Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-24T23:12:21.790Z Has data issue: false hasContentIssue false
  • English
  • Français

Approval of psychotherapy and medication for the treatment of mental disorders over the lifespan. An age period cohort analysis

Published online by Cambridge University Press:  12 January 2016

S. Van der Auwera ,
G. Schomerus ,
S. E. Baumeister ,
H. Matschinger  and
M. Angermeyer
S. Van der Auwera*
Affiliation:
Department of Psychiatry, University Medicine Greifswald, Greifswald, Germany
G. Schomerus
Affiliation:
Department of Psychiatry, University Medicine Greifswald, Greifswald, Germany HELIOS Hanseklinikum Stralsund, Stralsund, Germany
S. E. Baumeister
Affiliation:
Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
H. Matschinger
Affiliation:
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany
M. Angermeyer
Affiliation:
Department of Public Health, University of Cagliari, Cagliari, Italy Center for Public Mental Health, Gösing am Wagram, Austria
*
*Address for correspondence: S. Van der Auwera, Department of Psychiatry, University Medicine Greifswald, Ellernholzstraße 1-2, 17489 Greifswald, Germany. Tel: +49 (0)3834/86-22165 (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

Previous cross-sectional studies revealed inconsistent results regarding mental health treatment preferences among the general population. In particular, it is unclear to what extent specific age groups approve psychotherapy or psychotropic medication for the treatment of mental disorders. We explore whether treatment recommendations of either psychotherapy or psychiatric medication change over the lifespan which includes age-related effects due to increasing age of a person, cohort effects that reflect specific opinions during the time a person was born and period effects that reflect societal changes.

Methods.

Using data from three identical population surveys in Germany from 1990, 2001 and 2011 (combined n = 9046), we performed age-period-cohort analyses to determine the pure age, birth cohort and time period effects associated with the specific treatment recommendations for a person with either depression or schizophrenia, using logistic Partial Least-Squares regression models.

Results.

For both disorders, approval of both psychotherapy and medication for a person with mental illness increases with age. At the same time, younger cohorts showed stronger recommendations particularly for psychotherapy (OR around 1.07 per decade). The strongest effects could be observed for time period with an increase in recommendation between 1990 and 2001 with odds ratio of 2.36 in depression and 2.97 in schizophrenia, respectively. In general, the treatment option that showed the strongest increase in recommendation was medication for schizophrenia and psychotherapy for depression.

Conclusion.

Underutilisation of psychotherapy in old age seems not to reflect treatment preferences of older persons. Thus, special treatment approaches need to be offered for this group that seems to be willing for psychotherapy but do not yet use it. Cohort patterns suggest that approval of psychotherapy among older persons will likely further increase in the coming years as these people get older. Finally, strong period effects underpin the importance of changing attitudes in the society. These could reflect reporting changes about psychiatric topics in the media or a general increase in the perception of treatment options. Nevertheless, more treatment offers especially for older people are needed.

Keywords

Age-period-cohortpsychotherapy in old age
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 26 , Issue 1 , February 2017 , pp. 61 - 69
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, GS (2011). Pharmacotherapy for late-life depression. The Journal of Clinical Psychiatry 72, e04.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Matschinger, H (1997). Social distance towards the mentally ill: results of representative surveys in the Federal Republic of Germany. Psychological Medicine 27, 131–141.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Matschinger, H (2005). Have there been any changes in the public's attitudes towards psychiatric treatment? Results from representative population surveys in Germany in the years 1990 and 2001. Acta Psychiatrica Scandinavica 111, 68–73.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Beck, M, Matschinger, H (2003). Determinants of the public's preference for social distance from people with schizophrenia. Canadian Journal of Psychiatry. Revue canadienne de psychiatrie 48, 663–668.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Matschinger, H, Schomerus, G (2013 a). Attitudes towards psychiatric treatment and people with mental illness: changes over two decades. The British Journal of Psychiatry: The Journal of Mental Science 203, 146–151.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Matschinger, H, Schomerus, G (2013 b). Has the public taken notice of psychiatric reform? The image of psychiatric hospitals in Germany 1990–2011. Social Psychiatry and Psychiatric Epidemiology 48, 1629–1635.CrossRefGoogle ScholarPubMed
Bastien, P, Esposito-Vinzi, V, Tenenhaus, M (2005). PLS generalized linear regression. Computational Statistics & Data Analysis 48, 17–46.CrossRefGoogle Scholar
Beekman, AT, Copeland, JR, Prince, MJ (1999). Review of Community Prevalence of depression in later life. British Journal of Psychiatry 174, 307–311.CrossRefGoogle ScholarPubMed
Busch, MA, Neuner, B, Aichberger, MC, Hapke, U, Riedel-Heller, SG, Luppa, M (2013). Depressive Symptomatik und Inanspruchnahme von Gesundheits- und Pflegeleistungen bei Personen im Alter ab 50 Jahren in Deutschland. Ergebnisse einer bevölkerungsbasierten Querschnittstudie [Depressive symptoms and health service utilisation among persons 50 years or older in Germany. A population-based cross-sectional study]. Psychiatrische Praxis 40, 214–219.Google Scholar
Cepoiu, M, McCusker, J, Cole, MG, Sewitch, M, Belzile, E, Ciampi, A (2008). Recognition of depression by non-psychiatric physicians – a systematic literature review and meta-analysis. Journal of General Internal Medicine 23, 25–36.CrossRefGoogle ScholarPubMed
Coupland, C, Dhiman, P, Morriss, R, Arthur, A, Barton, G, Hippisley-Cox, J (2011). Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 343, d4551. doi: 10.1136/bmj.d4551.CrossRefGoogle ScholarPubMed
Dines, P, Hu, W, Sajatovic, M (2014). Depression in later-life: an overview of assessment and management. Psychiatria Danubina 26 (Suppl. 1), 78–84.Google ScholarPubMed
Gabler, S, Hoffmeyer-Zlotnik, JH (1997). Stichproben in der Umfragepraxis. Westdeutscher Verlag: Opladen.CrossRefGoogle Scholar
Gum, AM, Arean, PA, Hunkeler, E, Tang, L, Katon, W, Hitchcock, P, Steffens, DC, Dickens, J, Unutzer, J (2006). Depression treatment preferences in older primary care patients. The Gerontologist 46, 14–22.CrossRefGoogle ScholarPubMed
Harrell, FE Jr. (2001). Regression Modeling Strategies. With Applications to Linear Models, Logistic Regression, and Survival Analysis. Springer: New York.CrossRefGoogle Scholar
Jiang, T, Gilthorpe, MS, Shiely, F, Harrington, JM, Perry, IJ, Kelleher, CC, Tu, Y-K (2013). Age-period-cohort analysis for trends in body mass index in Ireland. BMC Public Health 13, 889.CrossRefGoogle ScholarPubMed
Kessing, LV, Hansen, HV, Demyttenaere, K, Bech, P (2005). Depressive and bipolar disorders: patients’ attitudes and beliefs towards depression and antidepressants. Psychological Medicine 35, 1205–1213.CrossRefGoogle ScholarPubMed
Koethe, D, Mattern, M, Herpertz, SC (2014). Psychotherapeutische Arbeit mit älteren Patienten. Der Nervenarzt 85, 1345–1351.CrossRefGoogle Scholar
Laidlaw, K (2013). A deficit in psychotherapeutic care for older people with depression and anxiety. Gerontology 59, 549–556.CrossRefGoogle ScholarPubMed
Leaf, PJ, Bruce, ML, Tischler, GL, Holzer, CE III (1987). The relationship between demographic factors and attitudes toward mental health services. Journal of Community Psychology 15, 275–284.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Luppa, M, Sikorski, C, Motzek, T, Konnopka, A, Konig, H-H, Riedel-Heller, SG (2012). Health service utilization and costs of depressive symptoms in late life – a systematic review. Current Pharmaceutical Design 18, 5936–5957.CrossRefGoogle ScholarPubMed
McGovern, AR, Kiosses, DN, Raue, PJ, Wilkins, VM, Alexopoulos, GS (2014). Psychotherapies for late-life depression. Psychiatric Annals 44, 147–152.CrossRefGoogle ScholarPubMed
Mirnezami, HF, Jacobsson, L, Edin-Liljegren, A (2015). Changes in attitudes towards mental disorders and psychiatric treatment 1976–2014 in a Swedish population. Nordic Journal of Psychiatry 70, 38–44.CrossRefGoogle Scholar
Mitchell, AJ, Rao, S, Vaze, A (2010). Do primary care physicians have particular difficulty identifying late-life depression? A meta-analysis stratified by age. Psychotherapy and Psychosomatics 79, 285–294.CrossRefGoogle ScholarPubMed
Mojtabai, R (2007). Americans’ attitudes toward mental health treatment seeking: 1990–2003. Psychiatric Services (Washington, DC) 58, 642–651.CrossRefGoogle ScholarPubMed
Mojtabai, R, Olfson, M (2014). National trends in long-term use of antidepressant medications: results from the U.S. National Health and Nutrition Examination Survey. The Journal of Clinical Psychiatry 75, 169–177.CrossRefGoogle ScholarPubMed
Morichi, V, Dell'Aquila, G, Trotta, F, Belluigi, A, Lattanzio, F, Cherubini, A (2015). Diagnosing and treating depression in older and oldest old. Current Pharmaceutical Design 21, 1690–1698.CrossRefGoogle ScholarPubMed
Morimoto, SS, Alexopoulos, GS (2013). Cognitive deficits in geriatric depression: clinical correlates and implications for current and future treatment. The Psychiatric Clinics of North America 36, 517–531.CrossRefGoogle ScholarPubMed
Olfson, M, Marcus, SC (2009). National patterns in antidepressant medication treatment. Archives of General Psychiatry 66, 848–856.CrossRefGoogle ScholarPubMed
Pinquart, M, Duberstein, P, Lyness, J (2007). Effects of psychotherapy and other behavioural interventions on clinically depressed older adults: a meta-analysis. Aging and Mental Health 11, 645–657.CrossRefGoogle ScholarPubMed
Reavley, NJ, Jorm, AF (2012). Public recognition of mental disorders and beliefs about treatment: changes in Australia over 16 years. The British Journal of Psychiatry: The Journal of Mental Science 200, 419–425.CrossRefGoogle ScholarPubMed
Rüsch, N, Müller, M, Ajdacic-Gross, V, Rodgers, S, Corrigan, PW, Rössler, W (2014). Shame, perceived knowledge and satisfaction associated with mental health as predictors of attitude patterns towards help-seeking. Epidemiology and Psychiatric Sciences 23, 177–187.CrossRefGoogle ScholarPubMed
Schomerus, G, Matschinger, H, Angermeyer, MC (2013). Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia, depression and alcohol dependence. Psychiatry Research 209, 665–669.CrossRefGoogle ScholarPubMed
Schomerus, G, Schwahn, C, Holzinger, A, Corrigan, PW, Grabe, HJ, Carta, MG, Angermeyer, MC (2012). Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 125, 440–452.CrossRefGoogle ScholarPubMed
Schomerus, G, Van der Auwera, S, Matschinger, H, Baumeister, SE, Angermeyer, MC (2015). Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis. Acta Psychiatrica Scandinavica 132, 357–364.CrossRefGoogle ScholarPubMed
Tu, Y-K, Krämer, N, Lee, W-C (2012). Addressing the identification problem in age-period-cohort analysis: a tutorial on the use of partial least squares and principal components analysis. Epidemiology (Cambridge, MA) 23, 583–593.CrossRefGoogle ScholarPubMed
Unützer, J, Katon, W, Callahan, CM, Williams, JW, Hunkeler, E, Harpole, L, Hoffing, M, Della Penna, RD, Noel, PH, Lin, EHB, Tang, L, Oishi, S (2003). Depression treatment in a sample of 1801 depressed older adults in primary care. Journal of the American Geriatrics Society 51, 505–514.CrossRefGoogle Scholar
Wittchen, H-U, Pittrow, D (2002). Prevalence, recognition and management of depression in primary care in Germany: the Depression 2000 study. Human Psychopharmacology 17 (Suppl. 1), S1–S11.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Van der Auwera supplementary material S1

Van der Auwera supplementary material

Download Van der Auwera supplementary material S1(PDF)
PDF 490.1 KB