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Hegde PR, Gowda GS, Vajawat B, Subramaniyan SS, Basavaraju V, Manjunatha N, Naveen Kumar C, Math SB. Proxy consultations for severe mental illnesses: An exploratory cross-sectional study from a tertiary care hospital. Int J Soc Psychiatry 2024:207640241255591. [PMID: 38849990 DOI: 10.1177/00207640241255591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Non-adherence to medication leading to a break in continuity of care poses significant challenges in severe mental illness (SMI), leading to poor outcomes. In India, proxy consultation, wherein caregivers consult on behalf of patients, is a commonly adopted but insufficiently researched area to address these challenges. AIMS To explore the extent of proxy consultation in outpatient care of persons with SMI and investigate its sociodemographic and clinical correlates. METHODOLOGY In a tertiary care psychiatry outpatient setting, we conducted a cross-sectional study involving 374 caregivers of persons with SMI (Schizophrenia, Bipolar and related disorders). Descriptive statistics and univariate logistic regression were performed to examine correlates' relationships with proxy consultation. RESULTS Proxy consultation prevalence was 43% in the past 1 year. Compared with 18 to 30 years, middle-aged patients aged 31 to 40, 41 to 50 and 51 to 60 years had twofold, threefold and sixfold increased chances of proxy consultation, respectively. Being illiterate had six times higher odds than graduates, three times and two times if they studied till primary and secondary education. Early age of onset was associated with three times higher chances of proxy consultation compared to the onset of illness in adulthood. On the contrary, male gender and upper and middle socioeconomic status decreased the chances of proxy consultation by 40%. Financial difficulties (n = 72, 45%) and patients' unwillingness to visit outpatients (n = 44, 27.5%) were the most commonly cited reasons for proxy consultation. CONCLUSION Proxy consultations are relatively common, driven by many social, economic, patient-related, pragmatic and practical factors. In formulating community care policies for persons with SMI, the primary imperative should be to conduct additional research, deepening our understanding of proxy consultations. Additionally, it is essential to be mindful of the diverse issues associated with proxy consultations during the formulation process.
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Affiliation(s)
- Prakyath Ravindranath Hegde
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Bhavika Vajawat
- General Adult Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sivakami Sundari Subramaniyan
- TeleMANAS (National Tele Mental Health Programme of India), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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Temkin-Greener H, Hua Y, Cai S. Assisted living residents with dementia: Disparities in mental health services pre and during COVID-19. J Am Geriatr Soc 2024; 72:1760-1769. [PMID: 38655803 PMCID: PMC11187647 DOI: 10.1111/jgs.18926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/17/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Little is known about mental health among Medicare beneficiaries with Alzheimer's disease or related dementias (ADRD) who reside in assisted living (AL) communities. The COVID-19 pandemic may have curtailed ambulatory care access for these residents, but telehealth may have expanded it. We examined in-person and telehealth use of ambulatory mental health visits among AL residents with ADRD, pre and during the COVID pandemic, focusing on race/ethnicity and Medicare/Medicaid dual status. METHODS A CY2018 cohort of AL residents with ADRD was identified. Outcome was any quarterly in-person or telemedicine mental health visit based on national CY2019-2020 Medicare claims. Key independent variables were individual race/ethnicity and dual status and the AL-level proportion of dual residents. We estimated a linear probability model with random effects and robust standard errors. Quarterly indicators captured service use before and after the onset of the pandemic. RESULTS The study included 102,758 fee-for-service Medicare beneficiaries with ADRD in 13,400 ALs. One in five residents had any mental health visits prior to the COVID-19 pandemic. Black residents, and those with dual Medicare/Medicaid eligibility, were significantly less likely to use mental health services prior to and during the pandemic. There were no significant differences in visits via telemedicine by race/ethnicity or individual dual status. Residents in AL communities with a higher proportion of duals had a lower likelihood of visits before and during the pandemic. CONCLUSIONS/IMPLICATIONS Mental health service use among AL residents with ADRD was low and declining prior to the pandemic. Telehealth allowed for mental health visits to continue during the pandemic, albeit at a lower level. Residents in ALs with a higher proportion of duals were less likely to have in-person or telehealth visits. The results suggest that some ALs may find it difficult to assure mental health service provision to this vulnerable population.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Yechu Hua
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
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Usidame B, McQueen Gibson E, Diallo A, Blondino C, Clifford J, Zanjani F, Sargent L, Price E, Slattum P, Parsons P, Prom-Wormley E. Understanding the preference for receiving mental health and substance use support in African Americans 50 and older. J Prev Interv Community 2023; 51:268-286. [PMID: 34053408 PMCID: PMC11139063 DOI: 10.1080/10852352.2021.1930820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aims to determine whether current tobacco and/or alcohol use is associated with setting preferences for seeking support for substance use (SU) and mental health (MH) services to African Americans ages 50 and older. METHODS Data from 368 African American individuals (aged 50+) who participated in a community-based needs assessment survey were used. Preferences included community-based (e.g., health centers) and traditional settings (e.g., doctor's office). SU was measured as a categorical variable detailing past-month use of conventional cigarettes and alcohol graded by risk levels. Logistic regression models tested the associations between SU and setting preference before and after adjusting for the influence of self-reported MH diagnoses. RESULTS Prior to adjustment for the influence of MH outcomes, high-risk use of tobacco and alcohol in the past month was associated with a lower odds of preferring MH/SU support in traditional settings (OR = 0.23, 95% CI = 0.06-0.85) compared to participants engaged in no-/low- risk substance use. This association was no longer significant after accounting for the influence of mental health symptoms and covariates. DISCUSSION These results provide preliminary evidence that mental health outcomes mediate the association between substance use and setting preference for seeking MH/SU support in traditional settings. TRANSLATIONAL SIGNIFICANCE This exploratory study encourages additional investigation of the association between substance use, setting preferences, and the likelihood of seeking treatment in community health centers using larger sample sizes. Additional opportunities to offer mental health/substance use support to African American older adults within clinical settings should be explored.
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Affiliation(s)
- Bukola Usidame
- Department of African American Studies, Virginia Commonwealth University, Richmond, Virginia, USA
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Ana Diallo
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Courtney Blondino
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - James Clifford
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Faika Zanjani
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elvin Price
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Patricia Slattum
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Pamela Parsons
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elizabeth Prom-Wormley
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
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Cheng J, Liu D, Zheng H, Jin Z, Wang DB, Liu Y, Wu Y. Perceived parenting styles and incidence of major depressive disorder: results from a 6985 freshmen cohort study. BMC Psychiatry 2023; 23:230. [PMID: 37020196 PMCID: PMC10074813 DOI: 10.1186/s12888-023-04712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/23/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Even though a fair amount of studies focus on depression among college students, the effect of perceived parenting styles on the incidence of major depressive disorder (MDD) among representative freshmen in Chinese context is scarcely studied. The aim of this study is to investigate the effect of parenting styles on MDD in Chinese freshmen. METHODS A total of 9,928 Chinese freshmen were recruited in 2018. 6985 valid questionnaires were collected at one-year follow-up. Composite International Diagnostic Interview 3.0 (CIDI-3.0) was used for the diagnosis of MDD. Egna Minnen Beträffande Uppfostran (EMBU) questionnaire and Beck Depression Inventory-II (BDI-II) were used to assess parenting styles and baseline depressive symptoms, respectively. The associations between parenting styles and MDD incidence was analyzed with logistic regression. RESULTS The incidence of MDD in freshmen was 2.23% (95%CI: 1.91-2.60%). Maternal overprotection (OR = 1.03, 95%CI: 1.01-1.05) and disharmony relationship between parents (OR = 2.35, 95% CI: 1.42-3.89) increased the risk of new-onset MDD in freshmen, respectively. Mild depressive symptoms (OR = 2.06, 95%CI: 1.06-4.02), moderate (OR = 4.64, 95%CI: 2.55-8.44) and severe depressive symptoms (OR = 7.46, 95%CI: 2.71-20.52) at baseline increased the risk of new-onset MDD. CONCLUSIONS Maternal overprotection, disharmony relationship between parents and baseline depressive symptoms are risk factors for new-onset MDD in Chinese freshmen.
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Affiliation(s)
- Jing Cheng
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Center of Evidence-Based Medicine, School of Mental Health, Jining Medical University, Jining, 272013, China
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, 272013, China
| | - Debiao Liu
- Center of Evidence-Based Medicine, School of Mental Health, Jining Medical University, Jining, 272013, China
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, 272013, China
| | - Huancheng Zheng
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Center of Evidence-Based Medicine, School of Mental Health, Jining Medical University, Jining, 272013, China
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, 272013, China
| | - Zhou Jin
- Zhejiang Provincial Clinical Research Center for Mental Disorders, School of Mental Health and The Affiliated Wenzhou Kangning Hospital, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Deborah Baofeng Wang
- Zhejiang Provincial Clinical Research Center for Mental Disorders, School of Mental Health and The Affiliated Wenzhou Kangning Hospital, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Yan Liu
- Center of Evidence-Based Medicine, School of Mental Health, Jining Medical University, Jining, 272013, China.
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, 272013, China.
| | - Yili Wu
- Zhejiang Provincial Clinical Research Center for Mental Disorders, School of Mental Health and The Affiliated Wenzhou Kangning Hospital, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
- Shandong Collaborative Innovation Centre for Diagnosis, Treatment & Behavioural Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining, 272013, China.
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Min SH, Topaz M, Lee C, Schnall R. Understanding changes in mental health symptoms from young-old to old-old adults by sex using multiple-group latent transition analysis. GeroScience 2023:10.1007/s11357-023-00729-1. [PMID: 36626018 PMCID: PMC10400747 DOI: 10.1007/s11357-023-00729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Older adults are classified into three homogeneous groups: young-old (age 65-74), old-old (age 75-84), and oldest-old (age 85 and over). Mental health symptoms are likely to change over time, especially when older adults transition from one age group to another. Yet, little is known on changes in mental health symptoms as they transition to another age group, and if these changes differ by sex. This is a secondary data analysis using the longitudinal data from the National Social Life, Health, and Aging Project. A total of 1183 young-old adults at wave 1 was included. Mental health symptoms were depression, anxiety, loneliness, perceived stress, and happiness. Multiple-group latent transition analysis was conducted to model the transition probabilities of latent classes and to compare these differences between sex. Descriptive and inferential statistics were conducted to obtain demographic characteristics and to test for differences. Three latent classes were identified based on severity: class 1-mild, class 2-moderate, and class 3-severe. Regardless of sex, young-old adults remained in the same class from waves 1 to 2. However, they moved to a less severe group when transitioning into the old-old from waves 2 to 3. Statistically significant differences were found in their demographic characteristics among the latent classes. Older adults, when transitioning from young-old to old-old, are likely to transition to latent classes with less severe mental health symptoms in both sex. Clinicians need to provide a comprehensive assessment to all older adults, regardless of the severity of their mental health symptoms, to promote well-being.
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Affiliation(s)
- Se Hee Min
- Columbia University School of Nursing, 560 W 168th St, New York, NY, 10032, USA.
| | - Maxim Topaz
- Columbia University School of Nursing, 560 W 168th St, New York, NY, 10032, USA
| | - Chiyoung Lee
- University of Washington Bothell School of Nursing & Health Studies, 18115 Campus Way NE, Bothell, WA, 98011, USA
| | - Rebecca Schnall
- Columbia University School of Nursing, 560 W 168th St, New York, NY, 10032, USA
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Barriers and Enablers to Help-Seeking Behaviour for Mental Health Reasons Among Community Dwelling Older Adults With Anxiety: Mixed-Methods Systematic Review. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bentham C, Eaves L. The Impact of Cognitive-Behavioral Interventions on Sleep Disturbance in Depressed and Anxious Community-dwelling Older Adults: A Systematic Review. Behav Sleep Med 2022; 20:477-499. [PMID: 34120539 DOI: 10.1080/15402002.2021.1933488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Depression and anxiety are prevalent mental health conditions in older adulthood. Despite sleep disturbance being a common comorbidity in late-life depression and anxiety, it is often discounted as a target for treatment. The current review aims to establish whether cognitive-behavioral therapy (CBT) is effective in treating concomitant sleep disturbance in depressed and anxious older adults and to review evidence supporting whether CBT interventions targeting anxiety and depression, or concurrent sleep disturbance, have the greatest effectiveness in this client group. METHOD A systematic database search was conducted to identify primary research papers evaluating the effectiveness of CBT interventions, recruiting older adults with symptoms of depression and/or anxiety, and employing a validated measure of sleep disturbance. The identified papers were included in a narrative synthesis of the literature. RESULTS Eleven identified studies consistently support reductions in sleep disturbance in elderly participants with depression and anxiety in response to CBT. Most CBT interventions in the review included techniques specifically targeting sleep, and only one study directly compared CBT for insomnia (CBT-I) with a CBT-I intervention also targeting depressive symptoms, limiting the ability of the review to comment on whether interventions targeting sleep disturbance or mental health symptoms have superior effectiveness. CONCLUSION The extant research indicates that CBT interventions are effective in ameliorating sleep disturbance in late-life depression and anxiety. Future high-quality research is required to substantiate this finding and to compare the effectiveness of CBT-I and CBT for depression and anxiety in this group to inform clinical practice.
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Affiliation(s)
| | - Lucy Eaves
- Department of Psychological Services, Sheffield Teaching Hospitals, UK
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8
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Boucher E, Honomichl R, Ward H, Powell T, Stoeckl SE, Parks A. The Effects of a Digital Well-Being Intervention in Older Adults: An Analysis of Real-World User Data (Preprint). JMIR Aging 2022; 5:e39851. [PMID: 36053569 PMCID: PMC9482073 DOI: 10.2196/39851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Digital interventions have been shown to be effective for a variety of mental health disorders and problems. However, few studies have examined the effects of digital interventions in older adults; therefore, little is known about how older adults engage with or benefit from these interventions. Given that adoption rates for technology among people aged ≥65 years remain substantially lower than in the general population and that approximately 20% of older adults are affected by mental health disorders, research exploring whether older adults will use and benefit from digital interventions is needed. Objective This study aimed to examine the extent to which older adults engaged with a digital well-being intervention (Happify) and whether engaging with this program led to improvements in both subjective well-being and anxiety symptoms. Methods In this retrospective analysis, we analyzed data from 375 real-world Happify users aged ≥65 years who signed up for the platform between January 1, 2019, and December 23, 2021. Changes in well-being and anxiety symptoms across 42 to 182 days were assessed using responses to the in-app assessment, which users were prompted to take every 2 weeks, and were compared among users who engaged with the program at the recommended level (ie, 2 or more activities per week) or below the recommended level. Results In all, 30% (113/375) of the sample engaged with the platform at the recommended level (ie, completed an average of 2 or more activities per week), and overall, users completed an average of 43.35 (SD 87.80) activities, ranging from 1 to 786, between their first and last assessment. Users were also active on the platform for an average of 19.36 (SD 27.16) days, ranging from 1 to 152 days. Moreover, older adults who engaged at the recommended level experienced significantly greater improvements in subjective well-being (P=.002) and anxiety symptoms (P<.001) relative to those who completed fewer activities. Conclusions These data provide preliminary evidence that older adults engage with and benefit from digital well-being interventions. We believe that these findings highlight the importance of considering older adult populations in digital health research. More research is needed to understand potential barriers to using digital interventions among older adults and whether digital interventions should be modified to account for this population’s particular needs (eg, ensuring that the intervention is accessible using a variety of devices). However, these results are an important step in demonstrating the feasibility of such interventions in a population that is assumed to be less inclined toward digital approaches.
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Teo K, Churchill R, Riadi I, Kervin L, Wister AV, Cosco TD. Help-Seeking Behaviors Among Older Adults: A Scoping Review. J Appl Gerontol 2022; 41:1500-1510. [PMID: 35156428 PMCID: PMC9024019 DOI: 10.1177/07334648211067710] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Although older adults may experience health challenges requiring increased care, they often do not ask for help. This scoping review explores the factors associated with the help-seeking behaviors of older adults, and briefly discusses how minority ethnic populations can face additional challenges in help-seeking, due to factors such as language barriers and differing health beliefs. Guided by Arksey and O’Malley’s scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-AnalysesScoping Review guidelines, a systematic search of five databases was conducted. Using a qualitative meta-synthesis framework, emergent themes were identified. Data from 52 studies meeting inclusion criteria were organized into five themes: formal and informal supports, independence, symptom appraisal, accessibility and awareness, and language, alternative medicine and residency. Identifying how factors, including independence and symptom appraisal, relate to older adults’ help-seeking behaviors may provide insights into how this population can be supported to seek help more effectively.
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Affiliation(s)
- Kelly Teo
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada
| | - Ryan Churchill
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada
| | - Indira Riadi
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada
| | - Lucy Kervin
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada
| | - Andrew V Wister
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada.,Gerontology Research Centre, 416185Simon Fraser University, Vancouver, BC, Canada
| | - Theodore D Cosco
- Department of Gerontology, 33507Simon Fraser University, Vancouver, BC, Canada.,Oxford Institute of Population Ageing, 416185University of Oxford, Oxford, UK
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Incidence of Anxiety in Latest Life and Risk Factors. Results of the AgeCoDe/AgeQualiDe Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312786. [PMID: 34886512 PMCID: PMC8657712 DOI: 10.3390/ijerph182312786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
Research on anxiety in oldest-old individuals is scarce. Specifically, incidence studies based on large community samples are lacking. The objective of this study is to assess age- and gender-specific incidence rates in a large sample of oldest-old individuals and to identify potential risk factors. The study included data from N = 702 adults aged 81 to 97 years. Anxiety symptoms were identified using the short form of the Geriatric Anxiety Inventory (GAI-SF). Associations of potential risk factors with anxiety incidence were analyzed using Cox proportional hazard models. Out of the N = 702 older adults, N = 77 individuals developed anxiety symptoms during the follow-up period. The incidence rate was 51.3 (95% CI: 41.2-64.1) per 1000 person-years in the overall sample, compared to 58.5 (95% CI: 43.2-72.4) in women and 37.3 (95% CI: 23.6-58.3) in men. Multivariable analysis showed an association of subjective memory complaints (HR: 2.03, 95% CI: 1.16-3.57) and depressive symptoms (HR: 3.20, 95% CI: 1.46-7.01) with incident anxiety in the follow-up. Incident anxiety is highly common in late life. Depressive symptoms and subjective memory complaints are major risk factors of new episodes. Incident anxiety appears to be a response to subjective memory complaints independent of depressive symptoms.
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Bretherton SJ. The Influence of Social Support, Help-Seeking Attitudes and Help-Seeking Intentions on Older Australians' use of Mental Health Services for Depression and Anxiety Symptoms. Int J Aging Hum Dev 2021; 95:308-325. [PMID: 34747228 DOI: 10.1177/00914150211050882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated the influence of predisposing factors (social support, help-seeking attitudes and help-seeking intentions) on older Australian adults' use of mental health services for depression and/or anxiety symptoms. Participants were 214 older Australian adults (61% female; aged between 60 and 96 years; M = 75.15 years, SD = 8.40 years) who completed a self-report questionnaire that measured predisposing factors and lifetime mental health service use for depression and/or anxiety symptoms. Higher levels of social support predicted non-use of mental health services. When this relationship was serially mediated by help-seeking attitudes and help-seeking intentions, it predicted mental health service use for depression and/or anxiety. Older adults are less likely to seek help for depression and/or anxiety symptoms unless members of their social support network encourage positive help-seeking attitudes, which lead to positive help-seeking intentions and the subsequent use of mental health services.
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Adams C, Gringart E, Strobel N, Masterman P. Help-seeking for mental health problems among older adults with chronic disease: an application of the theory of planned behaviour. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1952850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Claire Adams
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Eyal Gringart
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Natalie Strobel
- Kurongkurl Katitjin, Edith Cowan University, Perth, Australia
| | - Paul Masterman
- School of Arts and Humanities, Edith Cowan University, Perth, Australia
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Van NHN, Thi Khanh Huyen N, Hue MT, Luong NT, Quoc Thanh P, Duc DM, Thi Thanh Mai V, Hong TT. Perceived Barriers to Mental Health Services among the Elderly in the Rural of Vietnam: A Cross Sectional Survey in 2019. Health Serv Insights 2021; 14:11786329211026035. [PMID: 34220203 PMCID: PMC8221696 DOI: 10.1177/11786329211026035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/28/2021] [Indexed: 11/15/2022] Open
Abstract
While the burden of neurological and mental disorders has been drastically increased in Vietnam, the current mental healthcare services do not meet the public demand. In order to determine perceived barriers to the use of mental health services, we conducted a cross-sectional study on 376 elderly people from a rural district in Hanoi, Vietnam. We found that depression may be an important indicator of the need for formal and informal community and home care mental health services. Barriers to mental healthcare access were categorized into 7 groups namely stigma, emotional concerns, participation restrictions, service satisfaction, time constraints, geographic and financial conditions, and availability of services. The most significant barriers are the limited availability of and accessibility to health professionals and services in rural areas. Our study highlights the urgent efforts that need to be made in order to enhance availability of mental healthcare services in rural areas of Vietnam.
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Affiliation(s)
| | | | - Mai Thi Hue
- Hanoi Medical University Campus in Thanh Hoa, Hanoi Medical University, Thanh Hoa, Vietnam
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von Eitzen L, Valerius K, van den Berg N, Völzke H, Grabe HJ, Schomerus G, Speerforck S. [Sociodemographic and Disorder-Specific Determinants for Professional Help-seeking due to Depression in a Structurally Weak Region - The Important Role of Age]. PSYCHIATRISCHE PRAXIS 2021; 48:404-411. [PMID: 34015855 DOI: 10.1055/a-1468-3860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Study of sociodemographic and disorder-specific determinants of professional help-seeking in lifetime depression. METHODS In the population-based SHIP-Trend-1 study (2016-2019), we assessed N = 490 adults with lifetime depression and their help-seeking behaviour. Gender, socioeconomic status and disorder-specific variables were implemented in age-stratified logistic regression models. RESULTS Men and older adults at the time of the survey sought less help than women and younger people. In the younger and middle age group severity level was associated with professional help-seeking, in the older age group professional help-seeking was more prevalent in case of physical causes for the depression. CONCLUSION We found age-specific differences in the determinants for professional help-seeking. Latent variables like age-specific experiences, values, and life styles may explain those differences.
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Affiliation(s)
- Linnéa von Eitzen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Karsten Valerius
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | | | - Henry Völzke
- Institut für Community Medicine, Universitätsmedizin Greifswald
| | - Hans J Grabe
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Greifswald.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Greifswald/Rostock, Standort Greifswald
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Sven Speerforck
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
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15
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Lu S, Liu T, Wong GHY, Leung DKY, Sze LCY, Kwok WW, Knapp M, Lou VWQ, Tse S, Ng SM, Wong PWC, Tang JYM, Lum TYS. Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms. Epidemiol Psychiatr Sci 2021; 30:e10. [PMID: 33526166 PMCID: PMC8057460 DOI: 10.1017/s2045796020001122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/06/2022] Open
Abstract
AIMS Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. METHODS We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. RESULTS The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126-10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520-5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854-2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444-939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). CONCLUSIONS The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.
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Affiliation(s)
- Shiyu Lu
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, SAR, China
| | - Tianyin Liu
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Gloria H. Y. Wong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, SAR, China
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Dara K. Y. Leung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Lesley C. Y. Sze
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Wai-Wai Kwok
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Martin Knapp
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, UK
- School for Social Care Research, National Institute for Health Research, London, UK
| | - Vivian W. Q. Lou
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, SAR, China
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Siu-Man Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Paul W. C. Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Terry Y. S. Lum
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, SAR, China
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
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16
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Hernandez-Tejada MA, Skojec T, Frook G, Steedley M, Davidson TM. Addressing the psychological impact of elder mistreatment: Community-based training partnerships and telehealth-delivered interventions. J Elder Abuse Negl 2021; 33:96-106. [PMID: 33480307 DOI: 10.1080/08946566.2021.1876578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This manuscript describes a two-pronged approach to addressing elder abuse in community-residing older adults. Part 1 of the program involves briefly training community healthcare providers to screen for elder abuse and refer for services; Part 2 is an intervention program that addresses mental health impacts of elder abuse in a non-stigmatizing, non-threatening manner, and leverages telehealth for greater reach.
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Affiliation(s)
| | - Theresa Skojec
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Gabrielle Frook
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Mara Steedley
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Tatiana M Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
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17
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Youn HM, Kang SH, Jang SI, Park EC. Association between social participation and mental health consultation in individuals with suicidal ideation: a cross-sectional study. BMC Psychiatry 2020; 20:305. [PMID: 32546143 PMCID: PMC7296757 DOI: 10.1186/s12888-020-02724-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 06/09/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Suicidal ideation is a significant public health concern worldwide. Although suicides might be preventable through the provision of adequate treatment, mental health consultation is still mostly underutilized. This study thus aimed to examine the association between social participation and utilization of mental health consultations in individuals with suicidal ideation. METHODS Data were collected from the nationwide Community Health Survey (conducted by the Korea Centers for Disease Control and Prevention, 2017). A total of 17,067 individuals (men: 32.9%, women: 67.1%) who reported experiencing suicidal ideation were included in the analysis. The mean age of the study population was 60.1 (±17.8) years old. This study examined social participation; the number of social activities participated in among leisure, volunteer, social, and religion related activities. Multivariate logistic regression was then used to assess the significance of these associations. RESULTS Among those experienced suicidal ideation, 1860 (10.9%) reported receiving mental health consultation services (men: 8.8%, women: 11.9%). Overall, an increased social participation was significantly associated with increased odds of using forms of mental health consultation (OR = 1.65, 95% CI: 1.31-2.09). CONCLUSIONS In this study, significant evidence of the links between social participation and utilization of mental health consultation was discovered among at risk individuals with suicidal ideation. Suicide prevention policies and programs designed to enhance social participation could potentially encourage people at suicide risk to seek the help they need. Further research focusing on social approaches can produce useful information to plan and implement comprehensive and effective strategies.
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Affiliation(s)
- Hin Moi Youn
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Soo Hyun Kang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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18
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Schmutte T, Olfson M, Xie M, Marcus SC. Self-Harm, Suicidal Ideation, and Attempted Suicide in Older Adults: A National Study of Emergency Department Visits and Follow-Up Care. Am J Geriatr Psychiatry 2020; 28:646-658. [PMID: 31917069 PMCID: PMC7246137 DOI: 10.1016/j.jagp.2019.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/24/2019] [Accepted: 12/04/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Emergency department visits for self-harm and suicidal ideation have increased for US older adults. The purpose of this study was to examine discharge disposition, clinical recognition of mental disorder, and 30-day follow-up mental health outpatient care of older adults treated in emergency departments for suicide attempt (SA), suicidal ideation (SI), or deliberate self-harm (DSH). METHODS Retrospective cohort analysis using 2015 Medicare claims for adults ≥65 years of age with suicide-related emergency encounters (N = 52,383). Demographic, clinical, and service use characteristics from claims were merged with county-level Area Health Resource File data. Rates and adjusted risk ratios were assessed for discharge to the community, mental health diagnosis in the emergency department, and outpatient mental health visits with 30 days after the emergency encounter. RESULTS Encounters for SA (7.8%) and SI (17.2%) were less likely than those for DSH (29.1%) to be discharged to the community. Among community discharges, SA (95.6%) and SI (95.1%) encounters were more likely than DSH (52.3%) encounters to be diagnosed with a mental disorder in the emergency department. Encounters for SA (52.1%) and SI (59.9%) were also more likely than DSH (31.3%) encounters to receive follow-up mental care. CONCLUSIONS Although most older adults treated in EDs for suicide-related reasons are hospitalized, a substantial proportion of patients discharged back to the community do not receive follow-up mental healthcare within 30 days.
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Affiliation(s)
- Timothy Schmutte
- Department of Psychiatry, Program for Recovery and Community Health, Yale University (TS), Westport, CT.
| | - Mark Olfson
- Columbia University, Department of Psychiatry and the New York State Psychiatric Institute
| | - Ming Xie
- University of Pennsylvania, Department of Psychiatry
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19
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Schmutte TJ, Wilkinson ST. Suicide in Older Adults With and Without Known Mental Illness: Results From the National Violent Death Reporting System, 2003-2016. Am J Prev Med 2020; 58:584-590. [PMID: 32001049 PMCID: PMC7089842 DOI: 10.1016/j.amepre.2019.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/16/2019] [Accepted: 11/17/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Suicide risk increases with age, and evidence exists for the underdiagnosis and undertreatment of suicide risk in older adults. Recent data suggest that many U.S. adults who die from suicide do not have a known mental health condition. This study compares the characteristics and precipitating circumstances of geriatric suicide decedents with and without known mental illnesses. METHODS This study was a retrospective analysis of suicide deaths for adults aged ≥65 years from the National Violent Death Reporting System, 2003-2016 (n=26,884). ORs compared sociodemographic and clinical characteristics, cause of death, and precipitating circumstances based on coroner/medical examiner and law enforcement reports. Data were collected and analyzed in 2019. RESULTS Most older male (69.1%) and female (50.2%) suicide decedents did not have a known mental illness. A physical health problem was the most prevalent precipitating circumstance but was more common among older adults without known mental illness. Past suicide attempt, disclosure of suicidal intent, depressed mood, and substance use were more common among those with a known mental illness. More than three fourths of suicide decedents did not disclose their suicidal intent. Most suicide deaths involved firearms, which were disproportionately used by decedents without known mental illness (81.6% of male and 44.6% of female decedents) compared with those with known mental illness (70.5% of male and 30.0% of female decedents). CONCLUSIONS Most older adults who die from suicide do not have a known mental health condition. The rapidly growing U.S. geriatric population calls for more effective methods to identify and treat at-risk older adults, particularly those who are male.
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Affiliation(s)
- Timothy J Schmutte
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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20
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Comparative effectiveness of three exercise types to treat clinical depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. Ageing Res Rev 2020; 58:100999. [PMID: 31837462 DOI: 10.1016/j.arr.2019.100999] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/08/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies have directly compared the effects of different exercise therapies on clinical depression in older adults. Thus, we conducted a systematic review and network meta-analysis of current evidence from randomised controlled trials (RCTs) to compare the effectiveness of three major exercise types (aerobic, resistance, and mind-body exercise) in clinically depressed older adults. METHODS We followed PRISMA-NMA guidelines and searched databases for eligible RCTs (inception - September 12th, 2019). RCTs were eligible if they included clinically depressed adults aged >65 years, implemented one or more exercise therapy arms using aerobic, resistance, or mind-body exercise, and assessed depressive symptoms at baseline and follow-up using a validated clinical questionnaire. RESULTS A network meta-analysis was performed on 15 eligible RCTs comprising 596 participants (321 treatment and 275 controls), including aerobic (n = 6), resistance (n = 5), and mind-body (n = 4) exercise trials. Compared with controls, mind-body exercise showed the largest improvement on depressive symptoms (g = -0.87 to -1.38), followed by aerobic exercise (g = -0.51 to -1.02), and resistance exercise (g = -0.41 to -0.92). Notably, there were no statistically significant differences between exercise types: aerobic versus resistance (g = -0.10, PrI = -2.23, 2.03), mind-body versus aerobic (g = -0.36, PrI = -2.69, 1.97), or mind-body versus resistance (g = -0.46, PrI = -2.75, 1.83). CONCLUSIONS These findings should guide optimal exercise prescription for allied health professionals and stakeholders in clinical geriatrics. Notably, clinically depressed older adults may be encouraged to self-select their preferred exercise type in order to achieve therapeutic benefit on symptoms of depression. In coalition with high levels of compliance, these data provide encouraging evidence for the antidepressant effect of either aerobic, resistance, or mind-body exercise as effective treatment adjucts for older adults presenting with clinical depression.
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21
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Kiely KM, Brady B, Byles J. Gender, mental health and ageing. Maturitas 2019; 129:76-84. [PMID: 31547918 DOI: 10.1016/j.maturitas.2019.09.004] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022]
Abstract
This article presents a broad narrative review of the epidemiological evidence on how and why the mental health of older adults varies by gender. We draw upon international research literatures spanning gerontology and population mental health, as well as major reports from global health agencies. Compared with older men, older women are more likely to experience common mental disorders such as depression and anxiety, although the gender gap is smaller than it is at younger ages. In contrast, the mortality-related impacts of poor mental health, including suicide, are more severe for older men. These gendered patterns vary by country and other social contexts. Factors proposed to account for these findings include cultural and social norms, differentiation of gender roles, disadvantage and (dis)empowerment across the life course, and the coping styles of older men. However, little research has explicitly tested these explanations. Research to date has overwhelmingly focused on identifying differences in the mental health of older men and women. Notably, most studies have been restricted to binary comparisons, lacking the data to disentangle sex and gender dynamics, and few studies have examined the mental health of minority gendered adults in later life. Finally, there remains a need for high-quality population-based research into the mental health of those aged over 80 that includes coverage of people living in residential aged care settings.
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Affiliation(s)
- Kim M Kiely
- Neuroscience Research Australia (NeuRA), Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia; UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia.
| | - Brooke Brady
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia; ARC Centre for Excellence in Population Ageing Research, University of New South Wales, Sydney, Australia
| | - Julie Byles
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, Australia
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22
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Turner N, Hastings J, Neighbors HW. Mental health care treatment seeking among African Americans and Caribbean Blacks: what is the role of religiosity/spirituality? Aging Ment Health 2019; 23:905-911. [PMID: 29608328 PMCID: PMC6168439 DOI: 10.1080/13607863.2018.1453484] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES As adults increase in age, the likelihood for using mental health care services decrease. Underutilization, expecially among racial/ethnic minorities such as African American and Caribbean Blacks, can result in a decrease in quality of life, as well as significant costs to families, employers, and health systems. METHODS The study explored the differences in relationships between mental health care usage and strength of religious/spiritual beliefs between African American and Caribbean Black older adults (54 years or older) and adults (18-53 years) using data from the National Survey of American Life (NSAL). Descriptive statistics and logistic regression analyses were conducted using Stata version 13.1. RESULTS Subjective ratings about the strength of religious/spiritual beliefs (OR = 1.26; 95 CI: 0.99, 1.61), age (OR = 0.62; 95 CI: 0.48, 0.81), and sex (OR = 1.59; 95 CI: 1.25, 2.02) were significantly associated with the odds of seeking mental health care. Additionally, persons living in the South were less likely to seek mental health care services (OR = 0.47; 95 CI: 0.37, 0.60). CONCLUSION Strong religious/spiritual beliefs may promote mental health care usage. Future studies should examine the strength of religious/spiritual beliefs on mental health care usage among different demographic groups.
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Affiliation(s)
- Natalie Turner
- School of Social Welfare, University at Albany, State University of New York, Albany, NY, USA
| | - Julia Hastings
- School of Social Welfare, University at Albany, State University of New York, Albany, NY, USA,School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Harold W. Neighbors
- Division of Public Health, Department of Family Medicine, College of Human Medicine, Michigan State University, Flint, Michigan
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23
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Bryson WC, Cotton BP, Barry LC, Bruce ML, Piel J, Thielke SM, Williams BA. Mental health treatment among older adults with mental illness on parole or probation. HEALTH & JUSTICE 2019; 7:4. [PMID: 30923982 PMCID: PMC6717990 DOI: 10.1186/s40352-019-0084-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/11/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND The number of older adults on parole and probation is growing at an unprecedented rate, yet little is known about the mental health needs and treatment utilization patterns among this group. The objective of this study is to compare the prevalence of serious or moderate mental illness (SMMI), and the proportion of those with SMMI who receive mental health treatment, among community-dwelling older adults on correctional supervision (parole or probation) vs. not on correctional supervision. METHODS Design: Cross-sectional analysis of data from the 2008-2014 National Surveys for Drug Use and Health (NSDUH). SETTING Population-based national survey data. PARTICIPANTS Older adults (age ≥ 50) who participated in the NSDUH between 2008 and 2014 (n = 44,624). Participants were categorized according to whether they were on parole or probation during the 12 months prior to survey completion (n = 379) vs. not (n = 44,245). MEASUREMENTS Probable SMMI was defined using a validated measure in the NSDUH. Mental health treatment included any outpatient mental health services or prescriptions over the 12 months prior to survey completion. We compared the prevalence of SMMI, and the proportion of those with SMMI who received any treatment, by correctional status. RESULTS Overall, 7% (N = 3266) of participants had SMMI; the prevalence was disproportionately higher among those on parole or probation (21% vs. 7%, p < 0.001). Sixty-two percent of those with SMMI received any mental health treatment, including 81% of those on parole or probation and 61% of those who were not (p < 0.001). This result remained statistically significant after logistic regression accounted for differences in sociodemographics and health. CONCLUSIONS SMMI is disproportionally prevalent among older adults on parole or probation, and community correctional supervision programs may be facilitating linkages to needed community-based mental health treatment.
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Affiliation(s)
- William C. Bryson
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Multnomah Pavilion, Room 2316, Portland, OR 97239-3098 USA
| | - Brandi P. Cotton
- University of Rhode Island, College of Nursing, Kingston, RI USA
| | - Lisa C. Barry
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT USA
| | - Martha L. Bruce
- Geisel School of Medicine, Dartmouth University, Hanover, NH USA
| | - Jennifer Piel
- University of Washington Medical Center, Seattle, WA USA
- Puget Sound Veterans Affairs Medical Center, Seattle, WA USA
| | - Stephen M. Thielke
- University of Washington Medical Center, Seattle, WA USA
- Puget Sound Veterans Affairs Medical Center, Seattle, WA USA
| | - Brie A. Williams
- Division of Geriatrics, University of California San Francisco, San Francisco, CA USA
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Hohls JK, Wild B, Heider D, Brenner H, Böhlen F, Saum KU, Schöttker B, Matschinger H, Haefeli WE, König HH, Hajek A. Association of generalized anxiety symptoms and panic with health care costs in older age-Results from the ESTHER cohort study. J Affect Disord 2019; 245:978-986. [PMID: 30562680 DOI: 10.1016/j.jad.2018.11.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Little is known specifically about the association between generalized anxiety symptoms or panic and health care costs in older age. The aim of this study was to examine the association between generalized anxiety symptoms, panic and health care costs in people aged 65 and over. METHODS Cross-sectional data from the 8-year follow-up of a large, prospective cohort study, the ESTHER study, was used. Individuals aged 65 and over, who participated in the study's home assessment, were included in this analysis (n = 2348). Total and sectoral costs were analyzed as a function of either anxiety symptoms, probable panic disorder, or a panic attack, while controlling for selected covariates, using Two Part and Generalized Linear Models. Covariates were chosen based on Andersen's Behavioral Model of Health Care Use. RESULTS There was no significant association between either of the anxiety or panic measures and total health care costs. Stratified by health care sectors, only the occurrence of a panic attack was significantly associated with incurring costs for outpatient non-physician services (OR: 1.99; 95% CI: 1.15-3.45) and inpatient services (OR: 2.14; 95% CI: 1.07-4.28). Other illness-related factors, such as comorbidities and depressive symptoms, were associated with health care costs in several models. LIMITATIONS This was a cross-sectional study relying on self-reported data. CONCLUSION This study points to an association between a panic attack and sector-specific health care costs in people aged 65 and over. Further research, especially using longitudinal data, is needed.
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Affiliation(s)
- J K Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
| | - B Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - D Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - F Böhlen
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - K U Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - B Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - H Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany; Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
| | - W E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Germany
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - A Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
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Predisposing, enabling, and need factors of service utilization in the elderly with mental health problems. Int Psychogeriatr 2018; 30:1027-1037. [PMID: 29198254 DOI: 10.1017/s1041610217002526] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:Empirical data on the use of services due to mental health problems in older adults in Europe is lacking. The objective of this study is to identify factors associated with service utilization in the elderly. METHODS As part of the MentDis_ICF65+ study, N = 3,142 people aged 65-84 living in the community in six European and associated countries were interviewed. Based on Andersen's behavioral model predisposing, enabling, and need factors were analyzed with logistic regression analyses. RESULTS Overall, 7% of elderly and 11% of those with a mental disorder had used a service due to mental health problems in the last 12 months. Factors significantly associated with underuse were male sex, lower education, living in the London catchment area, higher functional impairment and more comorbid mental disorders. The most frequently reported barrier to service use was personal beliefs, e.g. "I can deal with my problem on my own" (90%). CONCLUSION Underutilization of mental health services among older people in the European community is common and interventions are needed to achieve an adequate use of services.
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A systematic review of the association of anxiety with health care utilization and costs in people aged 65 years and older. J Affect Disord 2018; 232:163-176. [PMID: 29494900 DOI: 10.1016/j.jad.2018.02.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/22/2018] [Accepted: 02/12/2018] [Indexed: 11/22/2022]
Abstract
THEORETICAL BACKGROUND In older people, anxiety disorders are among the most prevalent mental disorders and a high proportion suffers from clinically relevant anxiety symptoms. Despite studies suggesting an association of anxiety with health care utilization (HCU) and a resulting economic burden to the health care system, we found no review systematically analyzing evidence on this association in older people. OBJECTIVE To analyze and synthesize evidence on the association of anxiety disorders and symptoms with HCU and costs in people aged 65 years and over in a systematic review. METHODS A systematic search of peer-reviewed literature was conducted in three electronic databases. Additional references were identified through reference lists of included studies. Inclusion criteria were: studies reporting the association of anxiety disorders or symptoms with HCU or costs, specifically in people aged 65 years and over, with observational study design, in German or English language. Findings were synthesized qualitatively and study quality was assessed. RESULTS N = 15 studies (HCU n = 10, costs n = 5) were included in the final synthesis. Overall, studies either reported significantly increased HCU in anxiety disorders compared to a healthy comparison group/according to degree of symptoms, or found no significant association between these variables. Total excess costs for anxiety disorders ranged from -116 to 19,003 $PPP per year. LIMITATIONS Differences in methodology limited the comparability of included studies. CONCLUSION Most studies suggest an increased economic burden due to anxiety in older people. Studies using standardized instruments are needed.
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Muñoz M, Ausín B, Santos-Olmo AB, Härter M, Volkert J, Schulz H, Sehner S, Dehoust MC, Suling A, Wegscheider K, Canuto A, Crawford MJ, Grassi L, Da Ronch C, Hershkovitz Y, Quirk A, Rotenstein O, Shalev AY, Strehle J, Weber K, Wittchen HU, Andreas S. Alcohol use, abuse and dependence in an older European population: Results from the MentDis_ICF65+ study. PLoS One 2018; 13:e0196574. [PMID: 29708993 PMCID: PMC5927409 DOI: 10.1371/journal.pone.0196574] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 04/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Alcohol use disorders (AUD) in older people have been the subject of increasing interest in Europe and worldwide. However, thus far, no reliable data exist regarding the prevalence of AUD in people over the age of 65 years in Europe. OBJECTIVE To assess the current (past month), 12-month and lifetime prevalence of alcohol use, abuse and dependence in people aged 65-84 years. STUDY DESIGN The MentDis_ICF65+ study was a representative stepwise cross-sectional survey that was conducted in six European and associated cities (Hamburg, Germany; Ferrara, Italy; London/Canterbury, England; Madrid, Spain; Geneva, Switzerland and Jerusalem, Israel). METHOD In total, 3,142 community-dwelling people aged between 65 and 84 years who lived in participating cities were assessed with an age-sensitive diagnostic interview (CIDI65+). RESULTS The prevalence of lifetime alcohol use was 81% for the overall sample. The observed AUD (DSM-IV-TR) prevalence was as follows: current, 1.1%; 12-month, 5.3% and lifetime, 8.8%. Alcohol consumption and AUD were more prevalent in males, and a significant interaction between gender and city was observed; greater gender differences in the prevalence of these disorders were observed in Hamburg, London/Canterbury and Geneva in comparison to the other cities. The prevalence of lifetime alcohol consumption and 12-month AUD tended to be lower in older persons. CONCLUSION The results highlight the appropriateness of using age-adjusted diagnostic tools (CIDI65+) to identify alcohol use and AUD in older people. Different alcohol use patterns were observed in males and females. The results seem to indicate the presence of different alcohol use patterns between northern and southern European countries. Specialized services are proposed, including brief and/or more intensive interventions framed intensive and more simple interventions framed in stepped care strategies, to improve the social and health resources available for older people across Europe.
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Affiliation(s)
- Manuel Muñoz
- School of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Berta Ausín
- School of Psychology, Complutense University of Madrid, Madrid, Spain
- * E-mail:
| | | | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Volkert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Sehner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Christina Dehoust
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Suling
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Canuto
- Nant Foundation, East Vaud Psychiatric Institute, Geneva, Switzerland
| | | | - Luigi Grassi
- Institute of Psychiatry, Dpt. Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Chiara Da Ronch
- Institute of Psychiatry, Dpt. Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Yael Hershkovitz
- Department of Psychiatry, Hadassah University Medical Center, Jerusalem, Israel
| | - Alan Quirk
- Royal College of Psychiatrist, London, United Kingdom
| | - Ora Rotenstein
- Department of Psychiatry, Hadassah University Medical Center, Jerusalem, Israel
| | - Arieh Y. Shalev
- Department of Psychiatry, NY Langone Medical Center, New York, United States of America
| | - Jens Strehle
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Kerstin Weber
- Curabilis, Medical Direction, University Hospitals of Geneva, Geneva, Switzerland
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Sylke Andreas
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Adepoju O, Lin SH, Mileski M, Kruse CS, Mask A. Mental health status and healthcare utilization among community dwelling older adults. J Ment Health 2018; 27:511-519. [PMID: 29701495 DOI: 10.1080/09638237.2018.1466030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Shifts in mental health utilization patterns are necessary to allow for meaningful access to care for vulnerable populations. There have been long standing issues in how mental health is provided, which has caused problems in that care being efficacious for those seeking it. AIMS To assess the relationship between mental health status and healthcare utilization among adults ≥65 years. METHODS A negative binomial regression model was used to assess the relationship between mental health status and healthcare utilization related to office-based physician visits, while a two-part model, consisting of logistic regression and negative binomial regression, was used to separately model emergency visits and inpatient services. RESULTS The receipt of care in office-based settings were marginally higher for subjects with mental health difficulties. Both probabilities and counts of inpatient hospitalizations were similar across mental health categories. The count of ER visits was similar across mental health categories; however, the probability of having an emergency department visit was marginally higher for older adults who reported mental health difficulties in 2012. CONCLUSION These findings are encouraging and lend promise to the recent initiatives on addressing gaps in mental healthcare services.
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Affiliation(s)
- Omolola Adepoju
- a School of Health Administration , Texas State University , San Marcos , TX , USA and
| | - Szu-Hsuan Lin
- b School of Public Health , Texas A&M University , College Station , TX , USA
| | - Michael Mileski
- a School of Health Administration , Texas State University , San Marcos , TX , USA and
| | - Clemens Scott Kruse
- a School of Health Administration , Texas State University , San Marcos , TX , USA and
| | - Andrew Mask
- a School of Health Administration , Texas State University , San Marcos , TX , USA and
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Woodward AT, Taylor RJ. Factors associated with the use of social workers for assistance with lifetime and 12-month behavioral health disorders. SOCIAL WORK IN HEALTH CARE 2018; 57:267-283. [PMID: 29405882 PMCID: PMC6074041 DOI: 10.1080/00981389.2018.1437104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This study examined the use of social workers for assistance with a behavioral health disorder. Data were from the Collaborative Psychiatric Epidemiology Surveys. The analytic sample included respondents who reported using professional services for assistance with a behavioral health disorder during their lifetime (n = 5,585). Logistic regression was used to examine the use of a social worker during the respondent's lifetime or 12 months prior to the interview. Ten percent of respondents visited a social worker for help with a behavioral health disorder during their lifetime and 3% did so in the 12 months prior to the interview. Women were less likely than men to report using a social worker. Those who visited a social worker tended to also use other professionals for a behavioral health disorder although overall respondents reported visiting social workers less frequently for this reason than other types of professionals.
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Park NS, Jang Y, Chiriboga DA. Willingness to use mental health counseling and antidepressants in older Korean Americans: the role of beliefs and stigma about depression. ETHNICITY & HEALTH 2018; 23:97-110. [PMID: 27764962 DOI: 10.1080/13557858.2016.1246429] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Despite a high prevalence of mental health problems, racial/ethnic minorities are often reluctant to seek mental health services. Their reluctance may be shaped by cultural beliefs and stigma about mental health. The present study examined how beliefs and stigma about depression (e.g. disbelief in depression as a health-related condition, perception of depression as a normal part of aging, and/or depression as a sign of personal weakness/family shame) pose barriers to older Korean Americans' willingness to use mental health counseling and antidepressants. METHOD Data were drawn from surveys with 420 Korean American older adults (Mage= 71.6, SD = 7.6) living in the New York City metropolitan area in 2010. Using a separate logistic regression model, the role of beliefs and stigma about depression in predicting participants' willingness to receive mental health counseling and to take antidepressants was tested. Based on Andersen's behavioral health service use model, the analysis was conducted in consideration of predisposing characteristics (age, gender, marital status, education, and acculturation), mental health needs (anxiety, depressive symptoms, and self-rated mental health), and enabling/hindering factors (beliefs and stigma). RESULTS Similar proportions of the sample (69-70%) indicated their willingness to use mental health counseling or antidepressants. Willingness was more likely among participants who had beliefs about depression as a health-related concern (OR = 1.94, 95% CI = 1.15-3.27 for mental health counseling; OR = 4.47, 95% CI = 2.59-7.70 for antidepressants) and less likely among those who associated depression with family shame (OR = .55, 95% CI = 0.33-0.91 for mental health counseling; OR = .56, 95% CI = 0.33-0.95 for antidepressants). CONCLUSION In addressing mental health problems and promoting the use of mental health services, cultural beliefs and stigma shared within an ethnic community should be considered. Given that disbelief in the medical model of depression and family shame reduced willingness to use mental health counseling and antidepressants, promoting mental health literacy for older immigrants could be beneficial.
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Affiliation(s)
- Nan Sook Park
- a School of Social Work , University of South Florida , Tampa , FL , USA
| | - Yuri Jang
- b School of Social Work , University of Texas at Austin , Austin , TX , USA
| | - David A Chiriboga
- c Department of Child and Family Studies , University of South Florida , Tampa , FL , USA
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Brenes GA, Danhauer SC, Lyles MF, Anderson A, Miller ME. Long-Term Effects of Telephone-Delivered Psychotherapy for Late-Life GAD. Am J Geriatr Psychiatry 2017; 25:1249-1257. [PMID: 28673741 PMCID: PMC5654672 DOI: 10.1016/j.jagp.2017.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/17/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the long-term effects of telephone-delivered cognitive-behavioral therapy (CBT-T) compared with nondirective supportive therapy (NST-T) in rural older adults with generalized anxiety disorder (GAD). METHODS 141 adults aged 60 years and older with a principal/co-principal diagnosis of GAD were randomized to either CBT-T or NST-T. CBT-T consisted of up to 11 sessions (9 were required) focused on recognition of anxiety symptoms, relaxation, cognitive restructuring and use of coping statements, problem-solving, worry control, behavioral activation, exposure therapy, and relapse prevention, with optional chapters on sleep and pain. NST-T consisted of 10 sessions focused on providing a supportive atmosphere in which participants could share and discuss their feelings and did not provide any direct suggestions. Primary outcomes included interviewer-rated anxiety severity and self-report worry severity measured at 9 months and 15 months after randomization. Mood-specific secondary outcomes included self-report GAD symptoms and depressive symptoms. RESULTS At 15 months, after adjustment for multiple testing, there was a significantly greater decline in general anxiety symptoms (difference in improvement: 3.31; 95% CI: 0.45-6.17; t = 2.29; df = 136; p = 0.024) and worry (difference in improvement: 3.13; 95% CI: 0.59-5.68; t = 2.43; df = 136; p = 0.016) among participants in CBT-T compared with those in the NST-T group. There were no significant differences between the conditions in terms of depressive symptoms (difference in improvement: 2.88; 95% CI: 0.17-5.60; t = 2.10; df = 136; p = 0.0376) and GAD symptoms (difference in improvement: 1.65; 95% CI: -0.20 to 3.50; t = 1.76; df = 136; p = 0.080). CONCLUSIONS CBT-T is superior to NST-T in reducing worry and anxiety symptoms 1 year after completing treatment.
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Gao H, Söderhamn U, Cliffordson C, Guo L, Guo Q, Liu K. Reliability and validity of the Chinese version of the Self-care Ability Scale for the Elderly. J Clin Nurs 2017; 26:4489-4497. [PMID: 28231632 DOI: 10.1111/jocn.13779] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To translate the Self-care Ability Scale for the Elderly into Simplified Chinese and to test the Chinese version of the scale regarding its reliability and validity among older people. BACKGROUND Self-care is an important topic in nursing. When assessing older people's self-care ability, it is essential that a reliable and valid instrument is used. DESIGN This study employed across-sectional design. METHODS We translated the English version of the Self-care Ability Scale for the Elderly into Simplified Chinese according to Brislin's translation guidelines and carried out a questionnaire survey among 610 older people, including both community-dwelling people and hospital patients, in Jinzhou City, People's Republic of China. Eighty participants completed the instrument twice for test-retest reliability. Data analyses were performed using spss 17.0 and Mplus, version 5, to assess reliability and validity. RESULTS A Cronbach's alpha coefficient of .89 and statistically significant item-to-total correlations showed evidence of homogeneity. An intraclass correlation coefficient of .99 for the test-retest between total scores and intraclass correlation coefficients between .87-.99 for the test-retest scores of each item explained the almost perfect test-retest reliability noted in this study. Content validity was found to be good, and a three-factor model was obtained in an exploratory factor analysis (explaining a variance of 57%) and modified in a confirmatory factor analysis (χ2 = 261.559, df = 98, root mean square error of approximation = 0.074; standardised root mean square residual = 0.059), which reflected an acceptable construct validity. CONCLUSIONS This study shows that the Chinese version of the Self-care Ability Scale for the Elderly has sufficient psychometric properties for assessing self-care ability among older people in China. RELEVANCE TO CLINICAL PRACTICE A reliable and valid instrument is available to assess the self-care ability of older Chinese people.
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Affiliation(s)
- Han Gao
- College of Nursing, Jinzhou Medical University, Jinzhou City, Liaoning Province, China
| | - Ulrika Söderhamn
- Center for Caring Research-Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | | | - Lina Guo
- College of Nursing, Jinzhou Medical University, Jinzhou City, Liaoning Province, China
| | - Qiyun Guo
- College of Nursing, Jinzhou Medical University, Jinzhou City, Liaoning Province, China
| | - Kun Liu
- College of Nursing, Jinzhou Medical University, Jinzhou City, Liaoning Province, China
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Ewen HH, Washington TR, Emerson KG, Carswell AT, Smith ML. Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030330. [PMID: 28327507 PMCID: PMC5369165 DOI: 10.3390/ijerph14030330] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Abstract
Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place.
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Affiliation(s)
- Heidi H Ewen
- Institute of Gerontology, College of Public Health, The University of Georgia, 102 Spear Road, Hudson Hall, Athens, GA 30602, USA.
- Department of Financial Planning, Housing, and Consumer Economics, The University of Georgia, Athens, GA 30602, USA.
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
| | | | - Kerstin G Emerson
- Institute of Gerontology, College of Public Health, The University of Georgia, 102 Spear Road, Hudson Hall, Athens, GA 30602, USA.
- Department of Health Policy and Management, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
| | - Andrew T Carswell
- Department of Financial Planning, Housing, and Consumer Economics, The University of Georgia, Athens, GA 30602, USA.
| | - Matthew Lee Smith
- Institute of Gerontology, College of Public Health, The University of Georgia, 102 Spear Road, Hudson Hall, Athens, GA 30602, USA.
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77843, USA.
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Garg R, Shen C, Sambamoorthi N, Sambamoorthim U. Type of Multimorbidity and Propensity to Seek Care among Elderly Medicare. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2017; 10:34-51. [PMID: 31236309 PMCID: PMC6590680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Greater propensity to seek care is critical for improving health of elderly individuals with multimorbidity. We used the Medicare Current Beneficiary Survey (2012) to assess propensity to seek care among community-dwelling elderly Medicare beneficiaries (≥ 65 yrs.; N=11,270) having (1) no physical or mental illness; (2) single physical or mental condition; (3) multimorbidity with physical conditions only; and (4) multimorbidity with both physical and mental conditions. As compared to multimorbidity with physical conditions, elderly with no multimorbidity were less likely (Adjusted Odds Ratio [95% CI]: 0.50 [0.36, 0.68]) and elderly with both physical and mental conditions were more likely (1.57 [1.28, 1.93]) to have a health problem for which they should have seen a doctor but did not. Further, elderly having a usual source of care were less likely (0.53 [0.37, 0.75]) to have a health problem for which they should have seen a doctor but did not. Multimorbidity is negatively associated with propensity to seek care. The presence of both chronic mental and physical conditions worsened propensity to seek care among elderly individuals. Future efforts to increase the awareness of receiving timely care and improve the access to care can enhance propensity to seek care among elderly individuals with multimorbidity.
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Affiliation(s)
| | - Chan Shen
- University of Texas, MD Anderson Cancer Center
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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Choi NG, DiNitto DM, Marti CN. Relationship Between the Types of Insurance Coverage and Outpatient Mental Health Treatment Use Among Older Adults. J Appl Gerontol 2016; 35:1343-1362. [DOI: 10.1177/0733464815577143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/13/2015] [Indexed: 11/17/2022] Open
Abstract
Using the public use data files of the 2008 to 2012 National Survey on Drug Use and Health, this study examined (a) the payment sources for mental health treatment among those aged 50 to 64 years and those aged 65+ years and (b) the relationship between outpatient mental health treatment use and different types of insurance coverage among members of these two age groups. The results show that 16% of the 50 to 64 age group and 10% of the 65+ age group used inpatient or outpatient mental health treatment in the preceding year. Logistic regression analyses showed that mental health problem severity and public insurance programs (Medicare, Medicaid, and Department of Veterans Affairs [VA]/military insurance) significantly increased the odds of receiving outpatient treatment. Private insurance was not a significant factor for either age group. Older adults with mental health problems must be encouraged to seek treatment and need to be informed about mental health coverage included in their insurance(s).
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Miller E, Gonzalez R, Kim JH. Vocational rehabilitation outcomes among older adults with diabetes. JOURNAL OF VOCATIONAL REHABILITATION 2016. [DOI: 10.3233/jvr-150784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eva Miller
- Department of Rehabilitation Services and Counseling, The University of Rio Grande Valley, Edinburg, TX, USA
| | - Rene Gonzalez
- Department of Rehabilitation Services and Counseling, The University of Rio Grande Valley, Edinburg, TX, USA
| | - Jeong Han Kim
- Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond, VA, USA
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Brenes GA, Danhauer SC, Lyles MF, Hogan PE, Miller ME. Barriers to Mental Health Treatment in Rural Older Adults. Am J Geriatr Psychiatry 2015; 23:1172-8. [PMID: 26245880 PMCID: PMC4663185 DOI: 10.1016/j.jagp.2015.06.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 05/26/2015] [Accepted: 06/09/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to identify the barriers to seeking mental health treatment experienced by rural older adults. We also examined if barriers differed by age and worry severity. METHODS Participants were 478 rural older adults responding to a flyer for a psychotherapy intervention study. Interested participants were screened by telephone, and barriers to mental health treatment were assessed. Participants completed a demographic questionnaire and the Penn State Worry Questionnaire-Abbreviated. RESULTS The most commonly reported barrier to treatment was the personal belief that "I should not need help." Other commonly reported barriers included practical barriers (cost, not knowing where to go, distance), mistrust of mental health providers, not thinking treatment would help, stigma, and not wanting to talk with a stranger about private matters. Multivariable analyses indicated that worry severity and younger age were associated with reporting more barriers. CONCLUSIONS Multiple barriers interfere with older adults seeking treatment for anxiety and depression. Older age is associated with fewer barriers, suggesting that the oldest old may have found strategies for overcoming these barriers. Young-old adults may benefit from interventions addressing personal beliefs about mental health and alternative methods of service delivery.
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Affiliation(s)
- Gretchen A. Brenes
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine
| | - Suzanne C. Danhauer
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine
| | - Mary F. Lyles
- Department of Geriatrics, Wake Forest School of Medicine
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Perceived symptom targets of antidepressants, anxiolytics, and sedatives: the search for modifiable factors that improve adherence. J Behav Health Serv Res 2015; 41:529-38. [PMID: 23702612 DOI: 10.1007/s11414-013-9342-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Expectations about treatment and beliefs about illness influence adherence in physical disorders, but the extent to which this occurs in mood disorders is unknown. Identifying modifiable factors, such as beliefs, may improve adherence to mood disorder medications. Data from the Collaborative Psychiatric Epidemiology Surveys were used to examine relationships among perceived symptom targets of medication (mood only, non-mood only, mood, and non-mood) and self-reported adherence to antidepressants, anxiolytics, and sedatives. The sample included 807 community-dwelling individuals with and without depression and anxiety who regularly took one of these medications in the year before the survey. Slightly over half (53.2 %) of respondents were adherent. Perceived medication purpose was only significantly related to adherence among Latino respondents. Latino respondents who viewed their symptom target as non-mood only were the most adherent. Perceived symptom targets of medications were not associated with most patients' adherence behaviors for antidepressants, anxiolytics, and sedatives.
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Choi NG, DiNitto DM, Marti CN. Mental health treatment use and perceived treatment need among suicide planners and attempters in the United States: between and within group differences. BMC Res Notes 2015; 8:305. [PMID: 26179170 PMCID: PMC4502636 DOI: 10.1186/s13104-015-1269-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 07/02/2015] [Indexed: 12/19/2022] Open
Abstract
Background Despite many previous studies of suicidal ideation and/or attempts, little research has examined mental health treatment use and perceived treatment need among and within groups of ideators and/or attemptors. We examined mental health treatment use and perceived treatment need in four groups of US adults who had serious suicidal ideation: (1) no suicide plan/no attempt; (2) planned/no attempt; (3) no plan/attempted; and (4) planned/attempted. Methods We compared ideators and nonideators using the 154,923 U.S. residents aged 21 and older who participated in the 2008–2012 National Survey on Drug Use and Health (NSDUH). We then employed logistic regression analyses to discern factors associated with treatment use and perceived treatment need among and within the four groups of ideators (N = 7,348). Results More than 30% of ideators who made suicide plans and/or attempted suicide received no treatment before or after planning or attempting. Racial/ethnic minorities had lower odds of treatment use in all four groups, but major depression significantly increased the odds in all but the no plan/attempted group. Treatment use and substance use disorder increased the odds of perceived need in all four groups. Conclusions The four groups have different rates of treatment access and perceived treatment need that do not appear to be commensurate with their risk level. The findings underscore the importance of treatment access for all those at-risk of suicide, especially racial/ethnic minorities and those of lower SES.
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Affiliation(s)
- Namkee G Choi
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, D3500, Austin, TX, 78712, USA.
| | - Diana M DiNitto
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, D3500, Austin, TX, 78712, USA.
| | - C Nathan Marti
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, D3500, Austin, TX, 78712, USA.
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Choi NG, DiNitto DM, Marti CN. Alcohol and other substance use, mental health treatment use, and perceived unmet treatment need: Comparison between baby boomers and older adults. Am J Addict 2015; 24:299-307. [DOI: 10.1111/ajad.12225] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/21/2015] [Accepted: 03/23/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Namkee G. Choi
- University of Texas at Austin School of Social Work; 1925 San Jacinto Blvd, D3500 Austin Texas 78712
| | - Diana M. DiNitto
- University of Texas at Austin School of Social Work; 1925 San Jacinto Blvd, D3500 Austin Texas 78712
| | - C. Nathan Marti
- University of Texas at Austin School of Social Work; 1925 San Jacinto Blvd, D3500 Austin Texas 78712
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Garrido MM. Propensity scores: a practical method for assessing treatment effects in pain and symptom management research. J Pain Symptom Manage 2014; 48:711-8. [PMID: 24937162 DOI: 10.1016/j.jpainsymman.2014.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 11/23/2022]
Abstract
When conducting research on pain and symptom management interventions for seriously ill individuals, randomized controlled trials are not always feasible or ethical to conduct. Secondary analyses of observational data sets that include information on treatments experienced and outcomes for individuals who did and did not receive a given treatment can be conducted, but confounding because of selection bias can obscure the treatment effect in which one is interested. Propensity scores provide a way to adjust for observable characteristics that differ between treatment and comparison groups. This article provides conceptual guidance in addition to an empirical example to illustrate two areas of propensity score analysis that often lead to confusion in practice: covariate selection and interpretation of resultant treatment effects.
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Affiliation(s)
- Melissa M Garrido
- Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Cukrowicz KC, Duberstein PR, Vannoy SD, Lin EH, Unützer J. What factors determine disclosure of suicide ideation in adults 60 and older to a treatment provider? Suicide Life Threat Behav 2014; 44:331-7. [PMID: 24494695 DOI: 10.1111/sltb.12075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
Abstract
Correlates of patient disclosure of suicide ideation to a primary care or mental health provider were identified. Secondary analyses of IMPACT trial data were conducted. Of the 107 patients 60 years of age or older who endorsed thoughts of ending their life at least "a little bit" during the past month, 53 indicated they had disclosed these thoughts to a mental health or primary care provider during this period. Multiple logistic regression was used to identify predictors of disclosure to a provider. Significant predictors included poorer quality of life and prior mental health specialty treatment. Among participants endorsing thoughts of suicide, the likelihood of disclosing these thoughts to a provider was 2.96 times higher if they had a prior history of mental health specialty treatment and 1.56 times higher for every one-unit decrease in quality of life. Variation in disclosure of thoughts of suicide to a mental health or primary care provider depends, in part, on patient characteristics. Although the provision of evidence-based suicide risk assessment and guidelines could minimize unwanted variation and enhance disclosure, efforts to routinize the process of suicide risk assessment should also consider effective ways to lessen potential unintended consequences.
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Gonçalves DC, Coelho CM, Byrne GJ. The use of healthcare services for mental health problems by middle-aged and older adults. Arch Gerontol Geriatr 2014; 59:393-7. [PMID: 24856982 DOI: 10.1016/j.archger.2014.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/16/2014] [Accepted: 04/24/2014] [Indexed: 11/18/2022]
Abstract
Although mental disorders occur commonly in later life, it has been reported that older adults are reluctant to seek help for their mental health problems. The purpose of this research study was to analyze the contact with healthcare professionals, self-perceived mental health problems and unmet needs, as reported by a nationally representative sample of community-dwelling adults. We report a cross-sectional analysis of all the respondents of the Australian National Survey of Mental Health and Wellbeing aged 55 years and older (N=3178). Results indicated that 306 (9.6%) participants had a DSM-IV classifiable mental disorder based on self-identified symptoms over the preceding 12 months. Of these, 146 (48%) reported that they had not consulted a healthcare professional to deal with their mental health problems. Among those who consulted with a healthcare professional, the general practitioner was the main point of contact. Medication and psychotherapy/counseling were the most frequent form of help obtained. Informational and instrumental help, such as help to sort out practical problems and to look after oneself, were the most reported unmet needs. These results suggest a gap in the provision of healthcare services for mental health problems directed toward the specific needs of aging adults. The reported unmet needs might be met by increasing awareness amongst healthcare professionals regarding mental health problems in later stages of life and by improving the access of older people to the services commonly provided by multidisciplinary teams.
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Affiliation(s)
- Daniela C Gonçalves
- Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, 2nd floor, Walton Street, Jericho OX2 6NW, UK; School of Medicine, University of Queensland, Herston, QLD 4029, Australia
| | - Carlos M Coelho
- Centro Algoritmi, University of Minho, Campus Azurém, 4800-058 Guimarães, Portugal
| | - Gerard J Byrne
- School of Medicine, University of Queensland, Herston, QLD 4029, Australia; Royal Brisbane & Women's Hospital, Herston, QLD 4029, Australia.
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Erlangsen A, Conwell Y. Age-related response to redeemed antidepressants measured by completed suicide in older adults: a nationwide cohort study. Am J Geriatr Psychiatry 2014; 22:25-33. [PMID: 23567434 PMCID: PMC3844115 DOI: 10.1016/j.jagp.2012.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 08/13/2012] [Accepted: 08/29/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine if the suicide rate of older adults prescribed antidepressants varies with age and to assess the proportion of older adults who died by suicide that had recently been prescribed antidepressants. METHODS A population-based cohort study using a nationwide linkage of individual-level records was conducted on all persons aged 50+ living in Denmark during 1996-2006 (1,215,524 men and 1,343,568 women). Suicide rates by treatment status were calculated using data on all antidepressant prescriptions redeemed at pharmacies. RESULTS Individual-level data covered 9,354,620 and 10,720,639 person-years for men and women, respectively. Men aged 50-59 who received antidepressants had a mean suicide rate of 185 (95% confidence interval [CI]: 160-211) per 100,000, whereas for those aged 80+ the rate was 119 (95% CI: 91-146). For women, the corresponding values were 82 (95% CI: 70-94) and 28 (95% CI: 20-35). Logistic regression showed a 2% and 3% decline in the rate for men and women, respectively, considered in treatment with antidepressants, with each additional year of age. An opposite trend was found for persons not in treatment. Fewer persons aged 80+ dying by suicide had received antidepressant prescriptions during the last months of life than younger persons. CONCLUSION An age-dependent decline in suicide rate for antidepressant recipients was identified. One reason could be that older adults respond better to antidepressants than younger age groups. Still, the increasing gap with age between estimated prevalence of depression and antidepressant prescription rate in persons dying by suicide underscores the need for assessment of depression in the oldest old.
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Affiliation(s)
- Annette Erlangsen
- Research Unit, Mental Health Centre Copenhagen, Capital Region of Denmark, Denmark; Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD.
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Pérez-Zepeda MU, Arango-Lopera VE, Wagner FA, Gallo JJ, Sánchez-García S, Juárez-Cedillo T, García-Peña C. Factors associated with help-seeking behaviors in Mexican older individuals with depressive symptoms: a cross-sectional study. Int J Geriatr Psychiatry 2013; 28:1260-9. [PMID: 23585359 PMCID: PMC3797168 DOI: 10.1002/gps.3953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/15/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling "that something is wrong" and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms. METHODS A cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health. RESULTS A total of 2322 individuals were studied; from these, 67.14% (n = 1559) were women, and the mean age was 73.18 years (SD = 7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ(2) = 81.66, p < 0.0001), significant variables were female gender (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.511-0.958, p = 0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p = 0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant. CONCLUSIONS Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms.
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Affiliation(s)
| | | | - Fernando A. Wagner
- Center for Health Disparities Solutions, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA
| | - Joseph J. Gallo
- Department of Mental Health, Bloomberg School of Public Health and Policy, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sergio Sánchez-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), México
| | - Teresa Juárez-Cedillo
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), México
| | - Carmen García-Peña
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), México
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Dabelko-Schoeny H, Anderson KA, Guada J. Adult day services: a service platform for delivering mental health care. Aging Ment Health 2013; 17:207-14. [PMID: 23020155 DOI: 10.1080/13607863.2012.724653] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The purpose of this study was to understand the degree to which mental health services targeting anxiety and depression disorders are offered by adult day services (ADS) centers in the US. In addition, researchers wanted to determine whether staffing and organizational characteristics are associated with the provision of medication management, individual counseling, and group counseling for participants with anxiety or depression. METHOD Data were drawn from the MetLife National Study of ADS. Hierarchical logistic regression analyses were conducted to determine which staffing and organizational factors were associated with the provision of services to treat anxiety and depression. RESULTS Approximately, three in four adult day programs provided medication management for the treatment of anxiety and depression while 38% provided individual counseling and almost 30% group counseling. Programs offering medication management were more likely to have more registered nurse (RN) service hours available per shift and higher costs. Programs that provided individual and group counseling for participants with anxiety or depression were more likely to have more hours of RN and social work services available and a lower percentage of participants who pay privately for services. CONCLUSION The results suggest that ADS are well positioned to act as a platform for delivering mental health care to older persons with anxiety or depression.
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Ahmadzad-Asl M, Davoudi F, Mohammad Sadeghi H, Khademolreza N, Zarei N, Naserbakht M, Nojomi M, Rasoulian M. Correlates of mental health service utilization in married women in tehran 2011. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2013; 7:51-60. [PMID: 24644500 PMCID: PMC3939987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 09/06/2012] [Accepted: 02/26/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE There are disparities in mental health services (MHS) utilization within and between populations and several factors are studied as its potential correlates. Identifying those correlates would help health policy makers to adjust service provision with characteristics of their community. To evaluate demographic, socioeconomic and system correlates of MHS utilization among married women from Tehran, Iran. METHODS A household survey of 615 married women residents of 22 municipal districts of Tehran selected via a cluster sampling method. All subjects were asked about health services utilization during last one and 12 months as well as need and access for MHS, demographic and socioeconomic factors. Independent correlates of MHS use were determined with logistic regression analysis. RESULTS Total 615 women, mean±SE age and duration of marital life of 42.6±0.9 and 22±0.8 years, respectively were selected, rate of MHS utilization during last one and 12 months were 5.2% and 10.1% respectively. 23.6% of women reported having mental illness and 19.3% and 17.9% had need for MHS and access to outpatient health services, respectively. Logistic regression models showed that need for MHS (OR:5.25, 95%CI:2.7-10.1), access to outpatient services (OR:2.17, 95%CI:1.04-4.52), smoking (OR:3.4, 95%CI:1.16-10.2) and crowding index (OR:0.69, 95%CI:0.48-0.99). CONCLUSIONS Rate of MHS utilization in women are low considering the near to estimated rate of perceived illness. Bridging the gap between perceived illness and need for services, then providing better access to services in areas with higher crowding index and higher rates of smoking in residents should considered in any mental health promotion programs. DECLARATION OF INTEREST None.
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Affiliation(s)
- Masuod Ahmadzad-Asl
- Resident of psychiatry, Mental Health Research Center, Tehran psychiatry institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farnoush Davoudi
- Resident of Community Medicine, Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Mohammad Sadeghi
- Resident of psychiatry, Mental Health Research Center, Tehran psychiatry institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Noshin Khademolreza
- Psychiatrist, Mental Health Research Center, Tehran psychiatry institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Zarei
- Resident of psychiatry, Mental Health Research Center, Tehran psychiatry institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Morteza Naserbakht
- Specialist of Community Medicine, Mental Health Research Center, Tehran psychiatry institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Nojomi
- Professor of Community Medicine. Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Rasoulian
- Associate professor of psychiatry. Mental Health Research Center, Tehran psychiatry institute, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding author: Maryam Rasoulian M.D., Mental Health Research Center, Tehran psychiatry institute, Tehran University of Medical Sciences, Sattarkhan Ave., Niayesh St., Mansuri St., No.1, Tehran Psychiatry Institute, Tehran, Iran. Tel: +98-21-66506862 Fax: +98-21-66506862,
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Depression interventions among racial and ethnic minority older adults: a systematic review across 20 years. Am J Geriatr Psychiatry 2012; 20:915-31. [PMID: 22828202 PMCID: PMC3479358 DOI: 10.1097/jgp.0b013e31825d091a] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While there is strong evidence in support of geriatric depression treatments, much less is available with regard to older U.S. racial and ethnic minorities. The objectives of this review are to identify and appraise depression treatment studies tested with samples of U.S. racial and ethnic minority older adults. We include an appraisal of sociocultural adaptations made to the depression treatments in studies meeting our final criteria. Systematic search methods were utilized to identify research published between 1990 and 2010 that describe depression treatment outcomes for older adults by racial/ethnic group, or for samples of older adults who are primarily (i.e., >50%) racial/ethnic minorities. Twenty-three unduplicated articles included older adults and seven met all inclusion criteria. Favorable depression treatment effects were observed for older minorities across five studies that took place in different types of settings and with varying levels of sociocultural adaptations. The effectiveness of depression care remains mixed, although collaborative or integrated care shows promise for African Americans and Latinos. The degree to which the findings generalize to non-English-speaking, low acculturated, and low-income older persons, and to other older minority groups (i.e., Asian and Pacific Islanders, and American Indian and Alaska Natives), remains unclear. Given the high disease burden among older minorities with depression, it is imperative to provide timely, accessible, and effective depression treatments. Increasing their participation in behavioral health research should be a national priority.
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Gum AM, Iser L, King-Kallimanis BL, Petkus A, DeMuth A, Schonfeld L. Six-month longitudinal patterns of mental health treatment utilization by older adults with depressive symptoms. PSYCHIATRIC SERVICES (WASHINGTON, D.C.) 2012. [PMID: 22211216 DOI: 10.1176/appi.ps.62.11.1353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Aims of the study were to describe behavioral health treatment utilization patterns of community-dwelling older adults with depressive symptoms over a six-month period and to identify factors associated with treatment use, guided by a theoretical model emphasizing the dynamic nature of treatment use patterns over time and social context. METHODS A total of 144 participants ≥65 years old with depressive symptoms completed an in-person baseline interview and six monthly telephone follow-up interviews. Outcomes at each follow-up included the use of antidepressants or counseling. Covariates included personal and social context variables. RESULTS Approximately half of the participants (N=70, 48%) received no formal treatment (antidepressant prescription or counseling). Treatment use or nonuse did not change for most participants. More participants with severe symptoms received antidepressants (25%-37%) than did those with milder symptoms (10%-14%), although more participants in the latter group started (milder, 62%,versus severe, 49%) and stopped (milder, 77%, versus severe, 26%) antidepressant treatment at least once. Fewer individuals received counseling overall, with no clear patterns by symptom severity. In multivariate longitudinal analyses, treatment use at follow-up was independently associated with younger age, current major depressive episode, baseline use of antidepressant, intention to begin a new treatment at baseline, and receipt of advice to seek treatment. CONCLUSIONS Over a six-month period, most older adults with depressive symptoms in this study continued their use or nonuse of mental health treatment. Demographic, need, attitudinal, and social variables were related to treatment use over time. Addressing intentions and providing advice may facilitate treatment seeking.
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Affiliation(s)
- Amber M Gum
- Department of Aging and Mental Health Disparities, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa, FL 33612, USA.
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