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Mood and Anxiety Disorders Prevalent Among Older Adults

Megan BrooksMaintaining Therapy for Major Depressive Disorder (MDD)
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May 3, 2010 — Rates of mood and anxiety disorders meeting Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) criteria tend to decrease with age but remain "very common," especially in women, according to a study published in the May issue of the Archives of General Psychiatry.

Given the current and projected growth of the older segment of the US population, knowledge of the prevalence of mood and anxiety disorders in older, community-dwelling adults is important; "these are hidden and undertreated but treatable disorders associated with poor health outcomes," write the researchers, led by Amy L. Byers, PhD, MPH, of the Department of Psychiatry, University of California, San Francisco, and the San Francisco VA Medical Center.

Dr. Byers and associates determined nationally representative estimates of mood, anxiety, and combined mood and anxiety disorders in 2575 noninstitutionalized adults 55 years and older. Of these, 43% were 55 to 64 years old, 32% were 65 to 74 years old, 20% were 75 to 84 years, and 5% were 85 years or older.

The sample distribution was 59% women, 82% non-Hispanic white, 10% non-Hispanic black, and roughly 4% Hispanic. Roughly three-quarters of participants had a high school education or higher, and 57% was married or cohabitating.

Overall, 4.9% of the cohort had a mood disorder (most often major depressive disorder and bipolar disorder) in the previous 12 months, 11.6% had an anxiety disorder (most often specific phobia, social phobia, and generalized anxiety), and 2.8% had co-occurring mood and anxiety disorders.

"The likelihood of having a mood, anxiety, or combined mood-anxiety disorder generally showed a pattern of decline with age (P < .05)," the study authors report.

When comparing the young-old group (55 to 64 years) with the oldest-old group (85 years and older), 7.6% vs 2.4% had mood disorders, 16.6% vs 8.1% had anxiety disorders, and 4.8% vs 0.0% had both conditions.

Growing Burden

Rates of mood and anxiety disorders and comorbid mood-anxiety disorders were generally higher for women in each age group but did not vary by race or ethnicity; however, small cell counts for minority groups lowered the power to detect a difference, the study authors note.

The high rate of anxiety in the current cohort of older adults supports a prior study by the same researchers. This study of 70- to 79-year-old, community-dwelling adults found an overall rate of anxiety of 19% (20% women and 12% men). This shows that anxiety disorders are "prominent and pervasive in older adults even into the oldest years," Dr. Byers and colleagues note.

The strengths of the study, the researchers say, include a nationally representative sample, current DSM diagnostic assessment, and precise age stratification. The limitations of the study include underrepresentation of homeless, institutionalized, and non–English-speaking older adults; possible issue with stigma, whereby older adults with mental illness might be less inclined to participate in a mental health survey; and a lay-administered interview rather than a clinically administered assessment. Given these limitations, the derived estimates are likely to be conservative, the study authors say.

"Given the rapid aging of the US population, the potential public health burden of late-life mental health disorders will likely grow as well, suggesting the importance of continued epidemiologic monitoring of the mental health status of the young-old, mid-old, old-old, and oldest-old cohorts," the researchers conclude.

The study authors have disclosed no relevant financial relationships.