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Mental Health Issues and Treatment

Mental health in older ageDepressionCauses of depressionEffects of depressionSuicide

Newsom, Winter 2017, Psy 462/562 Psychology of Adult Development and Aging 1

Mental Health in Older Age


Older adults seem protected against serious psychological distress

Older adults seem protected against serious psychological distress

Substance Abuse and Mental Health Services Administration (2012). Results from the 2010 National Survey on Drug Use and Health: Mental health detailed tables. Rockville,MD: Substance Abuse and Mental Health Services Administration. http://www.samhsa.gov/data/NSDUH/2k10MH Findings/2k10MH DTables/TOC.htm


Forms of Anxiety Disorders


Generalized anxiety disorderOverall sense of uneasinessProne to worryingFeelings of restlessness and tension5.7% lifetime prevalence

Panic disorderInvolve panic attacks, or feeling that one is about to dieMay also involve agoraphobia1.4% lifetime prevalence but panic attacks are more frequent

Specific phobiasIrrational fear of particular object or situationAnimals, natural environment, blood‐injection‐injury, engaging in specific activities12.5% lifetime prevalence

Social anxiety disorderExtreme anxiety about being watched by other peopleMay become anxious at thought of eating in front of others12% lifetime prevalence


Trauma and stress-related disorders• Symptoms include intrusion of distressing reminders, dissociative symptoms, avoidance of situations that remind one of the event, and hyperarousal

• Acute stress disorder involves symptoms for up to 1 month• Post‐traumatic stress disorder involves symptoms for >1 month• 6.8% lifetime prevalence; older adults may suffer from late‐onset stress symptomatology

• PTSD rates expected to increase as Vietnam vet population ages



Alcohol dependence in older adults• As many as 14% who receive medical attention in hospitals and ERs

• Prevalent in nursing homes and retirement communities• Risks include cirrhosis to increased risk of injury as well as diabetes, high blood pressure, congestive heart failure, osteoporosis and mood disorders

• Alcohol also interacts badly with common meds• Chronic alcohol use can also lead to changes in kidneys and brain


Depression

Clinical depression – diagnosis according to Diagnostic and Statistical Manual (DSM‐V)

Dysthymia – less severe, long‐lasting (2 yrs or longer)Psychotic depression – sever depression that may include

hallucinations and/or delusionsAlzheimer’s related depression – mood disturbances

associated with Alzheimer’s diseaseDepressive symptomatology – some symptoms, not as

several, not as incapacitating


Blazer, D. G. (2003). Depression in late life: review and commentary. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58(3), M249-M265.

Depression Clinical depression

Specific symptoms, at least 5 of these 9, present nearly every day: Depressed mood or irritable most of the day, nearly every day Decreased interest or pleasure in most activities, most of each day Significant weight change (5%) or change in appetite Change in sleep: Insomnia or hypersomnia Change in activity: Psychomotor agitation or retardation Fatigue or loss of energy Guilt/worthlessness: Feelings of worthlessness or excessive or

inappropriate guilt Diminished concentration Suicidality



Depression


Figure 2. Lifetime (A) and 12-month (B) prevalence estimates for major depressive episode by age group and gender, according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition/Composite International Diagnostic Interview. Based on data from reference 5.

Uhmann, S. (2010). The timing of depression: an epidemiological perspective. Medicographia, 32, 115-125.

Center for Epidemiologic Studies – Depression (CES‐D)

Widely used in gerontology and epidemiological researchDepression symptomatology and clinical cutoffsGood sensitivity and specificity (about 75‐80) for predicting

clinical diagnosis20 questions rating frequency of feelings per week (0 = rarely or

none of the time to 3 = all of the time)Similar measurement properties across age, gender, cognitive

impairment, functional impairment, physical disease, and social desirability


Radloff, L. S. (1977). The CES‐D Scale: A self‐report depression scale for research in the general population. Applied Psychological Measurement, I, 385‐401.

Lewinsohn, P. M., Seeley, J. R., Roberts, R. E., & Allen, N. B. (1997). Center for Epidemiologic Studies Depression Scale (CES‐D) as a screening instrument for depression among community‐residing older adults. Psychology and aging, 12(2), 277.


Sutin, A. R., Terracciano, A., Milaneschi, Y., An, Y., Ferrucci, L., & Zonderman, A. B. (2013). The trajectory of depressive symptoms across the adult life span. JAMA psychiatry, 70(8), 803-811.

Baltimore Longitudinal Study of Aging, data from 1979‐2011

Health Effects of Depression Possible health effectsWeight lossCardiovascular diseaseHeart failureBone lossPoorer immune functioningFunctional impairment SuicideIn combination with mild cognitive impairment, higher risk of

Alzheimer’s diseaseMortality (non‐suicidal)



PsychodynamicInner conflictsAttachment issuesLife review

PsychodynamicInner conflictsAttachment issuesLife review

Cognitive‐behavioralChange thoughts and behavior

Cognitive‐behavioralChange thoughts and behavior

BehavioralChange reinforcements for behavior

BehavioralChange reinforcements for behavior

CognitiveFocus on dysfunctional thoughts

CognitiveFocus on dysfunctional thoughts

InterpersonalCognitive methods and social skills

InterpersonalCognitive methods and social skillsIntegration

Combination of approaches

Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.


http://www.psychiatrictimes.com/articles/depression‐stress‐and‐risk‐heart‐disease

Health Effects of Depression

Health Effects of Depression


Zhang, X., Norris, S. L., Gregg, E. W., Cheng, Y. J., Beckles, G., & Kahn, H. S. (2005). Depressive symptoms and mortality among persons with and without diabetes. American Journal of Epidemiology, 161(7), 652-660.

Suicide

• Alcohol, anti‐depressants, opiates were found in 33% of suicide victims

• 10th leading cause of death, majority 25‐54• 3rd leading cause of death for 15‐24 year olds (20% of all deaths)

• Males 75+ have highest rates, amounting to 2500 people• Older adults often have only mild to moderate symptoms of depression

• Between 43‐76% of suicide victims had seen health care provider within month of their death



https://www.cdc.gov/mmwr/preview/mmwrhtml/su6203a31.htm

Suicide


https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6338a8.htm

Suicide


Odds ratio of suicide ideation according to various demographic, lifestyle, psychosocial and clinical factors. All variables were forced together into a multivariate logistic regression model.

Osvaldo P. Almeida et al. BJP 2012;201:466-472

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