Perceived need for mental health care, mental health service utilization, and satisfaction with care in elderly people.

Abstract

Background. Elderly people experience symptoms, diagnosis, and treatment of mental illnesses differently than younger people, and only half of elderly people with a probable mental illness use mental health care services. Nevertheless, most mental health care research has focused on younger people. This study examined relationships among attitudes toward care, quality of social support, severity of mental illness, presence of physical comorbidities or alcohol abuse problems, sociodemographics, possession of supplemental insurance, perceived need for care, rates of utilization, and satisfaction with mental health care for elderly people.

Methods. Data were used from the Collaborative Psychiatric Epidemiology Surveys (CPES), a nationally representative, cross-sectional study of community-dwelling people's mental illnesses and mental health care utilization patterns. Logistic and linear regression models were used to study perceived need, utilization, and satisfaction with care.

Results. Perceived need for mental health care increased with severity of depression and anxiety, history of chronic physical conditions, and pressure to seek care. Among respondents who met diagnostic criteria for depression or anxiety, the number of mental illness symptoms experienced was still related to perceived need for care. The odds of using formal mental health care increased with severity of depression or anxiety and with history of chronic physical illnesses. When utilization was measured among respondents who perceived a need for care, however, most measures of mental illness severity and history of chronic physical illness were no longer significant. There was little variation in the satisfaction measure, and multivariate models of satisfaction were unstable.

Conclusion. Many elderly people who meet diagnostic criteria for depression and/or anxiety disorders do not use mental health services or even perceive a need for these services. Additionally, physical and mental health are associated with perceived need, but other factors are responsible for determining utilization among those with perceived need. Further studies that include more detailed measures of psychosocial factors and satisfaction with mental health care are necessary to understand what factors lead elderly people to perceive a need for mental health care and what factors influence those who perceive a need for care to actually seek treatment and adhere to it.