ABSTRACT
OBJECTIVE: To describe the design of the Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study and baseline characteristics of the randomized primary care patients with mental health problems and at-risk alcohol use. METHOD: Adults aged 65 and older were screened at primary care clinics from 10 study sites throughout the United States. Those diagnosed for depression, anxiety, and/or at-risk alcohol consumption were randomized to either integrated or enhanced referral care. RESULTS: Of the 23,828 participants, 14% had a positive assessment for depressive and/or anxiety disorders, and 6% had at-risk alcohol consumption diagnoses. Among patients with mental health diagnoses, there was a higher preponderance of younger ages, women, and ethnic minorities. Among patients with at-risk drinking, there was a higher preponderance of younger ages, Whites, and men. DISCUSSION: These findings indicate the need for screening in primary care and for engaging older adults in treatment.
Subject(s)
Alcohol-Related Disorders/diagnosis , Geriatric Assessment/statistics & numerical data , Mental Disorders/diagnosis , Substance-Related Disorders/diagnosis , Age Factors , Aged , Alcohol-Related Disorders/epidemiology , Alcohol-Related Disorders/therapy , Behavior Therapy , Comorbidity , Diagnosis, Dual (Psychiatry) , Female , Health Services for the Aged/statistics & numerical data , Health Surveys , Humans , Male , Mass Screening , Mental Disorders/epidemiology , Mental Disorders/therapy , Mental Health Services/statistics & numerical data , Models, Theoretical , Multi-Institutional Systems , Primary Health Care/statistics & numerical data , Quality Assurance, Health Care , Randomized Controlled Trials as Topic , Research Design , Risk Factors , Substance-Related Disorders/epidemiology , Substance-Related Disorders/therapy , Surveys and Questionnaires , United StatesABSTRACT
The authors identified correlates of active suicidal ideation and passive death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. Participants included 2,240 older primary care patients (age 65+), who were identified in three mutually exclusive groups on the basis of responses to the Paykel suicide questions: No Ideation, Death Ideation, and Suicidal Ideation. Chi-square, ANOVA, and polytomous logistic regression analyses were used to identify characteristics associated with suicidal ideation. The highest amount of suicidal ideation was associated with co-occurring major depression and anxiety disorder (18%), and the lowest proportion occurred in at-risk alcohol use (3%). Asians have the highest (57%) and African Americans have the lowest (27%) proportion of suicidal or death ideation. Fewer social supports and more severe symptoms were associated with greater overall ideation. Death ideation was associated with the greatest medical comorbidity and highest service utilization. Contrary to previous reports, authors failed to find that active suicidal ideation was associated with increased contacts with healthcare providers. Accordingly, targeted assessment and preventive services should be emphasized for geriatric outpatients with co-occurring depression and anxiety, social isolation, younger age, and Asian or Caucasian race.
