James D. Colliver

Serious Psychological Distress and Mental Health Service Use Among Community-Dwelling Older U.S. Adults

OBJECTIVES This study examined the prevalence and predictors of past-year serious psychological distress and receipt of mental health services among community-dwelling older adults in the United States. METHODS The sample included 9,957 adults aged 65 or older from the 2004-2007 National Survey on Drug Use and Health. Serious psychological distress was defined as having a score of 13 or higher on the K6 scale of nonspecific psychological distress. Descriptive analyses and logistic regression modeling were applied. RESULTS Among community-dwelling older adults, 4.7% had serious psychological distress in the past year. Among those with past-year serious psychological distress, 37.7% received mental health services in the past year (4.8% received inpatient services, 15.8% received outpatient services, and 32.1% received prescription medications) (weighted percentages). Logistic regression results suggested that among older adults with serious psychological distress, receipt of mental health services was more likely among women, non-Hispanic whites, those who were married, those who were highly educated, Medicare-Medicaid dual beneficiaries, those with a major depressive episode, and those with more general medical conditions. CONCLUSIONS These results suggest the need to screen for mental health problems among older adults and to improve the use and the quality of their mental health services. Since 2008 significant changes have revolutionized payment for mental health care and may promote access to mental health care in this population. Further studies are needed to assess trends in mental health service utilization among older adults and in the quality of their mental health care over time.

Drug Abuse Heterogeneity and the Search for Subtypes

In addition to the research on the association between substance use disorders and antisociality, there is a large body of literature reporting connections with behavior disinhibition and affect dysregulation. It is not possible in this short chapter to review these and other findings on risk factors for substance use disorders. However, the above discussion illustrates the convergences in the research findings on risk factors that point to possible clusters having implications for further understanding the heterogeneity of substance abuse and the identification of drug abuse subtypes.