Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-27T13:52:25.327Z Has data issue: false hasContentIssue false

Mental distress and service utilization among help-seeking, community-dwelling older adults

Published online by Cambridge University Press:  18 May 2010

Adam Simning
Affiliation:
Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
Thomas M. Richardson
Affiliation:
Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A. Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
Bruce Friedman
Affiliation:
Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A. Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
Lisa L. Boyle
Affiliation:
Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
Carol Podgorski
Affiliation:
Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
Yeates Conwell*
Affiliation:
Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
*
Correspondence should be addressed to: Yeates Conwell, MD, University of Rochester School of Medicine and Dentistry, 300 Crittenden Blvd., Rochester, NY 14642, U.S.A. Phone: +1 (585) 275-6739; Fax: +1 (585) 273-1066. Email: yeates_conwell@urmc.rochester.edu.

Abstract

Background: This study aimed to characterize healthcare and human services utilization among mentally distressed and non-distressed clients receiving in-home care management assessment by aging services provider network (ASPN) agencies in the U.S.A.

Methods: A two-hour research interview was administered to 378 English-speaking ASPN clients aged 60+ years in Monroe County, NY. A modified Cornell Services Index measured service utilization for the 90 days prior to the ASPN assessment. Clients with clinically significant anxiety or depressive symptoms were considered distressed.

Results: ASPN clients utilized a mean of 2.93 healthcare and 1.54 human services. The 42% of subjects who were distressed accessed more healthcare services (e.g. mental health, intensive medical services) and had more outpatient visits and days hospitalized than the non-distressed group. Contrary to expectations, distressed clients did not receive more human services. Among those who were distressed, over half had discussed their mental health with a medical professional in the past year, and half were currently taking a medication for their emotional state. A far smaller proportion had seen a mental health professional.

Conclusions: In the U.S.A., aging services providers serve a population with high medical illness burden and medical service utilization. Many clients also suffer from anxiety and depression, which they often have discussed with a medical professional and for which they are receiving medications. Few, however, have seen a mental health specialist preceding intake by the ASPN agency. Optimal care for this vulnerable, service intensive group would integrate primary medical and mental healthcare with delivery of community-based social services for older adults.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S. and Bruce, M. L. (2009). A model for intervention research in late-life depression. International Journal of Geriatric Psychiatry, 24, 13251334.CrossRefGoogle Scholar
Beekman, A. T. et al. (2002). The natural history of late-life depression: a 6-year prospective study in the community. Archives of General Psychiatry, 59, 605611.Google Scholar
Bruce, M. L. et al. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA, 291, 10811091.Google Scholar
Bruce, M. L. et al. (2007). A randomized trial of depression assessment intervention in home health care. Journal of the American Geriatrics Society, 55, 17931800.Google Scholar
Callahan, C. M., Unverzagt, F. W., Hui, S. L., Perkins, A. J. and Hendrie, H. C. (2002). Six-item screener to identify cognitive impairment among potential subjects for clinical research. Medical Care, 40, 771781.Google Scholar
Ciechanowski, P. et al. (2004). Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA, 291, 15691577.Google Scholar
Crabb, R. and Hunsley, J. (2006). Utilization of mental health care services among older adults with depression. Journal of Clinical Psychology, 62, 299312.CrossRefGoogle ScholarPubMed
Davies, B. and Challis, D. (1986). Matching Resources to Needs in Community Care: An Evaluated Demonstration of a Long-Term Care Model. Aldershot: Gower.Google Scholar
Goldberg, D., Bridges, K., Duncan-Jones, P. and Grayson, D. (1988). Detecting anxiety and depression in general medical settings. BMJ, 297, 897899.Google Scholar
Greenberg, P. E. et al. (1999). The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry, 60, 427435.Google Scholar
Greenberg, P. E. et al. (2003). The economic burden of depression in the United States: how did it change between 1990 and 2000? Journal of Clinical Psychiatry, 64, 14651475.Google Scholar
Gum, A. M., Petkus, A., McDougal, S. J., Present, M., King-Kallimanis, B. and Schonfeld, L. (2009). Behavioral health needs and problem recognition by older adults receiving home-based aging services. International Journal of Geriatric Psychiatry, 24, 400408.Google Scholar
Katon, W. J. et al. (2005). Cost-effectiveness of improving primary care treatment of late-life depression. Archives of General Psychiatry, 62, 13131320.CrossRefGoogle ScholarPubMed
Kessler, D., Lloyd, K., Lewis, G. and Gray, D. P. (1999). Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ, 318, 436439.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606613.Google Scholar
Licht-Strunk, E., Beekman, A. T., de Haan, M. and van Marwijk, H. W. (2009). The prognosis of undetected depression in older general practice patients: a one year follow-up study. Journal of Affective Disorders, 114, 310315.Google Scholar
Luber, M. P. et al. (2001). Depression and service utilization in elderly primary care patients. American Journal of Geriatric Psychiatry, 9, 169176.CrossRefGoogle ScholarPubMed
Luppa, M., Heinrich, S., Angermeyer, M. C., Konig, H. H. and Riedel-Heller, S. G. (2008). Healthcare costs associated with recognized and unrecognized depression in old age. International Psychogeriatrics, 20, 12191229.CrossRefGoogle ScholarPubMed
O'Shaughnessy, C. V. (2008). The Aging Services Network: Accomplishments and Challenges in Serving a Growing Elderly Population. Washington, DC: National Health Policy Forum.Google Scholar
Perneger, T. V. (1998). What's wrong with Bonferroni adjustments. BMJ, 316, 12361238.Google Scholar
Quijano, L. M. et al. (2007). Healthy IDEAS: a depression intervention delivered by community-based case managers serving older adults. Journal of Applied Gerontology, 26, 139156.Google Scholar
Roy-Byrne, P. P., Katon, W., Cowley, D. S. and Russo, J. (2001). A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care. Archives of General Psychiatry, 58, 869876.Google Scholar
Rummery, K. and Coleman, A. (2003). Primary health and social care services in the U.K.: progress towards partnership? Social Science and Medicine, 56, 17731782.Google Scholar
Schuurmans, J. et al. (2005). The outcome of anxiety disorders in older people at 6-year follow-up: results from the Longitudinal Aging Study Amsterdam. Acta Psychiatrica Scandinavica, 111, 420428.Google Scholar
Sirey, J. A. et al. (2005). The Cornell Service Index as a measure of health service use. Psychiatric Services, 56, 15641569.Google Scholar
Steinman, L. E. et al. (2007). Recommendations for treating depression in community-based older adults. American Journal of Preventive Medicine, 33, 175181.Google Scholar
Toseland, R. W., McCallion, P., Gerber, T., Dawson, C., Gieryic, S. and Guilamo-Ramos, V. (1999). Use of health and human services by community-residing people with dementia. Social Work, 44, 535548.CrossRefGoogle ScholarPubMed
Unützer, J., Simon, G., Belin, T. R., Datt, M., Katon, W. and Patrick, D. (2000). Care for depression in HMO patients aged 65 and older. Journal of the American Geriatrics Society, 48, 871878.Google Scholar
Unützer, J. et al. (2002). Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA, 288, 28362845.Google Scholar
Unützer, J. et al. (2008). Long-term cost effects of collaborative care for late-life depression. American Journal of Managed Care, 14, 95100.Google Scholar
Vink, D., Aartsen, M. J. and Schoevers, R. A. (2008). Risk factors for anxiety and depression in the elderly: a review. Journal of Affective Disorders, 106, 2944.Google Scholar
Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B. and Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 629640.Google Scholar