Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication.

OBJECTIVES

Current information on the prevalence of psychiatric disorders among older adults in the United States is lacking. Prevalence of anxiety, mood, and substance disorders was examined by age (18-44, 45-64, 65-74, and 75 years and older) and sex. Covariates of disorders for older adults (65 years and older) were explored.

DESIGN

Cross-sectional epidemiologic study, using data from the National Comorbidity Survey-Replication.

SETTING

Community-based epidemiologic survey.

PARTICIPANTS

Representative national sample of community-dwelling adults in the United States.

MEASUREMENTS

The World Health Organization Composite International Diagnostic Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders.

RESULTS

Prevalence of 12-month and lifetime mood, anxiety, and substance-use disorders was lower for older adults (65 years and older) than younger age groups: 2.6% for mood disorder, 7.0% for anxiety disorder, 0 for any substance-use disorder, and 8.5% for any of these disorders (for any disorder, 18-44 years = 27.6%, 45-64 years = 22.4%). Among older adults, presence of a 12-month anxiety disorder was associated with female sex, lower education, being unmarried, and three or more chronic conditions. Presence of a 12-month mood disorder was associated with disability. Similar patterns were noted for lifetime disorders (any disorder: 18-44 years = 46.4%, 45-64 years = 43.7%, and 65 years and older = 20.9%).

CONCLUSIONS

This study documents the continued pattern of lower rates of formal diagnoses for elders. These rates likely underestimate the burden of late-life psychiatric disorders, given the potential for underdiagnosis, clinical significance of subthreshold symptoms, and lack of representation from high-risk older adults (e.g., medically ill, long-term care residents).