Mental disorders in mid-life and older adulthood more prevalent than previously reported

January 8, 2014

Common methods of assessing mental or physical disorders may consistently underestimate the prevalence of mental disorders among middle-aged and older adults, a new study from the Johns Hopkins Bloomberg School of Public Health has found.

The analysis, led by postdoctoral fellow Dr. Yoichiro Takayanagi, and published in the January 8 online edition of JAMA Psychiatry, reveals substantial discrepancies among mid-life and late-life adults in reporting past , including depression, compared with physical disorders such as arthritis and hypertension.

"The takeaway is that lifetime estimates based on [participant] recall in cross-sectional surveys underestimate the occurrences of mental disorders over the lifetime," said Ramin Mojtabai, MD, PhD, MPH, MA, associate professor in the Bloomberg School's Department of Mental Health and senior author of the study.

The findings are believed to be the first to examine retrospective evaluations versus cumulative assessments among . Recent studies of adolescent and young adults have also found discrepancies in prevalence estimates of common mental disorders between retrospective reports versus multiple assessments over time.

The study was based on interviews in 2004 and 2005 with 1,071 adults who had since the early 1980s participated in the Baltimore Epidemiologic Catchment Area Survey, a longitudinal study that included three earlier sets of interviews going back 24 years.

When asked to provide so-called retrospective evaluations in six categories – major depressive disorder; obsessive-compulsive disorder; panic disorder; social phobia; alcohol abuse or dependence and drug abuse or dependence – participants underreported their disorders even though they had reported them one or more times in three previous assessments. In contrast, the same cohort, when asked for retrospective evaluations of physical disorders in five categories—diabetes, hypertension, arthritis, stroke, cancer—provided histories that were much closer to cumulative assessments from the earlier interviews. For instance, only one out of 10 underreported that they'd previously had diabetes.

As part of the study, trained interviewers administered a structured interview that yields psychiatric diagnoses based on DSM-III or DSM-III-R criteria, in four waves of interviews. In the first two waves, in 1981 and again in the 1982, DSM-III was used. In the third follow-up, which took place in 1996, and the fourth, in 2004 and 2005, the revised DSM-III was used. Failure to recall lifetime mental disorders was defined as not meeting criteria for the lifetime history of the in the fourth round of interviews, despite reporting symptoms that met criteria for that disorder in at least one previous interview.

The study found that the lifetime estimates of mental disorders ascertained by retrospective versus cumulative evaluations were 4.5% versus 13.1% for ; 0.6% versus 7.1% for obsessive-compulsive disorder, 2.5% versus 6.7% for panic disorder, 12.6% versus 25.3% for social phobia, 9.1% versus 25.9% for alcohol abuse or dependence, and 6.7% versus 17.6% for drug abuse or dependence.

In contrast, the estimates of physical disorders measured by retrospective versus cumulative evaluations were 18.2% versus 20.2% for diabetes, 48.4% versus 55.4% for hypertension, 45.8% versus 54.0% for arthritis, 5.5% versus 7.2% for stroke, and 8.4% versus 10.5% for cancer.

Dr. Mojtabai explained that the contrast between the recall of mental and physical disorders is noteworthy and may be attributable to differences in age at onset and the course of these disorders. "Stigma associated with mental disorders, as well as the fluctuating course of mental illnesses, might partly explain the discrepancies, as well as differences in ages of onset of mental and physical disorders. Mental disorders start earlier and have a higher prevalence in early to mid-life, whereas physical disorders are typically illnesses of middle and older age and tend to be chronic."

The authors noted that measurement issues might also help explain the differences in recall of mental and physical illnesses. Ascertainment of mental disorders was based on symptom criteria, while ascertainment of physical illnesses was based on the participant's report of presence versus absence of a particular physical disorder.

Explore further: CAMH study shows mental illness associated with heavy cannabis use

Related Stories

CAMH study shows mental illness associated with heavy cannabis use

April 2, 2013
People with mental illnesses are more than seven times more likely to use cannabis weekly compared to people without a mental illness, according to researchers from the Centre for Addiction and Mental Health (CAMH) who studied ...

Severe mental illness tied to higher rates of substance use

January 4, 2014
People with severe mental illness such as schizophrenia or bipolar disorder have a higher risk for substance use, especially cigarette smoking, and protective factors usually associated with lower rates of substance use do ...

Mental disorders lead to greater heart disease risk, study shows

December 9, 2013
(Medical Xpress)—Men with mental disorders are more at risk of developing coronary heart disease, according to a study by the Universities of Southampton and Edinburgh.

Secondary conditions affect length of hospital stay and charges for HIV patients

December 16, 2013
A University of Arkansas researcher and her colleagues have found that secondary conditions and diseases that could become deadly significantly affect how long HIV patients stay in the hospital.

One in five U.S. kids has a mental health disorder, CDC reports

May 16, 2013
(HealthDay)—As many as one in five American children under the age of 17 has a diagnosable mental disorder in a given year, according to a new federal report.

Childhood functional stomach pain ups risk for later anxiety

August 12, 2013
(HealthDay)—Children with functional abdominal pain (FAP) are at greater risk for anxiety disorders as they get older, according to research published online Aug. 12 in Pediatrics.

Recommended for you

Heart rate study tests emotional impact of Shakespeare

July 26, 2017
In a world where on-screen violence has become commonplace, Britain's Royal Shakespeare Company is turning to science to discover whether the playwright can still make our hearts race more than 400 years on.

Talking to yourself can help you control stressful emotions

July 26, 2017
The simple act of silently talking to yourself in the third person during stressful times may help you control emotions without any additional mental effort than what you would use for first-person self-talk – the way people ...

Do all people experience similar near-death-experiences?

July 26, 2017
No one really knows what happens when we die, but many people have stories to tell about what they experienced while being close to death. People who have had a near-death-experience usually report very rich and detailed ...

Risk for bipolar disorder associated with faster aging

July 26, 2017
New King's College London research suggests that people with a family history of bipolar disorder may 'age' more rapidly than those without a history of the disease.

Visual clues we use during walking and when we use them

July 25, 2017
(Medical Xpress)—A trio of researchers with the University of Texas and Rensselaer Polytechnic Institute has discovered which phase of visual information processing during human walking is used most to guide the feet accurately. ...

Toddlers begin learning rules of reading, writing at very early age, study finds

July 25, 2017
Even the proudest of parents may struggle to find some semblance of meaning behind the seemingly random mish-mash of letters that often emerge from a toddler's first scribbled and scrawled attempts at putting words on paper.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.