Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-10T10:53:38.416Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of Health Services for Psychological Distress Symptoms among Community-Dwelling Older Adults*

Published online by Cambridge University Press:  01 March 2009

Michel Préville ,
Helen-Maria Vasiliadis ,
Richard Boyer ,
Maria Goldfarb ,
Karine Demers ,
Joëlle Brassard  and
Sarah-Gabrielle Béland
Michel Préville*
Affiliation:
Faculty of Medicine, Université de Sherbrooke Research Center, Charles LeMoyne Hospital
Helen-Maria Vasiliadis
Affiliation:
Faculty of Medicine, Université de Sherbrooke Research Center, Charles LeMoyne Hospital
Richard Boyer
Affiliation:
Faculty of Medicine, Université de Montréal Fernand-Seguin Research Center, Canada
Maria Goldfarb
Affiliation:
Ph.D. candidate, Psychology Department, Université du Québec à Montréal
Karine Demers
Affiliation:
Ph.D. candidate, Clinical Sciences Program, Université de Sherbrooke
Joëlle Brassard
Affiliation:
Research Center, Charles LeMoyne Hospital
Sarah-Gabrielle Béland
Affiliation:
Ph.D. candidate, Pharmacy Program, Université de Montréal
*
†Address correspondence to Dr. Michel Préville Research Center Hôpital Charles LeMoyne 3120, boul. Taschereau Greenfield Park (Québec) J4V 2H1 (michel.preville@usherbrooke.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

To document the use of health services for psychological distress symptoms, we collected data from a cross-section of adults aged 65 years and over. Nearly 13 per cent met DSM-IV criteria for mood or anxiety disorders. In addition, 42.4 per cent of those having at least one DSM-IV diagnosis reported having used health services. Results show a direct association between the presence of a probable DSM-IV diagnosis and health service use. However, our results show no significant association between gender and health service use, and do not support the hypothesis that minimal social support increases the probability of older adults using health services for psychological distress. The analysis suggests unmarried elders are more likely than married elders to use health services. Furthermore, this study shows that older adults having a high level of daily hassles reported using health services for psychological distress than those reporting a low stress level. We conclude that a large proportion of elderly mental health needs in Quebec are potentially not being met.

Résumé

Cette étude visait à documenter l’utilisation des services de santé pour des symptômes de détresse psychologique dans la population âgée du Québec vivant à domicile. Les données utilisées dans cette étude proviennent d’une étude transversale réalisée en 2005-2006 auprès d’un échantillon représentatif (n = 2784) de la population de 65 ans et plus. Nos résultats ont montré que près de 13 pour cent des répondants rapportaient des symptômes rencontrant les critères diagnostiques de troubles dépressif ou d’anxiété selon le DSM-IV. De plus, 42.4 pour cent de ceux ayant au moins un diagnostic DSM-IV, ont rapporté avoir utilisé les services de santé pour leurs symptômes. La plupart des répondants (79%) ont visité un médecin généraliste. Peu (5%) ont visité un psychologue, un travailleur social (2.4%), ou une infirmière (0.7%). Contrairement aux conclusions d’autres études, nos résultats n’ont montré aucune association significative entre le sexe et l’utilisation des services de santé. En outre, nos résultats ne supportent pas l’hypothèse selon laquelle un faible soutien social augmente la probabilité d’utiliser les services de santé pour des symptômes de détresse psychologique chez les personnes âgées. Cependant, nos résultats suggèrent que les personnes non mariées ont une probabilité plus élevée d’utiliser les services de santé que les personnes âgées mariées. Cette étude a montré également que les personnes âgées présentant un niveau de stress élevé ont rapporté avoir utilisé les services de santé pour leurs symptômes de détresse psychologique dans une plus grande proportion. Nos résultats nous amènent à conclure qu’une grande proportion des besoins de santé mentale des personnes âgées au Québec est potentiellement non comblée. Des recherches longitudinales semblent nécessaires pour éviter une mauvaise interprétation de ces résultats. Les futures études longitudinales permettront de mieux documenter les facteurs reliés à la sous utilisation des services de santé par les personnes présentant un trouble psychiatrique.

Keywords

détresse psychologiquebesoin de santéutilisation des services de santévieillissmentpsychological distressneed for healthhealth services utilizationaging
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 28 , Issue 1 , March 2009 , pp. 51 - 61
Copyright
Copyright © Canadian Association on Gerontology 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This study was supported by the Canadian Institutes of Health Research (200403MOP) and the Fonds de recherche en santé du Québec (ref: 9854). The authors thank the members of the Scientific Committee of the ESA Study, who provided significant scientific advice, and Bernadette Wilson, who provided editing comments.

References

Alonso, J., Angermeyer, M.C., Bernert, S., Bruffaerts, R., Brugha, T.S., Bryson, H., et al. . (2004). Use of mental health services in Europe: Results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 109, Supplementum (420), 47–54.Google Scholar
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed., DSM-IV). Washington, DC: APA.Google Scholar
Barney, L.J., Griffiths, K.M., Jorm, A.F., & Christensen, H. (2006). Stigma about depression and its impact on help-seeking intentions. Australian and New Zealand Journal of Psychiatry, 40(1), 51–54.Google Scholar
Beekman, A.T., Deeg, D.J., Braam, A.W., Smit, J.H., & Van Tilburg, W. (1997). Consequences of major and minor depression in later life: A study of disability, well-being and service utilization. Psychological Medicine, 27(6), 1397–1409.Google Scholar
Bland, R.C., Newman, S.C., & Orn, H. (1997). Help-seeking for psychiatric disorders. Canadian Journal of Psychiatry, 42(7), 935–942.Google Scholar
Blazer, D.G. (1993). Depression in late life (2nd ed.). St. Louis: Mosby.Google Scholar
Bucholz, K.K., Marion, S.L., Shayka, J.J., Marcus, S.C., & Robins, L.N. (1996). A short computer interview for obtaining psychiatric diagnoses. Psychiatric Services, 47(3), 293–297.Google Scholar
Burke, W.J., Houston, M.J., Boust, S.J., & Roccafortte, W.H. (1989). Use of the Geriatric Depression Scale in dementia of the Alzheimer type. Journal of the American Geriatrics Society, 37(9), 856–860.Google Scholar
Clayer, J.R., McFarlane, A.C., & Wright, G. (1992). Epidemiology by computer. Social Psychiatry and Psychiatric Epidemiology, 27(6), 258–262.Google Scholar
Crabb, R., & Hunsley, J. (2006). Utilisation of mental health services among older adults with depression. Journal of Clinical Psychology, 62(3), 299–312.Google Scholar
Crawford, M.J., Prince, M., Menezes, P., & Mann, A.H. (1998). The recognition and treatment of depression in older people in primary care. International Journal of Geriatric Psychiatry, 13(3), 172–176.Google Scholar
Crum, R.M., Anthony, J.C., Bassett, S.S., & Folstein, M.F. (1993). Population-based norms for the mini-mental state examination by age and educational level, Journal of American Medical Association, 269(18), 2386–2391.Google Scholar
DeLongis, A., Coyne, J.C., Dakof, G., Folkman, S., & Lazarus, R.S. (1982). Relationship of daily hassles, uplifts, and major life events to health status. Health Psychology, 1(2), 119–136.Google Scholar
Erdman, H.P., Klein, M.H., Greist, J.H., Skare, S.S., Husted, J.J., Robins, L.N., et al. (1992). A comparison of two computer-administered versions of the NIMH Diagnostic Interview Schedule. Journal of Psychiatric Research, 26(1), 85–95.Google Scholar
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-Mental State: A practical method for grading the state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198.Google Scholar
Gallo, J.J., Anthony, J., & Muthen, B. (1994). Age differences in the symptoms of depression: A latent trait analysis. Journal of Gerontology, 49(6), 251–264.Google Scholar
Gallo, J.J., & Rabins, P.V. (1999). Depression without sadness: Alternative presentations of depression in late life. American Family Physician, 60(3), 820–826.Google Scholar
Gallo, J.J, Rabins, P.V., Lyketsos, C.G., Tien, A.Y., & Anthony, J.C. (1997). Depression without sadness: Functional outcomes of nondysphoric depression in later life. Journal of American Geriatric Society, 45(5), 570–578.Google Scholar
Gallo, J.J., Ryan, S.D., & Ford, D.E. (1999). Attitudes, knowledge, and behavior of family physicians regarding depression in late life. Archives of Family Medicine, 8(3), 249–256.Google Scholar
German, P.S., Shapiro, S., & Skinner, E.A. (1985). Mental health of the elderly: Use of health and mental health services. Journal of American Geriatric Society, 33(4), 246–252.Google Scholar
Greenberg, P.E., Kessler, R.C., Birnbaum, H.G., Leong, S.A., Lowe, S.W., Berglund, P.A., et al. , (2003). The economic burden of depression in the United States: How did it change between 1990 and 2000? Journal of Clinical Psychiatry, 64(12), 1465–1475.Google Scholar
Gurland, B.J., & Toner, J.A. (1982). Depression in the elderly: A review of recently published studies. In Eisdorfer, C. (Ed.), Annual Review of Gerontology and Geriatrics (pp. 228–265). New York: Springer.Google Scholar
Henderson, S., Andrews, G., & Hall, W. (2000). Australia’s mental health: An overview of the general population survey. Australian and New Zealand Journal of Psychiatry, 34(2), 197–205.Google Scholar
Holzer, C.E., Shea, B.M., Swanson, J.W., Leaf, P.J., Myers, J.K., George, L., et al. , (1986). The increased risk for specific psychiatric disorders among persons of low socioeconomic status: Evidence from the Epidemiologic Catchment Area Surveys. American Journal of Social Psychiatry, 4, 259–271.Google Scholar
Hosmer, D.W., & Lemeshow, S. (1989). Applied logistic regression. New York: Wiley & Sons.Google Scholar
Institut de la Statistique du Québec. (2005). Lexique du système du code géographique du Québec [Glossary of the system of geographical code in Quebec].Google Scholar
Issakidis, C., & Andrews, G. (2006). Who treats whom? An application of the pathways to care model in Australia. Australian and New Zealand Journal of Psychiatry, 40(1), 74–86.Google Scholar
Kafonek, S., Ettinger, W.H., Roca, R., Kittner, S., Taylor, N., & German, P.S. (1989). Instruments for screening for depression and dementia in a long-term facility. Journal of the American Geriatrics Society, 37(1), 29–34.Google Scholar
Kanner, A.D., Coyne, J.C., Schaefer, C., & Lazarus, R.S. (1981). Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. Journal of Behavioral Medicine, 4(1), 1–39.Google Scholar
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 593–602.CrossRefGoogle Scholar
Klap, R., Unroe, K.T., & Unützer, J. (2003). Caring for mental illness in the United States: A focus on older adults. American Journal of Geriatric Psychiatry, 11(5), 517–524.Google Scholar
Leaf, P.J., Bruce, M.L., Tischler, G.L., Freeman, D.H. Jr., Weissman, M.M., & Myers, J.K. (1988). Factors affecting the utilization of specialty and general medical mental health services. Medical Care, 26(1), 9–26.Google Scholar
Lebowitz, B.D, Pearson, J.L., Schneider, L.S., Reynolds, C.F. 3rd, Alexopoulos, G.S., Brace, M.L., et al. (1997) Diagnosis and treatment of depression in late life. Consensus statement update Journal of American Medical Association 278(14), 1186–1190.Google Scholar
Lefebvre, J., Lesage, A., Cyr, M., Toupin, J., & Fournier, L. (1998). Factors related to utilization of services for mental health reasons in Montreal, Canada. Society of Psychiatry and Psychiatric Epidemiology, 33(6), 291–298.Google Scholar
Levitan, R.D., Blouin, A.G., Navarro, J.R., & Hill, J. (1991). Validity of the computerized DIS for diagnosing psychiatric inpatients. Canadian Journal of Psychiatry, 36(10), 728–731.Google Scholar
Mackenzie, C.S., Gekoski, W.L., & Knox, V.J. (1999). Do family physicians treat older patients with mental disorders differently from younger patients? Canadian Family Physician, 45, 1219–1224.Google Scholar
Mechanic, D., Angel, R., & Davies, L. (1991). Risk and selection processes between the general and the specialty mental health sectors. Journal of Health & Social Behavior, 32(1), 49–64.Google Scholar
Mickus, M., Colenda, C.C., & Hogan, A.J. (2000). Knowledge of mental health benefits and preferences for type of mental health providers among the general public. Psychiatric Services, 51(2), 199–202.Google Scholar
Monroe, S.M. (1983). Social support and disorder: Toward an untangling of cause and effect. American Journal of Community Psychology, 11(1), 81–97.Google Scholar
Murphy, J.M., Monson, R.R., Laird, N.M., Sobol, A.M., & Leighton, A.H. (2000). A comparison of diagnostic interviews for depression in the Stirling County Study: Challenges for psychiatric epidemiology. Archives of General Psychiatry, 57(3), 230–236.Google Scholar
O’Connor, D.W., Rosewarne, R., & Bruce, A. (2001). Depression in primary care. 1: Elderly patients’ disclosure of depressive symptoms to their doctors. International Psychogeriatrics, 13(3), 359–365.Google Scholar
Parashos, I.A., Stamouli, S., Rogakou, E., Theodotou, R., Nikas, I., & Mougias, A. (2002). Recognition of depressive symptoms in the elderly: What can help the patient and the doctor. Depression & Anxiety, 15(3), 111–116.Google Scholar
Pfaff, J.J., & Almeida, O.P. (2005). A cross-sectional analysis of factors that influence the detection of depression in older primary care patients. Australian and New Zealand Journal of Psychiatry, 39(4), 262–265.Google Scholar
Phillips, M.A., & Murrell, S.A. (1994). Impact of psychological and physical health, stressful events, and social support on subsequent mental health help seeking among older adults. Journal of Consulting and Clinical Psychology, 62(2), 270–275.Google Scholar
Préville, M., Boyer, R., Grenier, S., Dubé, M., Voyer, P., Punti, R., et al. , & the Scientific Committee of the ESA study. (2008). The epidemiology of psychiatric disorders in the Quebec’s older adult population. Canadian Journal of Psychiatry, 53(12), 822–832.CrossRefGoogle Scholar
Préville, M., Hébert, R., Boyer, R., & Bravo, G. (2001). Correlates of psychotropic drug use in the elderly compared to adults aged 18-64: Results from the Quebec Health Survey. Aging and Mental Health, 5(3), 216–224.Google Scholar
Préville, M., Hébert, R., Bravo, G., & Boyer, R. (2001). Predisposing and facilitating factors of severe psychological distress among frail elderly adults. Canadian Journal on Aging, 21(2), 195–204.Google Scholar
Préville, M., Potvin, L., & Boyer, R. (1998). Psychological distress and use of ambulatory medical services in the Quebec medicare system. Health Services Research, 33(2), 249–260.Google Scholar
Rapp, S.R., Parisi, S.A., Walsh, D.A., & Wallace, C.E. (1988). Detecting depression in elderly medical inpatients. Journal of Consulting and Clinical Psychology, 56(4), 509–513.Google Scholar
Robb, C., Haley, W.E., Becker, M.A., Polivka, L.A., & Chwa, H.J. (2003). Attitudes towards mental health care in younger and older adults: Similarities and differences. Aging & Mental Health, 7(2), 142–152.Google Scholar
Robins, L.N., Helzer, J.E., Croughan, J., & Ratcliff, K.S. (1981). National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Archives of General Psychiatry, 38(4), 381–389.Google Scholar
Robins, L.N., Helzer, J.E., Orvaschel, H., Anthony, J.C., Blazer, D.G., Burnami, A., et al. , (1985). The Diagnostic Interview Schedule. In Eaton, W.W. & Kessler, L.G. (Eds.), Epidemiologic field methods in psychiatry (pp. 143–170). New York: Academic Press.Google Scholar
Robins, L.N., Locke, B.Z., & Regier, D.A. (1991). An overview of psychiatric disorders in America. In Robins, L.N., & Regier, D.A. (Eds.), Psychiatric Disorders in America (pp. 328–366). New York: Free Press.Google Scholar
Ruegg, R.G., Zisook, S., & Swerdlow, N.R. (1988). Depression in the aged. Psychiatric Clinics of North America, 11(1), 83–99.Google Scholar
Sarkisian, C.A., Lee-Henderson, M.H., & Mangione, C.M. (2003). Do depressed older adults who attribute depression to “old age” believe it is important to seek care? Journal of General Internal Medicine, 18(12), 1001–1005.Google Scholar
Schlesinger, H.J., Mumford, E., Glass, G.V., & Sharfstein, S. (1983). Mental health treatment and medical care utilization in a free-for-service system: Outpatient mental health treatment following the onset of a chronic disease. American Journal of Public Health, 73(4), 422–429.Google Scholar
Sheehan, B., Bass, C., Briggs, R., & Jacoby, R. (2003). Somatic symptoms among older depressed primary care patients. International Journal of Geriatric Psychiatry, 18(6), 547–548.CrossRefGoogle ScholarPubMed
Shulman, K.I. (1989). Conceptual problems in the assessment of depression in old age. Psychiatry Journal University of Ottawa, 14(2), 364–366.Google Scholar
Simon, G.E., & Von Korff, M. (1991). Somatization and Psychiatric Disorder in the NIMH Epidemiologic Catchment Area Study. American Journal of Psychiatry, 148(11), 1494–1500.Google Scholar
Simon, G.E., & Katzelnick, D.J. (1997). Depression, use of medical services and cost-offset effects. Journal of Psychosomatic Research, 42(4), 333–344.Google Scholar
Smith, L.D., McGovern, R.J., & Peck, P.L. (2004). Factors contributing to the utilization of mental health services in a rural setting. Psychological Reports, 95(2), 435–442.Google Scholar
Swartz, M.S., Wagner, H.R., Swanson, J.W., Burns, B.J., George, L.K., & Padgett, D.K. (1998). Administrative update: Utilization of services. I. Comparing use of public and private mental health services: The enduring barriers of race and age. Community Mental Health Journal, 34(2), 133–144.Google Scholar
Ten Have, M.T., Oldehinkel, A., Vollebergh, W., & Ormel, J. (2003). Does educational background explain inequalities in care service use for mental health problems in the Dutch general population? Acta Psychiatrica Scandinavica, 107(3), 178–187.Google Scholar
Ten Have, M.T., Vollebergh, W., Bijl, R., & Ormel, J. (2002). Combined effect of mental disorder and low social support on care service use for mental health problems in the Dutch general population. Psychological Medicine, 32(2), 311–323.Google Scholar
Tischler, G.L., Henisz, J.E., Myers, J.K., & Boswell, P.C. (1975a). Utilization of mental health services: I. Patienthood and the prevalence of symptomatology in the community. Archives of General Psychiatry, 32(4), 411–415.Google Scholar
Tischler, G.L., Henisz, J.E., Myers, J.K., & Boswell, P.C. (1975b). Utilization of mental health services: II. Mediators of service allocation. Archives of General Psychiatry, 32(4), 416–418.Google Scholar
Vasiliadis, H.M., Tempier, R., Lesage, A., & Kates, N. (In press). General practice and mental health care: Determinants of outpatient service use. The Canadian Journal of Psychiatry.Google Scholar
Veroff, J., Kulka, R., & Douvan, E. (1981). Mental health in America. New York: Basic Books.Google Scholar
Vézina, J., & Giroux, L. (1988). L’Échelle des Embêtements: une étude de validation et d’adaptation du Hassles Scale pour une population adulte âgée. Paper presented at the meeting of the Canadian Psychological Association, Montreal, June.Google Scholar
Volkers, A.C., Nuyen, J., Verhaak, P.F., & Schellevis, F.G. (2004). The problem of diagnosing major depression in elderly primary care patients. Journal of Affective Disorders, 82(2), 259–263.Google Scholar
Von Korff, M., Katon, W., & Lin, E. (1990). Psychological distress, physical symptoms, utilization and cost-offset effect. In Sartorius, N., Goldberg, D., et al. . (Eds.), Psychological disorders in general settings (pp. 159–169). Toronto: Hogrefe & Huber.Google Scholar
Wang, P.S., Lane, M., Olfson, M., Pincus, H.A., Wells, K.B., & Kessler, R.C. (2005). Twelve-month use of mental health services in the United States: Results from the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 629–640.Google Scholar
Wang, P.S., Berglund, P.A., Olfson, M., & Kessler, R.C. (2004). Delays in initial treatment contact after first onset of a mental disorder. Health and Service Research, 39(2), 393–415.Google Scholar
Waxman, H.M., Carner, E.A., & Klein, M. (1984). Under-utilization of mental health professionals by community elderly. The Gerontologist, 24(1), 23–30.Google Scholar
Wells, K.B., Manning, W.G., Duan, N., Newhouse, J.P., & Ware, J.E. Jr. (1986). Socio-demographic factors and the use of outpatient mental health services. Medical Care, 24(1), 75–85.Google Scholar
Weinberger, M., Hiner, S.L., & Tierney, W.M. (1987). In support of hassles as a measure of stress in predicting health outcomes. Journal of Behavioral Medicine, 10(1), 19–32.Google Scholar
Wetherell, J.L., Kaplan, R.M., Kallenberg, G., Dresselhaus, T.R., Sieber, W.J., & Lang, A.J. (2004). Mental health treatment preferences of older and younger primary care patients. International Journal of Psychiatry in Medicine, 34(3), 219–233.Google Scholar
Wittchen, H.U., Robins, L.N., Cottler, L.B., Sartorius, N., Burke, J.D., & Regier, D. (1991). Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). British Journal of Psychiatry, 159(5), 645–653.Google Scholar
Zemore, R., & Eames, N. (1979). Psychic and somatic symptoms of depression among young adults, institutionalized aged and noninstitutionalized aged. Journal of Gerontology, 34(5), 716.Google Scholar
Zola, I.K. (1966). Culture and symptoms: An analysis of patients’ presenting complaints. American Sociological Review, 31(5), 615–630.Google Scholar
Zylstra, R.G., & Steitz, J.A. (2000). Knowledge of late life depression and aging among primary care physicians. Aging & Mental Health, 4(1), 30–35.Google Scholar