Characteristics and Service Use of Older Adults with Schizoaffective Disorder Versus Older Adults with Schizophrenia and Bipolar Disorder

Public mental health service use among U.S. adults age 50+ compared to younger age groups

Despite increasing numbers of older-adult mental health service users, few studies have examined their use of public mental health services. Using the 2018 and 2019 Mental Health-Client Level data for clients age 18+ (N = 4,291,737 in 2018 and N = 4,513,946 in 2019), we examined whether those age 50+ who received outpatient-only, both outpatient and inpatient, or inpatient-only services had greater odds of certain types of mental disorders, especially schizophrenia, than younger adults. Of all users, 25.3% were age 50-64 and 6.7% were age 65 + . Multivariable logistic regression results, controlling for gender, race/ethnicity, census region, and alcohol/substance use disorder, showed that compared to the 30-49 age group, the 50-64 and 65+ age groups had higher odds of having depressive disorder in outpatient-only settings; however, they had consistently higher odds of a diagnosis of schizophrenia or other psychotic disorder in all three service settings. Along with advocating for increased funding for publicly-financed mental health services, social workers in public mental health service systems should ensure that they utilize effective intervention skills for older adults with serious mental illness.

Recent violence and legal involvement among young adults with early psychosis enrolled in Coordinated Specialty Care

AIM

Individuals with serious mental illnesses have a small increased risk of engaging in violence or legal involvement compared to the general population. This seems to be particularly true for young adults experiencing early stages of psychosis. This study analysed the prevalence of and risk factors for reports of violence and legal involvement in a sample of young adults receiving Coordinated Specialty Care for early non-affective psychosis.

METHODS

A total of 373 young adults (ages 16-30) within 2 years of the onset of non-affective psychosis were enrolled in 10 Coordinated Specialty Care sites in New York State from October 2013 to August 2016. Baseline violent ideation or behaviour and legal involvement was described and predictors identified.

RESULTS

Approximately one-quarter of individuals had either recent violent ideation or behaviour at baseline (n = 90, 24.6%); nearly one-tenth of the sample reported recent legal involvement (n = 33, 9.0%). Individuals with violent ideation or behaviour had lower levels of education and were less likely to be working. Those with recent legal involvement were more likely to be male and more likely to have substance use (alcohol, cannabis and other drugs).

CONCLUSIONS

The overall rate of recent violent ideation or behaviour is similar to other studies; up to one-third of individuals experiencing a first-episode of psychosis (FEP) report violence. Recent legal involvement was strongly associated with substance use. This study presents insight into violence and legal involvement among individuals with FEP and indicates the need for further research.

Patient experience with healthcare services among older adults with serious mental illness compared to the general older population

Objective To compare patient experience with healthcare services and providers among older patients (≥50 years old) with and without serious mental illness. Methods Using secondary data from the Medical Expenditures Panel Survey from 2003 through 2013, we compared adults aged 50 years and older with schizophrenia spectrum disorder ( n = 106), mood disorders (i.e., major depressive disorder and bipolar disorder) ( n = 419), and no serious mental illness ( n = 34,921). Results Older adults with schizophrenia spectrum disorder reported significantly worse provider communication than older adults without serious mental illness. Older adults with mood disorders reported the greatest barriers to shared decision-making and the greatest difficulty accessing services. Conclusions Our results highlight the need to improve the patient experience of older adults with serious mental illness. Addressing provider communication, shared decision-making, and access to care among this vulnerable group of older adults may impact clinical outcomes and costs. Future research examining the extent to which improving the patient experience may improve health outcomes and enhance treatment for this highly vulnerable older group is warranted.