黑媽媽

作者：Megan Brooks  
出處：WebMD醫學新聞

　　May 3, 2010 — 根據一篇發表於5月一般精神病學誌(Archives of General Psychiatry)的研究，符合精神疾病診斷與統計手冊第四版(Fourth Edition)(DSM-IV))之情緒與焦慮異常規範的比率傾向隨著年紀降低，但是依舊相當常見，特別是女性。
　　
　　舊金山VA醫學中心、加州大學舊金山分校精神科Amy L. Byers博士等研究者表示，基於美國人口年長者比率增加之預期，了解年長者、社區成人之情緒與焦慮異常的盛行率相當重要；這些與不佳健康結果有關，被隱匿且治療不足，但是是可以治療的。
　　
　　Byers博士等人，對2575名55歲以上的非安養護機構成人，確認了具全國代表性的情緒、焦慮與混合情緒與焦慮異常的估計比率，其中，43%是55-64歲、32%是65-74歲、20%是75-84歲、5%是85歲以上。
　　
　　樣本包括59%女性、82%非西班牙裔白人、10%非西班牙裔黑人、約4%為西班牙裔，約四分之三教育程度為高中以上，57%已婚或者同居。
　　
　　整體而言，此一世代有4.9%在過去的12個月有情緒異常(大部分是重度憂鬱異常和躁鬱症)，11.6%有一種焦慮異常(大多數為特定對象的恐懼症、社交恐懼症、廣泛性焦慮症)，2.8% 同時發生情緒和焦慮異常。
　　
　　研究作者報告指出，發生情緒、焦慮或同時有情緒焦慮異常的可能性，一般隨著年紀而減少(P < .05)。
　　
　　比較最年長組(85歲以上)和年輕組(55-64歲)時，分別有7.6%和2.4%有情緒異常、16.6%和8.1%有焦慮異常、4.8%和0.0%兩種狀況皆有。
　　
　　【負擔增加】
　　研究作者指出，不論任何種族，在各年齡層中，女性的情緒和焦慮異常以及同時有情緒焦慮異常的比率都比較高；不過，少數族群的人數較少，降低了發現差異的研究強度。
　　
　　目前這個世代中，年長者的焦慮比率較高支持了這些研究者以前的研究。這篇70-79歲、社區成人的研究發現，整體焦慮比率為19% (20%女性、12%男性)，Byers博士等人表示，這顯示，焦慮異常在這些年長者很常見且有增加趨勢。
　　
　　研究者表示，研究強度包括具有全國代表性的樣本、以目前的DSM診斷評估、精準的年紀分層。研究限制包括，不代表無家可歸者、機構住民、不是講英語的年長成人；可能產生污名化的議題，使得有心智疾病的年長者較少被納入參與心智健康調查；以及使用擱置管理訪視(lay-administered interview)而非臨床管理評估(clinically administered assessment)，研究者表示，因為有這些限制，提出的可能只是保守的估計。
　　
　　研究者結論表示，因為美國人口迅速老化，可能的公衛負擔以及晚年的心智健康異常也會增加，持續對少老組(young-old)、中老祖(mid-old)、耆老組(old-old)與最老組(oldest-old)進行心智健康狀態流行病學監測是相當重要的。
　　
　　研究作者皆宣告沒有相關財務關係。  


Mood and Anxiety Disorders Prevalent Among Older Adults

By Megan Brooks
Medscape Medical News

May 3, 2010 — Rates of mood and anxiety disorders meeting Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) criteria tend to decrease with age but remain "very common," especially in women, according to a study published in the May issue of the Archives of General Psychiatry.

Given the current and projected growth of the older segment of the US population, knowledge of the prevalence of mood and anxiety disorders in older, community-dwelling adults is important; "these are hidden and undertreated but treatable disorders associated with poor health outcomes," write the researchers, led by Amy L. Byers, PhD, MPH, of the Department of Psychiatry, University of California, San Francisco, and the San Francisco VA Medical Center.

Dr. Byers and associates determined nationally representative estimates of mood, anxiety, and combined mood and anxiety disorders in 2575 noninstitutionalized adults 55 years and older. Of these, 43% were 55 to 64 years old, 32% were 65 to 74 years old, 20% were 75 to 84 years, and 5% were 85 years or older.

The sample distribution was 59% women, 82% non-Hispanic white, 10% non-Hispanic black, and roughly 4% Hispanic. Roughly three-quarters of participants had a high school education or higher, and 57% was married or cohabitating.

Overall, 4.9% of the cohort had a mood disorder (most often major depressive disorder and bipolar disorder) in the previous 12 months, 11.6% had an anxiety disorder (most often specific phobia, social phobia, and generalized anxiety), and 2.8% had co-occurring mood and anxiety disorders.

"The likelihood of having a mood, anxiety, or combined mood-anxiety disorder generally showed a pattern of decline with age (P < .05)," the study authors report.

When comparing the young-old group (55 to 64 years) with the oldest-old group (85 years and older), 7.6% vs 2.4% had mood disorders, 16.6% vs 8.1% had anxiety disorders, and 4.8% vs 0.0% had both conditions.

Growing Burden

Rates of mood and anxiety disorders and comorbid mood-anxiety disorders were generally higher for women in each age group but did not vary by race or ethnicity; however, small cell counts for minority groups lowered the power to detect a difference, the study authors note.

The high rate of anxiety in the current cohort of older adults supports a prior study by the same researchers. This study of 70- to 79-year-old, community-dwelling adults found an overall rate of anxiety of 19% (20% women and 12% men). This shows that anxiety disorders are "prominent and pervasive in older adults even into the oldest years," Dr. Byers and colleagues note.

The strengths of the study, the researchers say, include a nationally representative sample, current DSM diagnostic assessment, and precise age stratification. The limitations of the study include underrepresentation of homeless, institutionalized, and non–English-speaking older adults; possible issue with stigma, whereby older adults with mental illness might be less inclined to participate in a mental health survey; and a lay-administered interview rather than a clinically administered assessment. Given these limitations, the derived estimates are likely to be conservative, the study authors say.

"Given the rapid aging of the US population, the potential public health burden of late-life mental health disorders will likely grow as well, suggesting the importance of continued epidemiologic monitoring of the mental health status of the young-old, mid-old, old-old, and oldest-old cohorts," the researchers conclude.

The study authors have disclosed no relevant financial relationships.

Arch Gen Psychiatry. 2010;67:489-496.