Electronic Theses and Dissertations

Date

2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Epidemiology

Committee Chair

Xinhua Yu

Committee Member

Abu Mohammed Naser Titu

Committee Member

Satish Kedia

Committee Member

Xichen Mou

Abstract

Mental health is a vital component of the overall well-being across the lifespan and is the third leading cause of disability globally. One in seven US adults aged 65 or older reported some anxiety and/or depression symptoms, but one in four older adults use some antidepressants and the prescriptions were steadily increasing. This study investigated the impact of antidepressant uses focusing on discontinuation of antidepressants and the risk of medication resumption, inconsistency of antidepressant prescription, and increased healthcare uses by self-reported anxiety and depression symptoms among community-dwelling older adults in the US. Our study conducted a longitudinal study using Medicare Current Beneficiary Survey (MCBS) data from 2015 to 2019. We included beneficiaries aged 65 years or older with information of anxiety, depression, and part D prescription drug benefits. Anxiety and depression symptoms were self-reported with Generalized Anxiety Disorder questionnaire (GAD-2) and Patient Health Questionnaire (PHQ-8). Survival analysis, logistic regression, and zero-inflated Poisson regression were used for the analysis. We identified 18,567 older adults in our cohort with at least one year follow-up. The median duration of continuous medication was 90 days. However, about 30% of patients had a treatment duration of 30 days or shorter and 30% for 181 days or more. Older adults with less than 30 days of continuous treatment were half as likely to resume the medications compared to those with 91-180 days of treatment. On the other hand, 1,837 (11.2%) of older adults reported any anxiety symptoms, 1,405 (8.6%) reported either depression or loss of interest. Older adults with at-risk anxiety received 41% and at-risk depression received 51% more antidepressant prescriptions. The overall hospitalization rate was 11% and the emergency department (ED) visit rate was 13%. Older adults reporting loss of interest had a 27% higher hospitalization rate and 29% higher risk of ED visits. Who took antidepressants for >90 days had a 17% lower hospitalization rate than those with a duration of ≤ 90 days. Symptoms and treatment of anxiety and depression are varied among older adults. Healthcare providers should give careful consideration for screening and treating older adults for anxiety and depression.

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Data is provided by the student.

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Notes

Open access.

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