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Caring for Mental Illness in the United States

A Focus on Older Adults

Received April 2, 2002; revised January 10, April 8, 2003; accepted April 11, 2003. From the Center for Health Services Research; UCLA Neuropsychiatric Institute, Los Angeles, CA (RK,JU), and the School of Medicine; Ohio State University College of Medicine and Public Health (KTU). Dr. Unützer is now at the University of Washington. Send correspondence to Jürgen Unützer, M.D., M.P.H., Professor and Vice Chair, Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA 98195. e-mail: unutzer{at}u.washington.edu
©2003 American Association for Geriatric Psychiatry

Objective: The authors compared rates of common mental disorders and the use of primary care and specialty mental health services among younger and older adults. Methods: They used data from 9,585 respondents to the HealthCare for Communities (HCC) Household Telephone Survey. Mental disorders during the past year, including depression, dysthymia, and generalized anxiety disorder, were identified with a short questionnaire. The survey also collected information about sociodemographic and insurance status, perceived need for mental health care, and use of health services. Results: Older adults (age 65 and older) were significantly less likely than younger adults (18–29) or middle-aged adults (30–64) to meet diagnostic criteria for a mental disorder (8% versus 15% in each of the younger age-groups). Older adults who met diagnostic criteria for mental disorders were less likely to perceive a need for mental health care, to receive specialty mental health care or counseling, or to receive referrals from primary care to mental health specialty care than young or middle-aged adults. Conclusion: Few older adults with mental disorders use mental health services, particularly specialty mental health services. The lack of perceived need for mental health care may contribute to low rates of mental health service use among older adults.

Key Words: Health Services