Research reportThe treatment of common mental disorders across age groups: Results from the 2007 adult psychiatric morbidity survey
Introduction
The forthcoming UK Equality Bill requires that access to health and social care services should be based on need, and not discriminate on grounds of age, race, religion or other personal characteristics (House of Commons, 2009). There is concern in all Western countries that people from older age groups with mental health problems are less likely to receive treatment, but treatment rates have never been compared using data from a national population survey. In 2009, the UK Healthcare Commission identified challenges to implementing the Equality Bill in mental health, including “a lack of awareness of the mental health needs of older people and proper diagnosis in primary care” and “variable quality and availability of some services”, including psychological therapies (Healthcare Commission, 2009). It has been estimated that eliminating age discrimination from UK mental health services would require additional expenditure of £2.0 billion (Beecham et al., 2008).
Beliefs that common mental disorders (CMDs) in older people are a natural consequence of ageing, physical illness, isolation, bereavement or other losses may prevent their active treatment. This is concerning, because CMDs in older people impact on quality of life, and are related to greater cost of care, obesity (Kivimaki et al., 2009), and worsening physical illness (Han, 2002), as well as attempted and completed suicide (NHS, 2009b). In USA and Australian national surveys, older adults with mental health problems were less likely to be in receipt of specialist mental health care, compared with those in middle age (Bogner et al., 2009, Burgess et al., 2009, Neighbors et al., 2007). In the Adult Psychiatric Morbidity Survey (APMS) 2000, which included adults aged 16–74, older men used less mental health services than younger men, although no such difference was identified in women (Beecham et al., 2008, Jenkins et al., 2009). In a UK study, primary care doctors were less likely to refer patients aged 65+ who were depressed to specialist services, but no less likely to prescribe antidepressant medication (Kendrick et al., 2009).
There is good evidence that psychological therapies are effective treatments for CMDs (such as anxiety and depressive disorders). Antidepressants are recommended for treatment of moderate and severe depression (National Institute for Clinical Excellence (NICE), 2007). Their prescription rates in primary care increased between 1993 and 2000 in a British survey, as did those of hypnotics and anxiolytics (mainly benzodiazepines) (Brugha et al., 2004). In the current study, we investigated whether receipt of medication and psychological treatment for CMD differs across age groups using data from a national probability survey, while controlling for level of neurotic (anxiety and depressive) symptoms.
Section snippets
Procedures
The third Adult Psychiatric Morbidity Survey was carried out in England in 2007. The interviewers underwent one day of survey-specific training that included introducing the survey, questionnaire content, confidentiality and managing respondent distress, and were provided with full sets of written instructions. Interviews took place in participants' homes. The structured assessments were conducted using laptops, which interviewers used to enter data. All interviewers were accompanied by a
Results
7461 (57%) of those contacted responded to the survey, but in 58 cases the interview was carried out by proxy respondents, who were not asked about receipt of treatment. 7403 people were therefore included in this analysis. The sociodemographic and treatment characteristics of the sample are described in Table 1. Because of the small numbers of people taking hypnotics and anxiolytics, we combined these categories for multivariate analyses. 118 people (1.3%) were taking either an anxiolytic or
Discussion
People aged 75+ were less likely to be receiving talking therapy compared with younger adults, after controlling for the severity of neurotic symptoms. Adults aged 35 to 74 were most likely to be prescribed antidepressant medication. While the lower likelihood of younger adults receiving antidepressants was balanced by their higher receipt of psychological therapy, this was not so for older people. Older people were more likely to be receiving benzodiazepines. This is concerning, as it suggests
Limitations
Fifty-seven percent of people approached agreed to participate, and while data was weighted to take account of known differences between responding and non-responding households, it is likely that they differed in ways that could not be measured using the area-level and observer-rated variables that were used to calculate these weights. As older people are believed to under-report symptoms of CMD (O'Connor and Parslow, 2009), we may have over-estimated their likelihood of receiving treatment.
Conclusion
Older adults are less likely to receive evidence-based treatment for CMD. Older people were less likely to approach their GP about a mental health problem, but more likely to receive benzodiazepines, suggesting that GPs could usefully invite those receiving benzodiazepines for a medication review. As insomnia is an often overlooked risk factor for late-life depression (Livingston et al., 1993), this could be a useful point at which to screen for depression. Greater vigilance for depression in
Role of the funding source
The third APMS was commissioned by The NHS information centre for health and social care. They were not involved in the analysis and interpretation of data; the writing of or the decision to submit this paper for publication.
Conflict of interest
None.
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