Do older Australians truly have low rates of anxiety and depression? A critique of the 1997 National Survey of Mental Health and Wellbeing

Prevalence of mental disorders among older Australians: Contrasting evidence from the 2020-2021 National Study of Mental Health and Wellbeing among men and women and the Health In Men Data Linkage Study

OBJECTIVE

To determine the prevalence of common mental disorders among older Australians included in the Health In Men Data Linkage Study and compare those with the results of the 2020-2021 National Study of Mental Health and Wellbeing (NSMHW).

METHOD

We used longitudinal record linkage to estimate the prevalence of mental disorders from age 65 years in a random sample of 38173 Australian men aged 65-85 years living in the Perth metropolitan region. Outcome was the proportion of participants affected by depressive episodes or dysthymia, bipolar disorder, anxiety disorder, psychotic disorder and alcohol use disorder.

RESULTS

Prevalence estimates for participants aged 65-69, 70-74, 75-79, 80-84 and ≥85 years were 0.9%, 2.0%, 3.6%, 5.8% and 12.6% for depressive, 0.2%, 0.3%, 0.4%, 0.4% and 0.7% for bipolar, 0.1%, 0.5%, 1.3%, 2.2%, 6.9% for anxiety, 0.2%, 0.4%, 0.5%, 0.4% and 0.6% for psychotic and 1.2%, 1.7%, 2.1%, 2.2% and 4.2% for alcohol use disorders.

CONCLUSIONS

In contrast to the NSMHW, our data indicate that the prevalence of depressive and anxiety disorders increases with age, particularly among the older old. We conclude that the NSMHW should not be relied upon to guide planning or policies to address the mental health needs of older Australians.

Neuronavigated repetitive transcranial magnetic stimulation improves depression, anxiety and motor symptoms in Parkinson's disease

Background

Repetitive transcranial magnetic stimulation (rTMS) is a potential treatment option for Parkinson's disease patients with depression (DPD), but conflicting results in previous studies have questioned its efficacy.

Method

To investigate the safety and efficacy of neuronavigated high-frequency rTMS at the left DLPFC in DPD patients, we conducted a randomized, double-blind, sham-controlled study (NCT04707378). Sixty patients were randomly assigned to either a sham or active stimulation group and received rTMS for ten consecutive days. The primary outcome was HAMD, while secondary outcomes included HAMA, MMSE, MoCA and MDS-UPDRS-III. Assessments were performed at baseline, immediately after treatment, 2 weeks, and 4 weeks post-treatment.

Results

The GEE analysis showed that the active stimulation group had significant improvements in depression, anxiety, and motor symptoms at various time points. Specifically, there were significant time-by-group interaction effects in depression immediately after treatment (β, -4.34 [95% CI, -6.90 to -1.74; P = 0.001]), at 2 weeks post-treatment (β, -3.66 [95% CI, -6.43 to -0.90; P = 0.010]), and at 4 weeks post-treatment (β, -4.94 [95% CI, -7.60 to -2.29; P < 0.001]). Similarly, there were significant time-by-group interaction effects in anxiety at 4 weeks post-treatment (β, -2.65 [95% CI, -4.96 to -0.34; P = 0.024]) and in motor symptoms immediately after treatment (β, -5.72 [95% CI, -9.10 to -2.34; P = 0.001] and at 4 weeks post-treatment (β, -5.43 [95% CI, -10.24 to -0.61; P = 0.027]).

Conclusion

The study suggested that neuronavigated high-frequency rTMS at left DLPFC is effective for depression, anxiety, and motor symptoms in PD patients.

Distinct health-related risk profiles among middle-aged and older adults with risky alcohol use from the Danish general population

BACKGROUND

Knowledge is lacking on distinct health-related risk profiles among the substantial group of middle-aged and older adults with risky alcohol use (AU). Such profiles could inform the planning of interventions and prevention.

AIMS

To 1) identify distinct health-related profiles based on different types of health-related functioning limitations and distress and 2) assess associations between these profiles and age, sex, and health-relevant behaviors (e.g., smoking).

METHODS

Cross-sectional nation-wide Danish health survey with n = 6630 adults aged 55-64 and n = 7605 aged 65-74 with at least risky AU (>84 g ethanol/week in women, >168 in men). Health-related risk profiles were identified with Latent Class Analysis (LCA). Multinomial regression was applied for the association between risk profiles and auxiliary variables.

RESULTS

A six-class LCA solution was found among 55-64 year-olds (classes: 'Normative' [61%], 'Distress' [6%], 'Mental health limitations [5%]', 'Pain-related distress [10%]', 'Broad limitations and pain distress [7%]', 'High overall burden' [11%]) and a five-class solution among 65-74 year-olds. Most classes were comparable across age groups. The 'Distress'-class characterized by pain-distress, tiredness-distress, and sleep-related distress (6%) only showed in the younger group. In both age groups, auxiliary covariates (high-risk AU, possible alcohol use disorder, weekly smoking) were positively associated with problematic profile membership (vs. normative class membership).

CONCLUSION

Middle-aged and older adults with risky AU have distinct health-related profiles relevant for the form and content of prevention and interventions. Despite their distinct features, almost all problematic health profiles warrant careful attention regarding high-risk AU and probable alcohol use disorder.

The Relationship between Oxidative Stress and Anxiety in a Healthy Older Population

Background/study context: F₂-Isoprostanes are putative markers of oxidative stress, one of the processes associated with biological senescence. Evidence exists for elevated F₂-Isoprostanes in chronic conditions including psychiatric disorders. Few studies have examined the relationship between oxidative stress and mood in older healthy samples, to establish the influence on mental health. Given current aging demographics in many nations, management of brain and mental health is crucial for longevity, chronic disease management, and quality of life.Method: We investigated the relationship between F₂-Isoprostanes, a marker for oxidative stress, and anxiety and mood in 262 healthy adults aged 60-75 years, using baseline data from the Australian Research Council Longevity Intervention (ARCLI; ANZCTR12611000487910), a 12-month nutraceutical intervention study.Results: Higher F2 levels significantly predicted increased Depression-dejection and Anger-hostility subscale scores from the Profile of Mood States (POMS). Fatigue-inertia subscale was predicted by increased Body Mass Index. Spielberger State-Trait Inventory (STAI) scores were significantly higher in females.Conclusion: While the primary outcome data did not find a definitive relationship between F2 and total mood or general anxiety levels, the sub-scale data adds weight toward growing literature that biological processes such as oxidative stress are in part related to mood. This is a modifiable risk factor contributing to physical and mental wellbeing that are crucial to healthy aging.

Depression in Parkinson's disease: Perspectives from an Australian cohort

INTRODUCTION

Depression is often an under-recognised feature of Parkinson's disease (PD). It is detrimental to physical and interpersonal functioning, negatively impacting a patient's clinical management, quality of life and well-being. We aimed to identify clinical predictors and management implications of depression in Australian PD patients.

METHODS

103 PD and 81 Healthy Control (HC) subjects were evaluated using the Beck Depression Inventory (BDI) and other validated PD motor and non-motor symptom (NMS) tools.

RESULTS

Nearly twice as many PD patients were depressed, (38.9% vs 20.1%, p = 0.009), with a corresponding increase in depression severity on the BDI (11.9; standard deviation (SD) 8.8 vs 5.2; SD 5.5, p<0.001), and an odds ratio of 2.4 (95% confidence interval 1.2 - 4.7). Employment appeared to be a relative protective factor for depression, whilst patients requiring support services seemed to be more vulnerable to depression. Rapid Eye Movement Sleep Behaviour Disorder, dyskinesias, impulse control disorder, higher daily levodopa equivalent dose, increased motor severity, as well as catechol-O-methyltransferase inhibitor and amantadine use, all showed associations with depression (p<0.05). Chronic pain, decreased physical activity, constipation and upper gastrointestinal dysfunction presented with an apparent increase in risk for developing depression and increased depression severity. Other NMS were also found to be associated with PD-related depression.

LIMITATIONS

Potential selection bias of self-reporting data collection from specialist PD clinics in a single metropolitan area.

CONCLUSION

Our findings provide novel insight into the prevalence of depression in PD, possible contributory factors and future treatment strategies targeting depression in PD.

Research on Supportive Psychosocial, Drug Treatment, and Health Education Intervention and Health Management Model of Community-Residing Elderly Adults With Late Life Depression in Liaoning Province: A Protocol

BACKGROUND

Late life depression (LLD), a common mental disorder, has become an increasingly acute public health concern with a quickly expanding geriatric population worldwide. To our knowledge, however, the incidence of LLD in northern cities in China has not been empirically investigated, and many elderly people with depressive moods and mild depressive symptoms have not been given sufficient attention.

METHODS/DESIGN

This is a multi-stage and prospective study. The first stage is a cross-sectional study, investigating the epidemiological characteristics of LLD in northern China and exploring the biological, psychological, and social risk factors for developing LLD based on a set of questionnaires from 6,800 community-residing elderly adults. The second stage involves statistical analysis, by constructing a risk factor model for LLD and analyzing their direct and indirect functional routes on the basis of structural equation modeling. The third stage is an experimental study a total of 60 elderly patients with LLD and their principle caregivers will be randomly assigned to control and trial groups. The trial group patients and caregivers will undergo supportive psychosocial, drug treatment, and health education (PDH) intervention, whereas the control group patients and caregivers will be treated routinely (treatment as routine, TAR, which includes drug treatment and health education). At the end of the intervention, depressive symptoms, quality of life, and the social and cognitive functioning of the patients in the two groups will be respectively assessed at a baseline and after 6, 9, and 12 months post-intervention by employing scales and questionnaires to analyze the effectiveness of the supportive PDH intervention measures in comparison with TAR. Ultimately, a supportive PDH intervention and health management model will be obtained by combining PDH intervention with mental health institutions, community health services, and aging families as the main line.

DISCUSSION

This study will provide strong and suitable evidence for enhancing the integrated supportive PDH intervention and health management model of LLD patients among community-dwelling residents.

ETHICS

This study has been approved by the Ethics and Research Committee of the First Affiliated Hospital of China Medical University (approval No. [2019] 2019-312-2).

Association of depression with mortality in an elderly treated hypertensive population

ABSTRACTBackground:Both elevated blood pressure and/or depression increase the risk of cardiovascular disease and mortality. This study in treated elderly hypertensive patients explored the incidence of depression, its association (pre-existing and incident) with mortality and predictors of incident depression.

METHODS

Data from 6,083 hypertensive patients aged ≥65 years enrolled in the Second Australian National Blood Pressure study were used. Participants were followed for a median of 10.8 years (including 4.1 years in-trial) and classified into: "no depression," "pre-existing" and "incident" depression groups based on either being "diagnosed with depressive disorders" and/or "treated with an anti-depressant drug" at baseline or during in-trial period. Further, we redefined "depression" restricted to presence of both conditions for sensitivity analyses. For the current study, end-points were all-cause and any cardiovascular mortality.

RESULTS

313 (5%) participants had pre-existing depression and a further 916 (15%) participants developed depression during the trial period (incidence 4% per annum). Increased (hazard-ratio, 95% confidence-interval) all-cause mortality was observed among those with either pre-existing (1.23, 1.01-1.50; p = 0.03) or incident (1.26, 1.12-1.41; p &lt; 0.001) depression compared to those without. For cardiovascular mortality, a 24% increased risk (1.24, 1.05-1.47; p = 0.01) was observed among those with incident depression. The sensitivity analyses, using the restricted depression definition showed similar associations. Incident depression was associated with being female, aged ≥75 years, being an active smoker at study entry, and developing new diabetes during the study period.

CONCLUSIONS

This elderly cohort had a high incidence of depression irrespective of their randomised antihypertensive regimen. Both pre-existing and incident depression were associated with increased mortality.

Childhood sexual abuse, poly-victimization and internalizing disorders across adulthood and older age: Findings from a 25-year longitudinal study

BACKGROUND

We aimed to investigate associations between childhood sexual abuse and maltreatment and internalizing disorders (anxiety, depression, PTSD) across adulthood.

METHODS

Following a postal survey of 2220 women, a subsample was selected to participate in an interview. The subsample included 276 women reporting childhood sexual abuse and 221 women with no reported history of childhood sexual abuse. Interviews were repeated six and 25 years following the first interview. Internalizing disorders were assessed using ICD-8 and DSM-III criteria.

RESULTS

There was a lower probability of having an internalizing disorder at older ages than younger ages for all women, regardless of maltreatment history. Latent class analysis was used to define three classes (no/low maltreatment, sexual abuse, poly-victimisation). Compared with no/low maltreatment, a history of childhood sexual abuse was associated with almost double the risk of an internalizing disorder and a history of poly-victimisation was associated with over four times the risk of an internalizing disorder. Childhood sexual abuse and poly-victimisation remained associated with an elevated risk of a disorder in older age.

LIMITATIONS

Findings are limited by attrition (39% participated at Time 3), low prevalence of severe physical abuse, and changes in assessment practice of childhood maltreatment and mental disorder in the past 30 years.

CONCLUSIONS

Screening and treatment for internalizing disorders in women with histories of childhood maltreatment remains important in older aged populations.

Prevalence of mental disorders in elderly people: the European MentDis_ICF65+ study

BACKGROUND

Except for dementia and depression, little is known about common mental disorders in elderly people.

AIMS

To estimate current, 12-month and lifetime prevalence rates of mental disorders in different European and associated countries using a standardised diagnostic interview adapted to measure the cognitive needs of elderly people.

METHOD

The MentDis_ICF65+ study is based on an age-stratified, random sample of 3142 older men and women (65-84 years) living in selected catchment community areas of participating countries.

RESULTS

One in two individuals had experienced a mental disorder in their lifetime, one in three within the past year and nearly one in four currently had a mental disorder. The most prevalent disorders were anxiety disorders, followed by affective and substance-related disorders.

CONCLUSIONS

Compared with previous studies we found substantially higher prevalence rates for most mental disorders. These findings underscore the need for improving diagnostic assessments adapted to the cognitive capacity of elderly people. There is a need to raise awareness of psychosocial problems in elderly people and to deliver high-quality mental health services to these individuals.

Post-Traumatic Stress Disorder Across the Adult Lifespan: Findings From a Nationally Representative Survey

OBJECTIVE

There is a dearth of community-based epidemiologic literature that examines post-traumatic stress disorder (PTSD) across the adult lifespan. In the current study the authors address this gap by examining the ways in which PTSD differs among young (ages 20-34), middle-aged (ages 35-64), and older (age 65+) adults with respect to past-year prevalence, nature of "worst" stressful experience ever experienced before the onset of PTSD, all traumatic experiences, symptom expression, psychiatric comorbidities, and mental health-related quality of life.

METHODS

We analyzed Wave 2 data from the National Epidemiologic Survey on Alcohol and Related Conditions, including adults with past-year diagnoses of PTSD (N = 1,715).

RESULTS

The prevalence of past-year PTSD was significantly higher for young (4.3% [SE: 0.3]) and middle-aged (5.2% [SE: 0.2]) adults compared with older adults (2.6% [SE: 0.2]). Respondents in the three age groups differed with regard to their "worst" stressful experience ever experienced before the onset of PTSD and to all traumatic experiences. Older adults experienced significantly fewer traumatic experiences (mean: 5.2; SE: 0.2) compared with young (mean: 5.7; SE: 0.2) and middle-aged adults (mean: 6.4; SE: 0.1). Young and middle-aged adults had significantly greater symptom counts and greater odds of comorbid psychiatric disorders when compared with older adults. PTSD had similar effects on mental health-related quality of life across the adult lifespan.

CONCLUSION

Results highlight key differences in the characteristics of PTSD across the adult lifespan. The overall pattern of findings indicates that increasing age is associated with less severe PTSD profiles, including lower prevalence, fewer traumatic experiences, lower symptom counts, and lower odds of psychiatric comorbidity.

Prevalence of depression in Parkinson's disease in a Lebanese tertiary clinic

INTRODUCTION

Diagnosis of Parkinson's disease can be emotionally and psychologically challenging to patients. The aim of this study is to investigate the association between Parkinson's disease and depression and the impact of the disease stage and patients' age and gender on this association.

METHOD

This is a cross-sectional retrospective study on 200 patients aged above 35 years old from 10 different nationalities.

RESULTS

Depression was diagnosed in 46% of the patients enrolled. Most of these patients were treated with an antidepressant. Young age, female gender, and moderate Parkinson's disease stage were found to be significantly associated with depression (odds ratio of 1.19, 1.23, and 1.22, respectively, p < .05).

CONCLUSION

This study, the first of its kind in Lebanon and the Middle East and North Africa region, highlights the importance of studying depression in Parkinson's disease and the need for identifying and treating depression symptoms when treating Parkinson's disease patients.

Association of depression with sexual and daily activities: a community study of octogenarian men

OBJECTIVE

To determine the association between clinically significant depressive symptoms, routine function, and sexual interest and practice in a community-derived sample of octogenarian men.

METHODS

Cross-sectional study of 1,649 community-dwelling men aged 80 years or over with no history of terminal illnesses or neurodegenerative diseases. Men with Patient Health Questionnaire (PHQ-9) scores greater than or equal to 10 were deemed to be clinically depressed. Scores between 5 and 9 were considered indicative of subthreshold depression. We used standard procedures to collect self-reported sociodemographic, lifestyle, and clinical data, as well as basic and instrumental activities of daily living, and a structured questionnaire to ask men about their 12-month interest in sex, frequency, past experiences, and current sexual problems.

RESULTS

121 men (7.3%) had clinically significant depression and 239 (14.5%) had subthreshold depression. Depressive symptoms were associated with difficulties in basic and instrumental activities of daily living, but not with sexual practice. Decreased interest in sex and anxiety before sex were associated with subthreshold depression. Clinically significant depressive symptoms were independently and positively associated with past history of diabetes (odds ratio [OR]: 2.1, 95% confidence interval [CI]: 1.1-4.0), depression (OR: 9.0; 95% CI: 4.6-17.3), impaired ability to groom (OR: 3.7, 95% CI: 1.2-11.0), carry out heavy housework duties (OR: 2.4, 95% CI: 1.1-5.1), manage finances (OR: 2.5, 95% CI: 1.1-5.7), or engage in leisure activities (OR: 4.1, 95% CI: 2.0-8.2).

CONCLUSIONS

Ability to function effectively at home, financial autonomy, and leisure are associated with clinically significant depression in octogenarian men. Maintaining daily function and autonomy may be a suitable target for interventions that aim to reduce the prevalence and incidence of depression in older age.

Sleep and aging: examining the effect of psychological symptoms and risk of sleep-disordered breathing

Controversy exists as to whether self-reported sleep quality declines with age, despite changes in sleep being accepted as part of normal aging. This study sought to investigate age-related differences in self-reported sleep quality, after controlling for conditions that are common with age, such as psychological symptoms and increased risk of sleep-disordered breathing (SDB). The Pittsburgh Sleep Quality Index (PSQI) was administered to a sample of 582 community adults (aged 18-89 years), and the association between age and 3 factors of the PSQI (sleep efficiency, perceived sleep quality, and daily disturbance), and global scores, was examined controlling for depression, anxiety, stress, gender, and SDB risk. Results indicate that (a) before controlling for covariates, there was no significant relation between age and all indexes of self-reported sleep quality, with the exception of sleep efficiency. However, once depression, gender, and SDB risk were controlled for, a significant, yet small, relation was revealed between older age and poorer global sleep quality; (b) there was no association between age and perceived sleep quality or daily disturbances before or after controlling for relevant covariates; and (c) depression, gender, and SDB risk were significant predictors of poorer sleep quality across the indexes but, in general, did not have a marked impact on the relation between age and sleep quality. In conclusion, results suggest that sleep problems are common across the lifespan, and that there were modest age-related differences in self-reported sleep quality, which were not due to depressed mood, gender, or risk of SDB.

Mood and anxiety disorders across the adult lifespan: a European perspective

BACKGROUND

The World Mental Health Survey Initiative (WMHSI) has advanced our understanding of mental disorders by providing data suitable for analysis across many countries. However, these data have not yet been fully explored from a cross-national lifespan perspective. In particular, there is a shortage of research on the relationship between mood and anxiety disorders and age across countries. In this study we used multigroup methods to model the distribution of 12-month DSM-IV/CIDI mood and anxiety disorders across the adult lifespan in relation to determinants of mental health in 10 European Union (EU) countries.

METHOD

Logistic regression was used to model the odds of any mood or any anxiety disorder as a function of age, gender, marital status, urbanicity and employment using a multigroup approach (n = 35500). This allowed for the testing of specific lifespan hypotheses across participating countries.

RESULTS

No simple geographical pattern exists with which to describe the relationship between 12-month prevalence of mood and anxiety disorders and age. Of the adults sampled, very few aged ≥ 80 years met DSM-IV diagnostic criteria for these disorders. The associations between these disorders and key sociodemographic variables were relatively homogeneous across countries after adjusting for age.

CONCLUSIONS

Further research is required to confirm that there are indeed stages in the lifespan where the reported prevalence of mental disorders is low, such as among younger adults in the East and older adults in the West. This project illustrates the difficulties in conducting research among different age groups simultaneously.

Relationship between measurement invariance and age-related differences in the prevalence of generalized anxiety disorder

BACKGROUND

Generalized anxiety disorder (GAD) peaks in prevalence in middle age and declines in prevalence into old age. Some commentators have suggested that this is not a meaningful epidemiological trend rather a methodological artifact. This study tested this hypothesis by matching respondents of different ages based on their severity and examining whether age influences the probability of endorsing GAD criteria and the prevalence of GAD.

METHODS

Self-reported worriers from a nationally representative survey of non-institutionalized adults were selected for investigation (n=1738). All respondents were interviewed using the World Mental Health version of the Composite International Diagnostic Interview. Age-related differences in the prevalence and invariance of the GAD criteria were examined between 16 and 29 years, 30 and 44 years, 45 and 59 years and 60 years+ age groups. Effect sizes were used to assess the impact of statistically significant criterion level non-invariance on the prevalence of GAD.

RESULTS

Respondents aged 60 years or more were less likely than younger adults to endorse most of the GAD criteria. Significant non-invariance was identified in each of the age group analyses. Nonetheless these differences had no impact on the prevalence of GAD in three group comparisons. In the other three group comparisons, the impact was minimal (d ≤ 0.3).

LIMITATIONS

Our results support age-related differences in the prevalence of GAD but we are limited to the extent to which we can say why these differences occur.

CONCLUSIONS

Age-related prevalence differences in GAD are meaningful epidemiological trends.

Investigating age-related differences in responses to screening items for internalising disorders in three national surveys

BACKGROUND

Epidemiological studies typically report lower prevalence of mental disorders among older adults relative to middle-aged and young adults. A possible explanation is that age-related bias in the screening items of diagnostic instruments leads to older adults being differentially screened out of the full assessment. This study investigated potential age-related bias in screening items for internalising disorders in three epidemiological surveys.

METHOD

Measurement invariance was estimated for the internalising disorder screening items in the 2007 and 1997 Australian National Survey of Mental Health and Wellbeing, and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. These surveys assessed mental disorders using the Composite International Diagnostic Interview (CIDI) and the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). A series of multi-group confirmatory factor analyses (CFA) were performed for each survey across older (65-85 years), middle (35-64 years) and young (16-34 years) adults.

RESULTS

Differences between successive CFA models for each survey were negligible, indicating measurement invariance across age groups for the CIDI and AUDADIS-IV screening items.

LIMITATIONS

The number of items and symptoms representing internalising pathology differed between surveys. The samples excluded people in aged-care institutions.

CONCLUSIONS

While findings do not rule out that other measurement errors may be present (e.g., age-related bias in the remaining items), these results support the validity of the screening items in the CIDI and AUDADIS-IV. Low prevalence estimates of internalising disorders in older adults are unlikely attributable to differences in response patterns to screening items.

Clinical issues in the treatment of anxiety and depression in older adults with Parkinson's disease

A significant proportion of persons affected by Parkinson's disease (PD) are over age 65 years. Mental health issues are often less a focus of treatment in this population than physical manifestations of the illness. Anxiety or depression alone, as well as comorbid depression and anxiety, are underrecognized in patients with PD and are associated with deleterious effects on physical and interpersonal functioning, negatively impacting quality of life and well-being. We offer a brief overview of salient clinical points with respect to assessment and treatment approaches to enhance efficacy of the treatment of mental health symptoms in older adults with PD. Cognitive behavior therapy involves the patient learning to overcome behavioral avoidance associated with anxiety and challenge unhelpful negative cognitions. It is suggested that cognitive behavior therapy is an effective approach to treatment of anxiety and depression in PD and should be offered as a treatment to patients.

Use of serotonergic antidepressants and St John's wort in older Australians: a population-based cohort study

OBJECTIVE

The study investigated the use of serotonergic antidepressants (SSRIs: selective serotonin reuptake inhibitors; SNRIs: serotonin-norepinephrine reuptake inhibitors) and St John's wort in a large NSW-based community sample, and sought to identify a potentially dangerous concomitant use of these medications.

METHODS

Cross-sectional data from 266,848 participants from the '45 and Up' study were used. The questionnaire captures self-reported treatment for depression or anxiety and antidepressant medications in the last four weeks.

RESULTS

5.8% of participants received treatment for depression or anxiety, with 4.7% taking an SSRI and 1.3% an SNRI. St John's wort was taken by 0.3% of the participants. Use of SSRIs and SNRIs was reported more frequently by females than males (respectively, 64.1% vs 35.9%, 66.9% vs 33.1%). The gender difference was even more pronounced for St John's wort (75.6% vs. 24.4%). Use of antidepressants decreased after the age of 65 years. One hundred and forty people reported concurrent use of an SSRI and an SNRI, and 11 people of an SSRI with St John's wort.

CONCLUSIONS

Around 7% of the study population aged 45-65 years reported the use of SSRIs or SNRIs, decreasing to 5% above 70 years of age. It is of concern that some individuals used an SSRI concurrently with St John's wort.

Stability and change in level of probable depression and depressive symptoms in a sample of middle and older-aged adults

BACKGROUND

Findings from studies investigating depression in adults in late life are mixed due to a lack of large longitudinal studies with the power necessary to yield reliable estimates of stability or change. We examined the long-term stability of probable depression and depressive symptomology over a 13-year period in the Dynamic Analyses to Optimize Ageing (DYNOPTA) project.

METHODS

Community-living participants (N = 35,200) were aged 45-103 at baseline, predominantly female (79%), partnered (73%), and educated to secondary school only (61%) and followed for up to 13 years.

RESULTS

At baseline, increased age was associated with lower prevalence of probable depression and depressive symptomology. Over time, prevalence of probable depression was stable while levels of depressive symptomology reported a small decline. However, this finding was not consistent for all age groups; there was evidence for increasing levels of depressive symptomology, but not probable depression, as individuals aged. This effect was particularly notable among males aged 70 plus years.

CONCLUSIONS

These results answer important questions relating to the longitudinal prevalence of probable depression and depressive symptomology in a sample of older Australians. These findings have policy implications for mental health service provision for older adults.

The prevalence of mental disorders in older people in Western countries - a meta-analysis

OBJECTIVE

To conduct a meta-analysis assessing the prevalence of mental disorders in older people in Europe and North America.

METHOD

Studies that reported prevalence rates of mental disorders in older people from the general population were identified through MEDLINE, PsycINFO, Web of Science, and reference lists for the period between January 2000 and December 2011. Studies were included if they reported prevalence rates of mental disorders in older people (50+ years) from the community. The final sample comprised 25 studies. Prevalence rates were extracted, and effect sizes were transformed into logits. Random-effects models were calculated due to significant heterogeneity. In meta-regression analyses possible sources of bias, including age of onset, gender distribution, and risk of bias were examined. To analyze the robustness of the results, sensitivity analyses were performed. Publication bias was assessed with funnel plots and the Egger method.

RESULTS

Disorders with the highest prevalence estimates were dimensional depression (19.47%), lifetime major depression (16.52%), and lifetime alcohol use disorders (11.71%). Disorders with the lowest estimates were current and lifetime drug use disorders (0.34% and 0.19%, respectively), and current bipolar disorder and current agoraphobia (both 0.53%).

CONCLUSION

The majority of studies investigated major depression, panic disorder and social phobia. Future research requires a larger database on the epidemiology of mental disorders in the elderly. Furthermore, an improvement to the methodology that addresses the challenges of older age and produces comparable data, including the use of instruments tailored to the needs of older people, is required.

Transcranial magnetic stimulation for treating depression in elderly patients

PURPOSE

The aim of the study reported here was to examine the safety and effectiveness of high-frequency repetitive transcranial magnetic stimulation (rTMS) in elderly patients with depression.

PATIENTS AND METHODS

Sixty-five depressed elderly patients received rTMS over their left prefrontal cortex for 6 days per week, from Monday to Saturday, for 3 weeks. The rTMS intensity was set at 100% of the motor threshold and 25 Hz stimulation with a duration of 2 seconds and was delivered 20 times at 30-second intervals. A full course comprised an average of 1000 magnetic pulses. Depression was rated using the Hamilton Depression Rating Scale (HAMD) before and after treatment. Response was defined as a 50% reduction in HAMD score. Patients with HAMD scores < 8 were considered to be in remission.

RESULTS

The mean HAMD score for the study group decreased from 21.94 ± 5.12 before treatment to 11.28 ± 4.56 after rTMS (P < 0.001). Following the treatment period, 58.46% of the study group demonstrated significant mood improvement, as indexed by a reduction of more than 50% on the HAMD score. Nineteen of these 38 patients attained remission (HAMD score < 8), while 41.54% of all study patients achieved a partial response. None of the patients had a worsened HAMD score at the end of the treatment. Treatment was generally well tolerated and no serious adverse effects were reported.

CONCLUSION

In this study, rTMS was found to be a safe, well-tolerated treatment, and a useful adjunctive treatment to medications in elderly treatment-resistant depressed patients. This study contributes to the existing evidence on the antidepressant effect of rTMS in the treatment of depression in patients over 60 years of age.

Incidence of late-life depression: a systematic review

BACKGROUND

In the past years, many studies have examined the prevalence of late-life depression. However, incidence studies, especially those including the oldest age groups, remained rare. The objective of this article is therefore to provide a systematic review on incidence of depressive disorders in latest life.

METHODS

A systematic search of the literature published between 1985 and 2011 was conducted using MEDLINE, Web of Science, PsycInfo and Cochrane databases. Inclusion criteria were: incidence specified for persons aged≥70 years at baseline, population-based sample or primary care sample. Incidence rates or risks were extracted or calculated.

RESULTS

We found 20 studies reporting incidence according to categorical (n=14) or dimensional diagnoses (n=6). The incidence of depressive disorders varied considerably. Major Depression (MD) was found to occur less often than Minor Depression (MinD), whereas clinically relevant depressive symptoms are at least as frequent as MinD. The incidence rate of MD was 0.2-14.1/100 person-years, and incidence of clinically relevant depressive symptoms was 6.8/100 person-years. Female incidence was mostly higher than male. Associations between age and incidence revealed to be rather inconsistent between studies.

LIMITATIONS

Methodological diversity of the studies concerning diagnostics, data collection methods, incidence definitions and sampling make the results difficult to interprete.

CONCLUSIONS

This review is the first to have focused on incidence studies on depression in latest life. The frequent occurrence of clinically relevant depressive symptoms will have to be considered in future health care planning. Physical health and psychosocial influences appear to be key variables in depression prevention.

Factors impacting on the well-being of older residents in rural communities

BACKGROUND

In Australia, rural areas have higher proportions of older persons than metropolitan areas, where ageing poses many challenges related to social isolation, reduced mobility, more chronic disease and comorbidity, greater socio-economic disadvantage, limited access to services, and economic restructuring. Although Australian national data indicate an age-dependent decline in the prevalence of mental disorders, physical ill health is clearly associated with mental disorder in the elderly. There are conflicting findings regarding rural-urban differences in the prevalence of mental disorder, reflecting the complexity of definitions of rurality, and the geographic, ethnic and cultural diversity that underpins location and its influence on health outcomes.

AIMS

This study aims to investigate the determinants of well-being in a sample of older adults from rural and remote communities, with particular focus on the role of social factors.

METHODS

Baseline cross-sectional survey data were used from the Australian Rural Mental Health Study, a population-based longitudinal cohort of adults aged 18-85 years randomly selected from electoral rolls. We compared measures of mental health and well-being in adults aged 65 years and over with middle-aged and younger adults living in rural and regional New South Wales. Factors associated with positive well-being and psychological distress in the older group were examined using multivariate logistic regressions, reporting adjusted odds ratios (AOR) and 99% confidence intervals (CI).

RESULTS

Of the 2,624 participants, 722 (28%) were aged between 65 and 85 years. Well-being was generally higher among those aged 65 years or older, compared with younger groups, with the notable exception of perceived physical health. Among those aged 65 years or older, poorer well-being was independently associated with older age (AOR 0.29, 99% CI 0.13-0.64), one or more chronic diseases (AOR 0.34, 99% CI 0.17-0.69), and a history of depression, stress or anxiety (AOR 0.31, 99% CI 0.12-0.76). Having increased community and personal support (AOR 4.7, 99% CI 2.5-8.9) significantly increased well-being in the older participants. A comparable profile emerged for the predictors of psychological distress, with higher trait neuroticism also making a substantial contribution (AOR 6.4, 99% CI 2.3-7.8).

CONCLUSIONS

Despite increased rates of chronic illness and poorer physical health, older rural Australians reported better well-being than younger groups, possibly reflecting a survivor effect or perhaps a generational effect, in terms of greater resilience or stoicism in the older generation. Higher levels of perceived community and personal support improve current well-being and are protective for moderate to high psychological distress.

Treatment of depression in older adults

Depression is the most frequent mental disorder in older people, often causing emotional distress and reduced quality of life. Despite its clinical significance, depression remains underdiagnosed and inadequately treated in older patients. Regarding prognosis, data suggest that almost 70% of patients, treated long enough and with appropriate doses, recover from an index episode of depression. Antidepressants are efficient for treating depressed outpatients with several comorbid physical diseases as well as hospitalized patients, with selective serotonin reuptake inhibitors being the antidepressants of choice for older patients. Available data can guide pharmacological treatment in both the acute and maintenance stages, but further research is required to guide clinical strategies when remission is not achieved. Approaches for the management of resistance to treatment are summarized, including optimization strategies, drug changes, algorithms, and combined and augmentation pharmacological treatments. Finally, additional therapeutic choices such as electroconvulsive therapy, transcranial magnetic stimulation, and integrated psychotherapy are presented.

Deriving prevalence estimates of depressive symptoms throughout middle and old age in those living in the community

BACKGROUND

There is considerable debate about the prevalence of depression in old age. Epidemiological surveys and clinical studies indicate mixed evidence for the association between depression and increasing age. We examined the prevalence of probable depression in the middle aged to the oldest old in a project designed specifically to investigate the aging process.

METHODS

Community-living participants were drawn from several Australian longitudinal studies of aging that contributed to the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. Different depression scales from the contributing studies were harmonized to create a binary variable that reflected "probable depression" based on existing cut-points for each harmonized scale. Weighted prevalence was benchmarked to the Australian population which could be compared with findings from the 1997 and 2007 National Surveys of Mental Health and Well-Being (NSMHWB).

RESULTS

In the DYNOPTA project, females were more likely to report probable depression. This was consistent across age levels. Both NSMHWB surveys and DYNOPTA did not report a decline in the likelihood of reporting probable depression for the oldest old in comparison with mid-life.

CONCLUSIONS

Inconsistency in the reports of late-life depression prevalence in previous epidemiological studies may be explained by either the exclusion and/or limited sampling of the oldest old. DYNOPTA addresses these limitations and the results indicated no change in the likelihood of reporting depression with increasing age. Further research should extend these findings to examine within-person change in a longitudinal context and control for health covariates.

Perceiving a Negative Event as Central to One’s Identity Partially Mediates Age Differences in Posttraumatic Stress Disorder Symptoms

Objective: Older adults report fewer posttraumatic stress disorder (PTSD) symptoms than younger adults, but the reasons for this age difference are unclear. In the current study, the authors explored the extent to which they may be due to age differences in event centrality (the extent to which a person construes a stressful event as central to their identity). Method: A sample of older and younger adults nominated their most stressful event and completed measures of PTSD symptoms and event centrality. Results: The results revealed that older adults were less likely to construe a stressful event as central to identity, even after controlling for type of event, how long ago the event occurred, and gender. In addition, the results of a mediation analysis indicated that age-related differences in event centrality partially mediated age-related differences in PTSD symptoms. Discussion: The results are consistent with the Socioemotional Selectivity Theory view that older adults tend to use cognitive strategies designed to protect emotional health.

Affective disorders, anxiety disorders and the risk of alcohol dependence and misuse

BACKGROUND

It is unclear whether common affective disorders and anxiety disorders increase the risk of alcohol dependence and alcohol misuse. Aims To investigate whether affective disorders and anxiety disorders increase the risk of alcohol dependence and alcohol misuse.

METHOD

This study is a retrospective cohort study based on data collected from the 2007 Australia Mental Health and Well-Being survey. Both Poisson and logistic regression models were used for multivariate analysis.

RESULTS

Participants with affective disorders (relative risk (RR) = 5.46, 95% CI 4.08-7.31 for alcohol dependence within 5 years of onset; RR = 2.77, 95% CI 1.93-3.99 after first 5 years) and anxiety disorders (RR = 3.33, 95% CI 2.37-4.68 for alcohol dependence within first 5 years of onset; RR = 3.56, 95% CI 2.72-4.64 after first 5 years) were at higher risk of alcohol misuse and alcohol dependence.

CONCLUSIONS

Common affective disorders and anxiety disorders may increase the risk of alcohol dependence and alcohol misuse among the Australian population.

Factors associated with depression in Parkinson's disease

BACKGROUND

Depression is common in Parkinson's disease (PD) and contributes significantly to a reduced quality of life in PD patients. The determinants of depression in PD are complex and poorly understood. We investigated the factors associated with depression in PD.

METHODS

PD patients were recruited from Neurology clinics. A validated method was used to screen for a lifetime history of depression. 'Depressed' patients were identified by a score of >6 in the Geriatric Depression Scale (GDS-15) or by having had prescribed treatment for depression. 'Never depressed' patients were recognised by a score of <5 in the GDS-15 with no signs of a history of depression. A newly developed and validated questionnaire was used to collect other information.

RESULTS

Depression was identified in 66% of the 639 PD patients who met the inclusion criteria. Depression was associated with an increased severity of illness as evidenced by higher Unified PD Rating Scale scores and a higher Hoehn and Yahr stage. Other clinical factors associated with disease severity were also more frequently observed in depressed patients. Similar to findings in non-PD samples, depressed PD patients were more likely to have a lower education level, a history of smoking and to regularly use non-aspirin based NSAIDs or analgesics. Comorbidities such as anxiety, memory problems, hallucinations, sleep disturbances and postural hypotension were more common in depressed PD patients.

LIMITATIONS

To avoid patient exhaustion of over-surveying, some factors within the psychological domain were not examined.

CONCLUSION

Our results provide a focus for future intervention strategies.

Affective disorders and anxiety disorders predict the risk of drug harmful use and dependence

AIM

To investigate whether affective disorders, anxiety disorders and alcohol use disorders may increase the risk of subsequently developing drug (non-alcohol-related) dependence and/or drug (non-alcohol-related) harmful use.

SETTING AND DESIGN

A retrospective cohort study based on nationally representative household survey data collected from the 2007 National Survey of Mental Health and Wellbeing (MHW).

MEASUREMENT

The MHW survey applied the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (WMH-CIDI 3.0) to collect information on ICD-10 mental disorder diagnoses. Ages at first onset for mental disorders and harmful drug use were used to reconstruct the cohort according to definition of exposure, time at risk and outcome.

PARTICIPANTS

A total of 8841 Australian adults aged 18-85 years who were included in the 2007 MHW survey.

FINDINGS

Participants with affective disorders and anxiety disorders were at higher risk of drug harmful use and drug dependence, and the effects did not vary by the length of time respondents had been exposed to mental disorders.

CONCLUSION

It is uncertain whether experience of affective disorders and anxiety disorders, possibly prior to the disorder being identified by the individual or a health worker, may lead to self-medication with psychoactive substances or whether common genetic factors linking mental disorder and drug use disorders are the underlying cause. Symptoms of mental health disorders should alert health-care providers to the possibility of drug use disorder comorbidity and the need for early intervention, especially among young males.

Validity and reliability of the Geriatric Anxiety Inventory in Parkinson's disease

AIM

To examine the psychometric properties of a novel anxiety rating scale, the Geriatric Anxiety Inventory (GAI) in Parkinson's disease (PD).

METHOD

The predictive validity of the GAI was tested against the presence of any DSM-IV anxiety disorders in 58 PD patients using receiver operating curve analysis. The concurrent validity of this scale was also studied against the state half of the Spielberger State Trait Anxiety Inventory (STAI). The internal consistency and test-retest reliability of the GAI were also examined.

RESULTS

The GAI displayed good concurrent validity against the STAI and the DSM-IV. It also showed good internal consistency and test-retest reliability.

CONCLUSIONS

This study suggested that the GAI is an appropriate scale to use in non-demented PD patients.

Differences in older people's responses to CIDI's depression screening and diagnostic questions may point to age-related bias

BACKGROUND

Psychiatric surveys based on the Composite International Diagnostic Interview (CIDI) report very low rates of affective disorder in older people, perhaps because CIDI's long, convoluted screening questions present a special challenge to aged respondents. We have shown previously that inconsistencies in responses to CIDI's two screening questions about dysphoria and anhedonia rose in frequency with age. By contrast, responses to the short, simple K-10 and GHQ-12 mental health scales showed much less change over the lifespan. As a check on age-related bias, we now compare responses to CIDI's depression screening questions with responses to subsequent, simpler questions about other depressive symptoms.

METHODS

Secondary analysis of an Australian national survey in which CIDI was administered to 10,641 adults by trained lay interviewers.

RESULTS

Rates of positive responses to both CIDI screening questions fell from 11% in age-group 18-34 years to 3% in respondents aged > or = 65 years. Responses to simpler CIDI items about other depressive symptoms and help-seeking behaviour showed much less change with age.

CONCLUSION

Older respondents may deny symptoms when subjected to complex batteries of questions concerning severity, time frame, attribution and consequences. CIDI diagnoses need to be validated across the full age spectrum.

LIMITATIONS

Residents of aged care facilities and those with low cognitive scores were excluded.

Anxiety disorders in Parkinson's disease: prevalence and risk factors

Anxiety disorders are common in Parkinson's disease (PD) patients, yet are poorly studied. We examined the prevalence of anxiety disorders in PD, investigated the association between anxiety, and presentation and progression of PD, and studied for the first time the contribution of putative risk factors for anxiety in PD. A case-series of 79 PD patients recruited from neurology out-patient clinics was examined for anxiety disorders using the DSM-IV criteria. The Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr Staging of PD were employed to understand the relationship between anxiety disorders, and the clinical presentation and severity of PD. A validated survey assessed putative risk factors for anxiety in PD. Twenty-five percent of PD patients were diagnosed with anxiety. Panic disorder, generalised anxiety disorder and social phobia were prevalent anxiety disorders. Comorbid depression with anxiety was observed (14%). The severity but not the duration of PD was positively related to anxiety. PD patients with postural instability and gait dysfunction symptom clustering were more likely to experience anxiety than tremor-dominant patients. While levodopa dosage had no relationship to anxiety, experience of dyskinesias or on/off fluctuations increased the risk. Lateralisation of PD had no association with anxiety. Anxiety disorders decreased with age and young onset PD patients were more likely to experience anxiety than the late onset subjects. Anxiety adds to the complexity of PD, lowering patients' quality of life. Future research can be directed to identify reactive and organic nature of anxiety in PD.

Worry and rumination in older adults: Differentiating the processes

OBJECTIVES

This study examined the factor structure of the adapted Ruminative Response Scale in a large Australian older adult sample. Previously, the factor structure has only been explored in small UK sample and thus remains tentative. A further objective was to explore overlapping and distinct characteristics of worry, brooding and reflection in relation to coping behaviour which has not previously been examined in older adults.

METHOD

A total of 138 older adults aged between 65 and 97 years (M = 77, SD = 7.9) completed a number of instruments to measure worry, rumination, anxiety and coping behaviour.

RESULTS

A three-factor structure comprised of worry, brooding and reflection emerged. However, no unique relationship was found between the rumination components (brooding and reflection) and worry and coping pathways.

CONCLUSION

The factor structure supports the idea that worry, brooding and reflection are distinguishable constructs in the elderly. However, the lack of differential associations between the rumination components and worry in relation to coping strategies provided evidence that rumination and worry are part of the same theoretical construct of repetitive thought. The implications of these findings for the management of anxiety and depression in the elderly are discussed.

Anxiety and depression in old age: challenges in recognition and diagnosis

Recent years have seen much debate about both the prevalence and the nature of anxiety and depression in older adults. On the one hand, some authors have suggested that older populations are characterized by surprisingly high levels of well-being and resilience, despite increasing losses and functional impairment (Staudinger and Fleeson, 1996) and that the prevalence of mental illness, with the exception of dementia, decreases in late life (Jorm, 2000). Others have suggested that this is a spurious finding resulting from the methodological problems in obtaining accurate data for older adults (Beekman et al., 1998, Krasucki et al., 1999; O'Connor, 2006), with categorical diagnostic systems, such as the DSM-IV (American Psychiatric Association, 1994) and ICD-10 (World Health Organization, 1992) frequently cited as aggravating these difficulties (Palmer et al., 1997).

Effect of age on the frequency of anxiety disorders in major depression with psychotic features

OBJECTIVE

To compare the frequency of anxiety disorders in older and younger persons with major depressive disorder with psychotic features.

DESIGN

Cross-sectional.

SETTING

University medical centers.

PARTICIPANTS

Two hundred fifty-nine persons (N = 117 aged 18-59 years and N = 142 aged > or =60 years) with major depressive disorder with psychotic features who were enrolled in the Study of the Pharmacotherapy of Psychotic Depression (STOP-PD).

MEASUREMENTS

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) defined anxiety disorders were determined by Structured Clinical Interview for DSM-IV interview at baseline assessment. Younger and older participants were compared on the frequencies of any current anxiety disorder and any lifetime anxiety disorder, as well as the frequencies of individual anxiety disorders.

RESULTS

Older persons had significantly lower frequencies of any current anxiety disorder and any lifetime anxiety disorder, even after controlling for relevant demographic and clinical variables. With respect to specific anxiety disorders, older persons had significantly lower frequencies of current and lifetime panic disorder, current and lifetime social anxiety disorder, and current and lifetime posttraumatic stress disorder.

CONCLUSION

The findings of this study are consistent with those of community-based epidemiologic surveys that anxiety disorders are less prevalent in older than younger adults. Because of the rigorous assessment used in STOP-PD, our findings suggest that the age-related decline in the prevalence of anxiety disorders is not simply due to a failure to detect cases in older people, as has been previously suggested.

Mental health scales and psychiatric diagnoses: responses to GHQ-12, K-10 and CIDI across the lifespan

BACKGROUND

Surveys based on complex interviews like CIDI report very low rates of affective disorder in older people, perhaps because the lengthy, convoluted questions present a special challenge to aged respondents. By contrast, mental health scales like the GHQ-12 and K-10 show much less change in score with age. Before concluding that scales present a fairer picture of aged mental health, it is important to check if scores are inflated by items that might reflect normal involutional changes in cognition, energy and social role.

METHODS

Secondary analysis of an Australian national survey of 10,641 adults.

RESULTS

GHQ-12 and K-10 scores declined with age to a relatively minor degree. When scores were bisected, the proportion of respondents scoring above the cutpoints fell with age but to a lesser degree than with ICD-10 diagnoses. Scores on GHQ-12 and K-10 items relating to cognition, energy and social role rose with age but, on factor analysis, these items loaded similarly in a two-factor model.

CONCLUSION

No evidence emerged of age-related bias in either GHQ-12 or K-10. Items concerning cognition, energy and social role were associated with affect in older people, just as they were in younger ones. It seems unlikely therefore that the different trajectories over the lifespan of CIDI diagnoses and scores on GHQ-12 and K-10 are due to limitations within the scales. The possibility that CIDI minimizes affective disorder in older age-groups cannot be discounted.

LIMITATIONS

Residents of aged care facilities and those with low cognitive scores were excluded.

Different responses to K-10 and CIDI suggest that complex structured psychiatric interviews underestimate rates of mental disorder in old people

BACKGROUND

Epidemiological surveys based on complex diagnostic interviews, such as the Composite International Diagnostic Interview (CIDI), report very low rates of anxiety and depressive disorders in older age groups. Mental health checklists show much less change over the lifespan. This paper explores the possibility that complex interviews present a special challenge to older respondents and thereby exaggerate the decline in mental disorder with age.

METHOD

Analysis of data from an Australian national mental health survey with 10,641 community-resident adult respondents. Measures of interest included ICD-10 anxiety and depression diagnoses, scores on the Kessler Psychological Distress Scale (K-10), agreement between K-10 and CIDI anxiety and depressive questions, and changes in agreement with age.

RESULTS

Levels of inconsistency between simple and complex questions about anxiety and depression rose with age.

CONCLUSIONS

Older people may have difficulty attending to and processing lengthy, complex questionnaires. When in doubt, their preferred response may be to deny having experienced symptoms, thus deflating rates of diagnosed mental disorder. We recommend that simple mental health scales be included in epidemiological studies involving older age groups.

2007 National Survey of Mental Health and Wellbeing: methods and key findings

OBJECTIVE

To provide a description of the methods and key findings of the 2007 Australian National Survey of Mental Health and Wellbeing.

METHOD

A national face-to-face household survey of 8841 (60% response rate) community residents aged between 16 and 85 years was carried out using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Diagnoses were made according to ICD-10. Key findings include the prevalence of mental disorder, sex and age distributions of mental disorders, severity of mental disorders, comorbidity among mental disorders, and the extent of disability and health service use associated with mental disorders.

RESULTS

The prevalence of any lifetime mental disorder was 45.5%. The prevalence of any 12 month mental disorder was 20.0%, with anxiety disorders (14.4%) the most common class of mental disorder followed by affective disorders (6.2%) and substance use disorders (5.1%). Mental disorders, particularly affective disorders, were disabling. One in four people (25.4%) with 12 month mental disorders had more than one class of mental disorder. One-third (34.9%) of people with a mental disorder used health services for mental health problems in the 12 months prior to the interview.

CONCLUSIONS

Mental disorders are common in Australia. Many people have more than one class of mental disorder. Mental disorders are associated with substantial disability, yet many people with mental disorders do not seek help for their mental health problems.

The community prevalence of depression in older Australians

OBJECTIVE

To estimate the prevalence of depression among older adults in Australia.

METHOD

All general practitioners in Australia's five most populous states who satisfied certain eligibility criteria (e.g., sufficient weekly working hours, sufficient numbers of elderly patients) were invited to participate. Those who consented were asked to identify all of their patients aged 60+ and invite them (either directly or via the study team) to complete a questionnaire. The questionnaire identified those who had experienced 'clinically significant depression' and those who had experienced a 'major depressive episode' in the past two weeks, via the Patient Health Questionnaire (PHQ-9). Consenting patients completed the questionnaire and returned it to the study team in a reply-paid envelope.

RESULTS

In total, 22,251 patients returned questionnaires. Overall, the age-adjusted rate of clinically significant depression was 8.2% (95%CI=7.8%-8.6%), with the age-adjusted rates for males being 8.6% (95%CI=7.9%-9.2%) and for females being 7.9% (95%CI=7.4%-8.4%). The overall, male and female age-adjusted rates for a major depressive episode were 1.8% (95%CI=1.6%-2.0%), 1.9% (95%CI=1.6%-2.2%) and 1.7% (95%CI=1.5%-2.0%), respectively.

DISCUSSION

Our study suggests that depression among older people is a major public health problem. The above estimates provide guidance for efficient planning of services, and establish a baseline against which preventive and treatment interventions can be assessed. Armed with this information, we can progress efforts at reducing this major health problem and its consequences.

Patterns of hospitalisation for depressive and anxiety disorders across the lifespan in Australia

BACKGROUND

Hospitalisation rates for anxiety and depressive disorders vary with age and sex but there are few detailed analyses.

METHODS

Specialist psychiatric hospital separation data compiled by the Australian Institute of Health and Welfare in the National Hospital Morbidity Database from 1998/99-2004/5 were analysed for the principal psychiatric diagnoses of depressive disorders and neurotic, stress related and somatoform disorders. Separation rates were calculated by age, year and sex using population data linearly extrapolated from Australian censuses.

RESULTS

The average annual rate of specialised psychiatric separations for all depressive disorders was 2.61 per 1000 for men, 4.77 for women. The highest separation rates for depression occurred in men aged 75-79 years. Severe depression without psychosis separations peaked in women in midlife. Psychotic depression separations peaked in late life. The average annual rate of separations for neurotic, stress related and somatoform disorder was 2.08 per 1000 for men, 1.96 for women. In women rates declined with age but in men rates peaked between ages 50 and 60 years due to PTSD. The average length of stay for depressive and anxiety disorders increased with age.

LIMITATIONS

Accuracy of data collection by clinicians and coding by medical records staff is unknown.

CONCLUSIONS

Planning for hospital services should take into account that separation rates for depressive and anxiety disorders vary with age, sex and type of disorder.

Age patterns in the prevalence of DSM-IV depressive/anxiety disorders with and without physical co-morbidity

BACKGROUND

Physical morbidity is a potent risk factor for depression onset and clearly increases with age, yet prior research has often found depressive disorders to decrease with age. This study tests the possibility that the relationship between age and mental disorders differs as a function of physical co-morbidity.

METHOD

Eighteen general population surveys were carried out among household-residing adults as part of the World Mental Health (WMH) surveys initiative (n=42 697). DSM-IV disorders were assessed using face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). The effect of age was estimated for 12-month depressive and/or anxiety disorders with and without physical or pain co-morbidity, and for physical and/or pain conditions without mental co-morbidity.

RESULTS

Depressive and anxiety disorders decreased with age, a result that cannot be explained by organic exclusion criteria. No significant difference was found in the relationship between mental disorders and age as a function of physical/pain co-morbidity. The majority of older persons have chronic physical or pain conditions without co-morbid mental disorders; by contrast, the majority of those with mental disorders have physical/pain co-morbidity, particularly among the older age groups.

CONCLUSIONS

CIDI-diagnosed depressive and anxiety disorders in the general population decrease with age, despite greatly increasing physical morbidity with age. Physical morbidity among persons with mental disorder is the norm, particularly in older populations. Health professionals, including mental health professionals, need to address barriers to the management of physical co-morbidity among those with mental disorders.

The prevalence of anxiety in older adults: methodological issues and a review of the literature

BACKGROUND

Despite the relative neglect of anxiety in older adults, the growing literature on its prevalence suggests that anxiety is highly prevalent and associated with considerable distress and morbidity in this age group. This review provides a comprehensive overview of this literature and discusses some unresolved controversies in the field.

METHODS

A systematic search of articles published from 1980-2007 was performed. Articles were included for review if they reported the prevalence of anxiety symptoms, anxiety disorder or specified anxiety disorders in adults aged >60 in either community or clinical settings.

RESULTS

The prevalence of anxiety in community samples ranges from 1.2% to 15%, and in clinical settings from 1% to 28%. The prevalence of anxiety symptoms is much higher, ranging from 15% to 52.3% in community samples, and 15% to 56% in clinical samples. These discrepancies are partly attributable to the conceptual and methodological inconsistencies that characterise this literature. Generalised Anxiety Disorder is the commonest anxiety disorder in older adults.

LIMITATIONS

The methodologies used in the studies are so variable as to make comparisons difficult.

CONCLUSIONS

Although anxiety disorder, particularly Generalised Anxiety Disorder is common, issues in relation to comorbidity and the nature of anxiety in old age remain unresolved. This hampers the design of intervention programmes, and highlights the need for further research with a primary focus on anxiety.

A review of the cognitive effects of electroconvulsive therapy in older adults

OBJECTIVE

To review studies that examined the impact of electroconvulsive therapy (ECT) on cognitive functioning in depressed older people.

METHODS

Studies were systematically retrieved using PsychINFO and MEDLINE, with additional articles sourced from lists of references. Given our aged-care focus, study participants had a minimum mean age of 60 years, with no single participant younger than 50 years.

RESULTS

Twenty-seven studies met our criteria. Apart from evidence of interictal slowing of information processing speed, there were mixed results with regard to the impact of ECT on other cognitive domains. Factors contributing to this variability in results include the lack of discrimination between unilateral, bilateral, or mixed electrode placement; the inclusion of patients with dementia; the small sample sizes; and the use of tests insensitive to subtle cognitive changes.

CONCLUSIONS

The effect of ECT in elderly recipients' cognition remains unclear, and further research with more critically selected methods is required. In the meantime, we recommend that clinicians regularly administer brief focused cognitive tests before, during, and after treatment to monitor progress.

Recent understandings in geriatric affective disorder

PURPOSE OF REVIEW

This article focuses on recent research into depression, bipolar disorder and anxiety in older people.

RECENT FINDINGS

Many physical illnesses are associated with a high prevalence of depression but overall medical burden may largely account for this. The relationship between depression and vascular disease is two way. Frontal brain dysfunction may underlie depression both in cerebrovascular disease and neurodegenerative disorders. Besides antidepressants, psychological treatments, psychosocial interventions and enhanced primary care services are effective. Longer-term outcomes are poor but preventive strategies show promise. Medical and psychiatric comorbidity are also important themes in later-life anxiety and bipolar disorders.

SUMMARY

Improving prognosis is a key concern and more research into novel pharmacological approaches (including vasoprotection), psychological interventions and prevention is needed.

Age shall not weary them: mental health in the middle-aged and the elderly

OBJECTIVE

The prevalence of mental disorders in the elderly is disputed. The debate in this area can be informed by data from large population surveys that contain sufficient elderly participants. The aim of the present paper was to provide the first direct comparison of the prevalence and demographic correlates of ICD-10 anxiety and affective disorders in the middle-aged and the elderly.

METHOD

The 12 month prevalence and demographic correlates of affective and anxiety disorders were compared in a community sample of middle-aged and elderly Australian residents who took part in the Australian National Mental Health and Well-being Survey (NMHWS).

RESULTS

One in seven middle-aged participants and one in 16 elderly participants experienced symptoms consistent with any anxiety or affective disorder in the preceding 12 months. Compared to the middle-aged participants, the elderly had lower rates for most affective and anxiety disorders, and for the combined presence of any disorder. Demographic correlates of mental disorder, especially marital status, were different for the two groups.

CONCLUSIONS

Community-dwelling elderly in Australia have lower rates of mental disorder compared to the middle-aged. Differences in demographic correlates between groups support the notion that the determinants of mental disorder in the elderly differ substantially from those in middle age.

Prevalence of mental disorders in the elderly: the Australian National Mental Health and Well-Being Survey

OBJECTIVE

To describe the 1- and 12-month prevalence of mental disorders, their demographic correlates, and their impact on service utilization and disability in individuals 65 years of age and over in a comprehensive epidemiological survey of mental health in Australia.

METHODS

A noninstitutionalized national probability sample of elderly Australian residents was interviewed as part of the Australian National Mental Health and Well-being Survey (NMHWS). The prevalence of International Classification of Diseases, Tenth Revision and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders was estimated from the Composite International Diagnostic Interview and other screening instruments.

RESULTS

Of 1,792 elderly NMHWS respondents, 13% reported symptoms consistent with a mental disorder in the past 1 month, and 16% reported symptoms consistent with a mental disorder in the past 12 months. Women experienced higher rates of affective disorders and generalized anxiety disorder and had lower rates of substance abuse compared with men. After excluding cognitive disorder, increasing age was associated with less likelihood of having symptoms of any mental disorder. Older age and never having been married were associated with less likelihood of having symptoms of an affective disorder. Those with cognitive impairment were more likely to have had symptoms consistent with an affective disorder. Comorbidity was predictive of increasing disability on the 12-item Short Form but rates of mental health consultation were low, even for those with multiple disorders.

CONCLUSION

Community-dwelling elderly Australians experience substantial rates of mental disorders. Demographic correlates of mental disorder in this elderly population appear to differ from those established in younger populations. Mental disorder in elderly Australians is associated with significant disability, but rates of specialist mental health consultation is low, even for those with multiple comorbidities. The reasons for this must be examined.