A dimensional liability model of age differences in mental disorder prevalence: Evidence from a national sample. (May 2015)

• Record Type: Journal Article
• Authors: Hoertel, Nicolas; McMahon, Kibby; Olfson, Mark; Wall, Melanie M.; Rodríguez-Fernández, Jorge Mario; Lemogne, Cédric; Limosin, Frédéric; Blanco, Carlos
• Is Part Of: Journal of psychiatric research. Volume 64(2015:May)
• Page Start: 107
• Page End: 113
• Publication Date: 2015-05
• Subjects: Age differences -- Age invariance -- Older adults -- Elderly -- Psychiatric disorders -- Mental disorders -- Comorbidity -- Internalizing-externalizing; Psychiatry -- Periodicals; Mental Disorders -- Periodicals; Maladies mentales -- Périodiques; Psychiatry; Electronic journals; Periodicals; 616.89005
• DOI: 10.1016/j.jpsychires.2015.03.017
• Languages: English
• ISSNs: 0022-3956

Abstract

Abstract: Recent theories have proposed a metastructure that organizes related mental disorders into broad dimensions of psychopathology (i.e., internalizing and externalizing dimensions). Prevalence rates of most mental disorders, when examined independently, are substantially lower in older than in younger adults, which may affect this metastructure. Within a nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43, 093), we developed a dimensional liability model of common psychiatric disorders to clarify whether aging affects specific disorders or general dimensions of psychopathology. Significant age differences existed across age groups (18–24, 25–34, 35–44, 45–54, 55–64, 65–75 and 75+), such that older adults showed lower prevalence rates of most disorders compared to younger adults. We next investigated patterns of disorder comorbidity for past-year psychiatric disorders and found that a distress-fear-externalizing liability model fit the data well. This model was age-group invariant and indicated that the observed lower prevalence of mental disorders with advancing age originates from lower average means on externalizing and internalizing liability dimensions. This unifying dimensional liability model of age and mental disorder comorbidity can help inform the role of aging on mental disorder prevalence for research and intervention efforts, and service planning for the impending crisis in geriatric mental health. Highlights: We examined whether aging affects specific disorders or dimensions of psychopathology. A distress-fear-externalizing liability model of mental disorders fit the data well. This model was invariant across seven age groups. Aging affected dimensions of psychopathology and not specific disorders. This model can help inform the role of aging for research and intervention efforts.