June 23, 2015
In recognition of the essential role mental health plays in overall health, the Healthy Aging Program at the Centers for Disease Control and Prevention (CDC) and the National Association of Chronic Disease Directors (NACDD) are releasing two issue briefs focused on the mental health of older adults in the United States. This first issue brief reviews existing data and lays the foundation for understanding key issues related to mental health in adults over 50. The second brief will focus on depression, an important and emerging public health issue. Recent public health efforts to develop, test, and disseminate programs that address depression in older adults have led to practical information on this topic; the second issue brief will examine interventions to address depression that communities can use to improve the mental health and quality of life of older Americans.
Mental Health Problems in Older Adults The Behavioral Risk Factor Surveillance System and Indicators
It is estimated that 20% of people age 55 years or older experience some type of mental health concern (6). The most common conditions include anxiety, severe cognitive impairment, and mood disorders (such as depression or bipolar disorder) (6). Mental health issues are often implicated as a factor in cases of suicide. Older men have the highest suicide rate of any age group (7). Men aged 85 years or older have a suicide rate of 45.23 per 100,000, compared to an overall rate of 11.01 per 100,000 for all ages (7). The Significance of Depression Depression, a type of mood disorder, is the most prevalent mental health problem among older adults. It is associated with distress and suffering (4). It also can lead to impairments in physical, mental, and social functioning (4). The presence of depressive disorders often adversely affects the course and complicates the treatment of other chronic diseases (8). Older adults with depression visit the doctor and emergency room more often, use more medication, incur higher outpatient charges, and stay longer in the hospital (4).
Although the rate of older adults with depressive symptoms tends to increase with age (4), depression is not a normal part of growing older. Rather, in 80% of cases it is a treatable condition (8). Unfortunately, depressive disorders are a widely under-recognized condition and often are untreated or undertreated among older adults (4). As described earlier, a core public health function related to mental health is the collection of surveillance data that can be used for priority setting and as the foundation for developing public health programs. Through CDC’s Behavioral Risk Factor Surveillance System (BRFSS—see Technical Information), states collect data on the mental health of older adults. The BRFSS questionnaire consists of three parts: 1) core questions asked to all 50 states, the District of Columbia and three territories, 2) supplemental modules which are a series of questions on specific topics (e.g. mental health, adult asthma history, intimate partner violence), and 3) state-added questions that are selected by individual states.
There are BRFSS core questions related to mental health that collect information on the prevalence of social and emotional support, life satisfaction, and the number of mentally unhealthy days. An Anxiety and Depression module was developed for the BRFSS to collect additional information on mental health conditions. In 2006, 38 states and three territories used this module to determine the prevalence of current depression, lifetime diagnosis of depression, and lifetime diagnosis of anxiety. This issue brief reports on six indicators related to mental health that were part of the 2006 BRFSS survey, both from core questions and the Anxiety and Depression module. Data are provided for the U.S. population age 50 years or older, with a focus on age, racial/ethnic differences, and sex.