionnaire. The survey also collected information about sociodemographic and insurance status, perceived need for mental health care, and use of health services.

Results

Older adults (age 65 and older) were significantly less likely than younger adults (18–29) or middle-aged adults (30–64) to meet diagnostic criteria for a mental disorder (8% versus 15% in each of the younger age-groups). Older adults who met diagnostic criteria for mental disorders were less likely to perceive a need for mental health care, to receive specialty mental health care or counseling, or to receive referrals from primary care to mental health specialty care than young or middle-aged adults.

Conclusion

Few older adults with mental disorders use mental health services, particularly specialty mental health services. The lack of perceived need for mental health care may contribute to low rates of mental health service use among older adults.

Section snippets

METHODS

We analyzed data from the Healthcare for Communities (HCC) household survey, fielded between September 1997 and March 1998. This survey, funded by the Robert Wood Johnson Foundation, was designed to provide information about treatment for alcohol, drug, and mental health conditions. The HCC survey respondents were selected from participants in the Community Tracking Study (CTS), a nationally representative study of 60,446 individuals run in 1996 and 1997 (65% response rate). The HCC sample was

RESULTS

Sample characteristics, broken down into three age categories (young adults from 18 to 29, middle-aged adults from 30 to 64, and older adults age 65 and older) can be found in Table 1, which contains weighted percentages and unweighted Ns. HCC data are weighted to be nationally representative and to track the census numbers based on the Current Population Survey (CPS) well, suggesting that HCC findings are generalizable.16

Largely because of Medicare coverage, the oldest age-group was the least

DISCUSSION

Only about half of all respondents who met research diagnostic criteria for mental disorders reported any treatment for such disorders in primary care or specialty mental health care settings during a 1-year period, confirming a high level of unmet need for mental health care that has been documented in previous studies.1, 5, 17 Our findings suggest that middle-aged adults with probable mental disorders have higher rates of mental health care than younger or older adults in almost every

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    We thank Dr. Kenneth B. Wells for his support and review of an earlier version of this manuscript and Lily Zhang, M.S., for outstanding programming support.

    This work was funded by The Robert Wood Johnson Foundation Healthcare for Communities (Grant #031280; Kenneth B. Wells, M.D., M.P.H., P.I.), The John A. Hartford Foundation/AFAR Medical Student Geriatric Scholars Program (Kathleen Tschantz), The John A. Hartford Foundation (Jürgen Unützer, M.D., M.P.H.), and The Research Center on Managed Care for Psychiatric Disorders (National Institute of Mental Health: #2 P50MH54623; Kenneth B. Wells, M.D., M.P.H., P.I.).

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