Prevalence and Correlates of Psychiatric Disorders among Older Adults

描述（由申请人提供）：“美国老龄化”代表了一种前所未有的人口趋势，即55岁及以上的美国人口正在迅速增加。因此，确定美国老年人晚年生活的心理健康需求是很重要的。通过了解老年人精神疾病的发病率、患病率、相关性和治疗需求，研究人员可以更有效地指导有限的预防和治疗资源。很少有调查对老年人进行流行病学抽样，以便充分估计老年精神疾病的模式和相关性，包括那些“亚阈值”的疾病，不符合既定的诊断标准，但可能极其致残。身体疾病，可能是极具压力的心理社会事件，也更常见于老年期，并且缺乏关于由医疗条件引起的精神疾病发病的更多信息。这项RO3申请是由一名新研究者提交的，旨在通过汇集一个跨学科的流行病学和临床研究人员团队，专注于老年心理健康，来克服这些限制。本申请建议对2001-2002年全国酒精及相关疾病流行病学调查（NESARC）中的老年人子集（n=13,420）进行二次分析，以研究老年人（55岁或以上）精神障碍的发病率、流行率、相关性和治疗等更广泛的问题。NESARC是独一无二的，因为它包含了对全国具有代表性的老年人精神疾病样本的全面评估。具体目的是：(1)估计老年人（55岁或以上）精神情绪和焦虑障碍的患病率和人口统计学相关性（例如，婚姻状况、性别、种族、就业和教育）以下疾病亚型：(a)独立于药物或药物滥用（IDs）和(b)药物引起的疾病（MIDs）；我们还将检查每个障碍组中的阈下障碍。(2)根据：(a)共发病模式（如单纯与共发病）和(b)早期（即小于55岁）与晚发病（即55岁或以上）疾病，检查区分老年人精神疾病亚型结构的人口学和临床因素（如症状概况、发作次数和时间）；(3)评估不同类型障碍的治疗利用模式。从这项研究中获得的信息将有助于评估跨障碍亚型需要进行独特筛查和干预的程度。本提案中涉及的问题与国家心理健康研究所（PA-03-014）推动的心理健康和老龄化研究的科学议程相一致。

DESCRIPTION (provided by applicant): The "graying of America" represents an unprecedented demographic trend whereby the population of Americans aged 55 or older is increasing rapidly. Therefore, it is important to identify the mental health needs of older Americans as they move toward later life. By understanding the incidence, prevalence, correlates, and treatment needs of psychiatric disorders among older adults, researchers can make greater inroads to more efficiently direct limited preventive and treatment resources. Few investigations have an epidemiological sample of older adults to permit adequate estimation of the patterns and correlates of geriatric psychiatric disorders, including those disorders that are "sub-threshold" and do not meet established diagnostic criteria but may be extremely disabling. Physical illnesses, which may be extremely stressful psychosocial events, are also more present during older adulthood, and additional information is lacking regarding the onset of psychiatric disorders resulting from medical conditions. This RO3 application, submitted by a new investigator, seeks to overcome these limitations by bringing together an interdisciplinary team of epidemiological and clinical researchers to focus on geriatric mental health. This application proposes secondary analyses of the subset of older adults (n=13,420) within the National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002) (NESARC) to examine the broader issues of incidence, prevalence, correlates, and treatment of mental disorders among older adults (aged 55 or older). The NESARC is unique because it contains comprehensive assessments of psychiatric disorders in a nationally representative sample of older adults. The specific aims are to: (1) Estimate the prevalence and demographic correlates (e.g., marital status, gender, race, employment, and education) of psychiatric mood and anxiety disorders during older adulthood (aged 55 or older) for the following the disorder subtypes: (a) independent of medical or substance abuse (IDs) and (b) medically induced disorders (MIDs); We will also examine subthreshold disorders within each disorder group. (2) Examine the demographic and clinical factors (e.g. symptom profile, number and length of episodes) that differentiate the structure of psychiatric disorder subtypes among older adults based on: (a) patterns of co-morbidity (e.g. pure versus co-morbid) and (b) early (i.e. less than age 55) versus late onset (i.e. age 55 or older) disorders; and (3) Estimate the patterns of treatment utilization among disorder subtypes. Information learned from this study will help assess the degree to which unique screening and intervention efforts are needed across disorder subtypes. Issues addressed in this proposal are in concert with the scientific agenda for mental health and aging research promoted by National Institute of Mental Health, Mental Illnesses in Older Adults (PA-03-014).