Six-Month Longitudinal Patterns of Mental Health Treatment Utilization by Older Adults With Depressive Symptoms

Abstract

OBJECTIVE For community-dwelling older adults with depressive symptoms, aims were to: describe behavioral health service utilization patterns over a six-month period; and identify factors associated with service use, guided by a multidimensional, comprehensive theoretical model emphasizing the dynamic nature of service use patterns over time and social context. METHODS 144 participants with depressive symptoms completed an in-person baseline interview and six monthly telephone follow-up interviews. Outcomes included use of antidepressants or counseling at each follow-up. Covariates included individual (demographic, need, prior treatment experience, intentions) and social context (stigma, advice) variables. RESULTS Approximately half of participants received no formal service (antidepressant or counseling; n = 70, 48%). Service use or non-use did not change for most participants. More participants with severe symptoms received antidepressants (25–37%) than those with milder symptoms (10–14%), although more of the milder cases started (62% vs. 49%) and stopped antidepressants (77% vs. 26%) at least once. Fewer individuals received counseling overall, with no clear patterns by symptom severity. In multivariate longitudinal analyses, service use at follow-up was independently associated with younger age, current major depressive episode, baseline use of antidepressant, intention to begin a new service at baseline, and receipt of advice to use services over follow-up. CONCLUSIONS Over a six-month period, the majority of older adults with depressive symptoms in this study continued use or non-use of mental health services. Demographic, need, attitudinal and social variables were related to service use over time. Addressing intentions and providing advice may facilitate uptake of services.

Older Adults Display Concurrent but not Delayed Associations Between Life Stressors and Depressive Symptoms: A Microlongitudinal Study

“…32 Therefore, participants were included in the original study if they had depressive symptoms (i.e., score of ≥5 on the Short-Geriatric Depression Scale [S-GDS], 33 were not receiving any specialty mental health services at study entry, and passed a cognitive screener. 34 Participants were required to screen negative for substance misuse.…”

“…34 Participants were required to screen negative for substance misuse. 35 Although the parent study assessed mental health service use, 32 the use of services was not associated with S- GDS scores and was not included in the present analyses.…”

Mental Health Service Use Among Depressed, Low-Income Homebound Middle-Aged and Older Adults

“…Moreover, a significant proportion of depressed homebound older adults does not seek and receive treatment for their depression because of both personal and systemic barriers previously mentioned. As in the case of older adults in general, receiving prescriptions of antidepressant and/or anxiolytic medications from their PCP tends to be the most prevalent form of treatment for low-income and/or homebound older adults with mental disorders (Gum et al, 2011;Gum, Iser, & Petkus, 2010;Simning, van Wijngaarden, Fisher, Richardson, & Conwell, 2012). However, outpatient psychotherapy services tend to be inaccessible for low-income, homebound older adults because (a) even with Medicare, they cannot afford the 50% copay required for mental health visits; (b) they have difficulty finding transportation to office-based psychotherapy; (c) there is a lack of home-based psychotherapy services for them (Choi & Kimbell, 2009).…”