Background
Methods
Study Population
Assessments
Assessment of Depressed Mood
Assessment of Mental Health-Related Health Service Utilization
Statistical Analysis
Results
Baseline Characteristics
Characteristic | Overall N = 2,005 | Mental health score ≥ 60 N = 1,429 | Mental health score < 60 N = 576 | p-value * |
---|---|---|---|---|
Sex (% female)
| 73.2 | 72.2 | 75.5 | 0.13 |
Age in years: mean (S.D.) | 70.7 (9.1) | 71.2 (8.9) | 69.7 (9.4) | 0.002 |
Region (% urban)
| 43.5 | 41.5 | 48.4 | 0.005 |
Income (%)
| < 0.0001 | |||
≤ $20,000 | 52.4 | 47.7 | 63.9 | |
> $20,000 | 30.2 | 33.2 | 22.6 | |
Missing | 17.5 | 19.0 | 13.5 | |
Education (%)
| < 0.0001 | |||
< high school graduation | 35.7 | 33.0 | 42.4 | |
High school graduation | 47.5 | 47.7 | 47.1 | |
Some post-secondary education | 14.9 | 17.6 | 8.3 | |
Missing | 2.0 | 1.8 | 2.3 | |
Living arrangements (%)
| 0.16 | |||
Lives alone | 30.3 | 29.5 | 32.1 | |
Lives with others | 66.4 | 67.5 | 63.7 | |
In long-term care | 1.4 | 1.1 | 2.1 | |
missing | 2.0 | 1.9 | 2.1 | |
Race (%)
| 0.082 | |||
Caucasian | 93.0 | 93.1 | 92.7 | |
Non-Caucasian | 3.7 | 3.2 | 4.9 | |
Missing | 3.3 | 3.7 | 2.4 | |
Number of comorbidities (%)
| < 0.0001 | |||
None | 29.2 | 31.0 | 24.8 | |
1 | 30.6 | 32.4 | 26.0 | |
2 | 21.0 | 19.7 | 24.3 | |
3+ | 19.2 | 16.9 | 24.8 | |
Body Mass Index: mean (S.D.) | 28.1 (5.4) | 28.1 (5.2) | 28.0 (5.8) | 0.82 |
SF-36 general health scale /100: mean (S.D.) | 49.2 (22.1) | 54.7 (20.7) | 35.5 (19.2) | < 0.0001 |
WOMAC total score /100: mean (S.D.) | 40.3 (19.5) | 37.5 (18.6) | 47.3 (20.0) | < 0.0001 |
WOMAC pain score /100: mean (S.D.) | 40.5 (21.7) | 37.9 (21.0) | 46.8 (21.9) | < 0.0001 |
Mental Health Subscale score /100: Mean (S.D.) | 68.5 (20.4) | 79.0 (11.3) | 42.5 (13.2) | < 0.0001 |
Self-reported depression
| ||||
(% reporting ever depressed or other major mental illness) | 16.4 | 7.2 | 39.2 | < 0.0001 |
(% reporting treatment for depression or other major mental illness in past year) | 9.2 | 3.2 | 24.1 | < 0.0001 |
Prevalence and Correlates of "Depressed Mood"
Mental Health-Related Physician Visits Over Two Years
Visits - Full Sample | Overall N = 2,005 | Mental health score ≥ 60 N = 1,429 | Mental health score < 60 N = 576 | p-value* |
---|---|---|---|---|
Visits to a primary care physician | ||||
% (CI†) with at least one visit | 95.2 (94.2 - 96.1) | 94.5 (93.4 - 95.7) | 96.7 (95.2 - 98.2) | 0.05 |
Total number of visits to a primary care physician in the first 2 years: median (inter-quartile range) | 13 (7-23) | 13 (7-21) | 16 (9-26) | < 0.0001 |
Mental health visits to a primary care physician | ||||
% (CI†)with at least one mental health visit | 28.9 (26.9 - 30.9) | 24.8 (22.5 - 27.0) | 39.1 (35.1 - 43.1) | < 0.0001 |
Number of visits, for those who had at least one visit: | ||||
median (inter-quartile range) | 2 (1-3) | 1 (1-3) | 2 (1-4) | 0.0007 |
Visits to a psychiatrist | ||||
% (CI†) with at least one visit | 5.3 (4.3 - 6.3) | 3.4 (2.4 - 4.3) | 10.1 (7.6 - 12.5) | < 0.0001 |
Number of visits, for those who had at least one visit: | ||||
median (inter-quartile range) | 3 (1-13) | 3 (1-10) | 5 (2-20) | 0.11 |
Visits to a PCP and/or psychiatrist | ||||
% (CI†) with at least one visit | 30.8 (28.8 - 32.8) | 26.1 (23.8 - 28.4) | 42.5 (38.5 - 46.6) | < 0.0001 |
Number of visits, for those who had at least one visit: | 2 (1-4) | 2 (1-3) | 2 (1-6) | < 0.0001 |
median (inter-quartile range) | ||||
Visits - Those aged 65+ years at baseline
|
Overall
N = 1,425
|
Mental health score ≥ 60
N = 1,049
|
Mental health score < 60
N = 376
|
p-value*
|
Visits to a primary care physician | ||||
% (CI†) with at least one visit | 95.1 (94.0 - 96.2) | 94.3 (92.9 - 95.7) | 97.3 (95.7 - 99.0) | 0.018 |
Total number of visits to a primary care physician in the first 2 years: median (inter-quartile range) | 14 (8-23) | 13 (7-22) | 17 (9-27) | < 0.0001 |
Mental health visits to a primary care physician | ||||
% (CI†)with at least one mental health visit | 28.1 (25.7 - 30.4) | 24.9 (22.3 - 27.5) | 37.0 (32.1 - 41.9) | < 0.0001 |
Number of visits, for those who had at least one visit: | 2 (1-3) | 1 (1-3) | 2 (1-4) | 0.0087 |
median (inter-quartile range) | ||||
Visits to a psychiatrist | ||||
% (CI†) with at least one visit | 4.6 (3.5 - 5.7) | 3.2 (2.1 - 4.2) | 8.8 (5.9 - 11.6) | < 0.0001 |
Number of visits, for those who had at least one visit: | 3 (1-10) | 3 (1-9) | 4 (1-15) | 0.23 |
median (inter-quartile range) | ||||
Any mental health care visit (to a PCP or psychiatrist) | ||||
% (CI†) with at least one visit | 30.0 (27.6 - 32.3) | 26.1 (23.5 - 28.8) | 40.7 (35.7 - 45.7) | < 0.0001 |
Number of visits, for those who had at least one visit: | 2 (1-4) | 2 (1-3) | 2 (1-6) | 0.0024 |
median (inter-quartile range) | ||||
Prescriptions for antidepressants | ||||
% (CI†) who filled at least one prescription | 23.1 (20.9 - 25.3) | 18.4 (16.1 - 20.7) | 36.2 (31.3 - 41.0) | < 0.0001 |
Number of prescriptions filled, for those who filled at | 6 (2-11) | 6 (2-10) | 7 (2-12) | 0.064 |
least one: median (inter-quartile range) | ||||
Any mental health care | ||||
% (CI†) with at least one mental health visit to a PCP or at least one visit to a psychiatrist or filling at least one prescription for an antidepressant | 40.6 (38.1 - 43.2) | 34.9 (32.0 - 37.8) | 56.7 (51.6 - 61.7) | < 0.0001 |
Mental Health Care Use (Physician Visits and Prescriptions for Anti-Depressants) in Those 65+ Years at Baseline
Predictors of Mental Health-Related Physician Visits (Full Sample)
Model 1: Regression Model with SF-36 Mental Health Score as the Only Independent Variable | |||
---|---|---|---|
Odds of having at least one mental health visit
|
odds ratio
|
95% confidence interval
|
p-value
|
SF-36 mental health per 10-point deterioration | 2.14 | 1.08 to 4.26 | 0.031 |
Predictors of number of visits, given that one has visits
|
Change in number of mental health visits
|
95% confidence interval
|
p-value
|
SF-36 mental health per 10-point deterioration | 25.3% | 17.6% to 33.4% | < 0.0001 |
Model 2: Regression Model for the Effect of SF-36 Mental Health Score, Adjusted for Additional Covariates*
| |||
Odds of having at least one mental health visit
|
odds ratio
|
95% confidence interval
|
p-value
|
SF-36 mental health score per 10-point deterioration | 1.63 | 1.18 to 2.24 | 0.0027 |
Female sex (baseline is male) | 5.87 | 1.73 to 20.0 | 0.0046 |
Predictors of number of visits, given that one has any visits)
|
Change in number of mental health visits
|
95% confidence interval
|
p-value
|
SF-36 mental health per 10-point deterioration | 22.4% | 15.1% to 30.2% | < 0.0001 |
Urban region (reference is rural) | 106% | 65.7% to 157% | < 0.0001 |
Education (reference is < high school graduation) | 0.046 | ||
High school graduation | 13.5% | -10.9% to 44.6% | 0.31 |
Some post-secondary education | 58.0% | 12.5% to 122% | 0.0082 |
Missing | 40.6% | -36.8% to 213% | 0.40 |
Predictors of Receiving Any Mental Health Care (Physician Visit or Anti-Depressant Prescription) (Those 65+ Years at Baseline)
Model 1: Regression Model with SF-36 Mental Health Score as the Only Independent Variable (R-square = 0.080) | |||
---|---|---|---|
Independent variable
|
Odds Ratio
|
95% confidence interval
|
p-value
|
SF-36 Mental Health score per 10-point deterioration | 1.3 | 1.23 to 1.38 | < 0.0001 |
Model 2: Regression Model for the Effect of SF-36 Mental Health Score, Adjusted for Additional Covariates* (R-square = 0.124)
| |||
Independent variable
|
Odds ratio
|
95% confidence interval
|
p-value
|
Age per 10-year increase in age | 0.8 | 0.68 to 0.95 | 0.012 |
Female sex (baseline is male) | 1.79 | 1.37 to 2.34 | < 0.0001 |
Urban region (reference is rural) | 1.36 | 1.08 to 1.71 | 0.0083 |
Interaction between mental and general health† | 0.0009 | ||
Effect of a 10-point deterioration in general health score | 1.04 | 0.97 to 1.11 | 0.32 |
when mental health score = 56 (25th percentile for mental health score; poor mental health) | |||
Effect of a 10-point deterioration in general health score when mental | 1.11 | 1.05 to 1.18 | 0.0007 |
health score = 72 (median mental health score) | |||
Effect of a 10-point deterioration in general health score when mental | 1.15 | 1.10 to 1.21 | < 0.0001 |
health score = 84 (75th percentile mental health score; good mental health) | |||
Effect of a 10-point deterioration in mental health score when general | 1.2 | 1.12 to 1.29 | < 0.0001 |
health score = 35 (25th percentile general health score; poor health) | |||
Effect of a 10-point deterioration in mental health score when general | 1.28 | 1.20 to 1.37 | < 0.0001 |
health score = 50 (median general health score) | |||
Effect of a 10-point deterioration in mental health score when general health score = 67 (75th percentile general health score; good health) | 1.38 | 1.26 to 1.52 | < 0.0001 |