Health Disparities Research in Geriatric Mental Health: Commentary from the National Institute of Mental Health

Trends, heterogeneity, and correlates of mental health and psychosocial well-being in later-life: study of 590 community-dwelling adults aged 40-104 years

OBJECTIVE

The goal of this study was to examine if mental health and psychosocial well-being differed between middle-aged (MA; 40-59 years), younger-old (YO; 60-79 years), and older-old (OO; 80+ years) adults with respect to their trends, heterogeneity, and correlates.

METHODS

Eighteen mental health and psychosocial well-being instruments were administered to 590 adults over age 40. Cross-sectional data also included self-report-based measures of sociodemographics, cognitive functioning, physical health and activity, and body mass index.

RESULTS

Age trends across instruments varied in magnitude and shape, but generally supported an inverted U-shaped trend in mental health and psychosocial well-being, with small increases from MA to YO age (d = 0.29) and smaller declines from YO to OO age (d = -0.17). A U-shaped association between age and mental health heterogeneity was also observed. The strongest correlates of mental health and psychosocial well-being differed by age (MA: perceived stress; YO: successful aging; OO: compassion toward others), as did the associations of a flourishing versus languishing mental health and well-being profile.

CONCLUSIONS

Our findings support the "paradox of aging," whereby declines in physical and cognitive health co-occur with relatively preserved mental health and well-being. Our findings indicate that variance in mental and psychosocial health does not increase linearly with age and support careful consideration of heterogeneity in mental health and aging research. Our findings also suggest that mental health and psychosocial well-being decouple from stress-related dimensions in MA and become increasingly associated with positive, other-oriented emotions in OO, broadly supporting socioemotional theories of aging.

Social Disconnection in Late Life Mental Illness - Commentary From the National Institute of Mental Health

•Social disconnection – both objective social isolation as well as perceived social isolation (otherwise known as loneliness) – is a prevalent affliction among older adults, with profound effects on mental health. •Mechanistic understanding of how mental illness contributes to, is exacerbated by, or is otherwise linked to social disconnection remains elusive, and therapeutic interventions which leverage social connection to enhance compliance with or efficacy of mental health treatment, though promising, remain scarce. •The National Institute of Mental Health (NIMH) is committed to transforming the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. To translate basic knowledge into new methods for diagnosis, treatment, and prevention of mental illness demands appreciation for the broader milieu of social and environmental factors in which mental illness prevails – of which, social connection or disconnection is one.

Storm Impact and Depression Among Older Adults Living in Hurricane Sandy–Affected Areas

Objective

Research on the impact of natural disasters on the mental health of older adults finds both vulnerabilities and resilience. We report on the rates of clinically significant depression among older adults (aged ≥60 years) living in areas affected by Hurricane Sandy in 2012 and the factors associated with mental health need.

Methods

The Sandy Mobilization, Assessment, Referral and Treatment for Mental Health (SMART-MH) program integrates community outreach and needs assessments to identify older adults with mental health and aging service needs. Older adults with significant anxiety or depressive symptoms were offered short-term psychotherapy. Social service referrals were made directly to community agencies. All SMART-MH activities were offered in Spanish, Russian, Mandarin/Cantonese, and English.

Results

Across the full sample, 14% of participants screened positive for depression. Hurricane Sandy stressors predicted increased odds of depression, including storm injury, post-storm crime, and the total count of stressors. Outcomes varied significantly by age group, such that all Sandy-related variables remained significant for younger-old adults (aged 60–74 years), whereas only the loss of access to medical care was significant for older-old adults (aged ≥75 years).

Conclusions

Storm-affected communities show higher rates of depressive symptoms than seen in the general population, with storm stressors affecting mental health needs differentially by age group. (Disaster Med Public Health Preparedness. 2017;11:97–109)

Improving Mental Health Treatment Initiation among Depressed Community Dwelling Older Adults

OBJECTIVE

Depression screening has been widely implemented in community settings to increase detection of late-life depression. Rates of treatment initiation are low without additional structured follow-up, however. The current study evaluates the effectiveness of a brief psychosocial intervention, Open Door, designed to improve initiation of mental health treatment among clients of aging service meals programs.

DESIGN

Older adult social service clients with depressive symptoms were randomized to either the Open Door intervention or a Service Referral control condition. In Open Door, the counselor collaborates with the client to identify and address both attitudinal and structural barriers to seeking mental health treatment. Independent research assessments were conducted 12 and 24 weeks after baseline to document treatment initiation (at least one session).

RESULTS

At follow up, 64.6% (104 out of 161) of participants had initiated a provider visit. Participants in Open Door were more likely to initiate treatment compared with those in the control condition (χ(2) = 5.83, df = 2, p = 0.016). Among participants with at least mild depressive symptoms, Open Door remained significantly more effective than the control condition (p < 0.05). In multivariate analyses controlling for gender differences, both participation in the Open Door group and depression severity predicted treatment initiation (χ(2) = 15.18, df = 3, p = 0.002).

CONCLUSIONS

High rates of depression have been documented among older adults receiving social services (case management or home meals). The Open Door program offers a useful strategy to overcome the barriers to treatment initiation while fitting within the responsibilities of aging service staff. The intervention can improve initiation of late-life depression care.