The British Journal of Psychiatry (2017)

210, 125–131. doi: 10.1192/bjp.bp.115.180463

Prevalence of mental disorders in elderly people:

the European MentDis_ICF65+ study
Sylke Andreas, Holger Schulz, Jana Volkert, Maria Dehoust, Susanne Sehner, Anna Suling, Berta Ausı́n,
Alessandra Canuto, Mike Crawford, Chiara Da Ronch, Luigi Grassi, Yael Hershkovitz, Manuel Muñoz,
Alan Quirk, Ora Rotenstein, Ana Belén Santos-Olmo, Arieh Shalev, Jens Strehle, Kerstin Weber,
Karl Wegscheider, Hans-Ulrich Wittchen and Martin Härter

Background
Except for dementia and depression, little is known about one in four currently had a mental disorder. The most
common mental disorders in elderly people. prevalent disorders were anxiety disorders, followed by
affective and substance-related disorders.
Aims
To estimate current, 12-month and lifetime prevalence rates Conclusions
of mental disorders in different European and associated Compared with previous studies we found substantially
countries using a standardised diagnostic interview adapted higher prevalence rates for most mental disorders. These
to measure the cognitive needs of elderly people. findings underscore the need for improving diagnostic
assessments adapted to the cognitive capacity of elderly
Method people. There is a need to raise awareness of psychosocial
The MentDis_ICF65+ study is based on an age-stratified, problems in elderly people and to deliver high-quality mental
random sample of 3142 older men and women (65–84 years) health services to these individuals.
living in selected catchment community areas of participating
countries. Declaration of interest
None.
Results
One in two individuals had experienced a mental disorder in Copyright and usage
their lifetime, one in three within the past year and nearly B The Royal College of Psychiatrists 2017.

In 2010, 16.2% of the world population consisted of people aged and age-sensitive standardised and structured instruments for
65 or over, a figure that is expected to rise to 26.9% by 2050.1 diagnosing mental disorders in elderly people.16–18 Older adults
Increasing life expectancy highlights the importance of physical with health problems may also deny symptoms when asked to
and mental health in old age.2 Previous studies have generated complete lengthy assessments.16,17 Additionally, important
very inconsistent findings about the prevalence of mental illness information on the planning of intervention-based approaches
among older adults,3,4 although most studies report decreased must consider severity, impairment, quality of life and coping
prevalence rates in advanced age.3,5,6 Studies have tended to focus mechanisms. Taken together, this information indicates an urgent
on selective disorders such as dementia7 or depression,8–10 implying need to administer diagnostic instruments that have been adapted
that the entire range of mental disorders has been insufficiently to the needs of elderly people.
addressed.9 Previous studies using different study designs have The aim of the study is to determine lifetime, 12-month and
found lifetime and current prevalence rates of mental disorders current prevalence estimates for a wide range of mental disorders
in elderly people ranging from 1 to 18%.9,11 Studies of bipolar for people aged 65–84 years based on DSM-IV19 in different
disorder, anxiety disorders and alcohol disorders based on European and associated countries using a standardised and
structured and standardised assessment instruments such as the structured interview that was specifically adapted for elderly
Composite International Diagnostic Interview (CIDI)12 are people.
scarce.9 Currently prevalence estimates for depression – the only
disorder that is examined consistently – are approximately 3%.9
A few studies report lifetime prevalence rates of substance-related Method
(in particular alcohol-related) disorders in people 65 years and
over ranging from 1 to 12%; for schizophrenia, schizotypal Participants
disorders and other psychotic disorders, the lifetime and current The MentDis_ICF65+ study is a cross-sectional multicentre
rate is estimated at 0.5–1.0%, respectively.9 Rates for anxiety survey20 and the protocol has been previously reported.20 The
disorders vary between 0.9 and 6.7%.9 Only one study used the selection of different catchment areas and countries was balanced
CIDI to evaluate somatoform disorders in elderly people13 and according to geographical and socioeconomic population
found a current prevalence rate of 18.4% (participants were 66 distribution in Europe. Southern European regions of Ferrara
and older from Norway’s general population).13 (Italy) and Madrid (Spain) were selected as well as London and
There is debate over the source and the causes of the Canterbury (England) for northern Europe and Hamburg
heterogeneity of these empirical results: some authors have argued (Germany) for central Europe. The sample further consisted of
that older people may have developed coping strategies over the European Union (EU)-associated regions including Jerusalem
course of their lives that enable them to manage their mental (Israel) and Geneva (Switzerland). A random sample of n = 3142
health better than younger people,14,15 whereas others have older men and women (65–84 years) living in selected catchment
attributed the heterogeneity of the findings to a lack of feasible community areas of each participating country (at least 500

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Andreas et al

participants from each country) stratified by age and gender was The interview covers a wide range of mental health problems
drawn from the population registries in Hamburg and Ferrara such as anxiety disorders, affective disorders, psychotic symptoms,
and from postal addresses of market research units in Madrid, obsessive–compulsive disorder, substance misuse, somatoform
Geneva, London/Canterbury and Jerusalem. Inclusion criteria disorders and acute and post-traumatic stress disorders. Cognitive
for participating in the study included the ability to provide impairment, somatic morbidity and the use of healthcare services
informed consent, having residence in the predefined catchment were also assessed. The instrument also provides differential
area at the beginning of the study, and being at least 65 and less diagnoses for mental disorders because of general medical
than 85 years old. Potential participants were excluded on the conditions.
basis of moderate cognitive impairment as assessed by the Mini-
Mental State Examination (MMSE; cut-off score 418)21 or an Statistical analyses
insufficient level of corresponding language. A harmonised Survey analyses were weighted according to the number of
procedure in contacting each participant and conducting the inhabitants in each country and stratified by gender and two
survey was realised, including initial contact by phone and age groups: 65–74 years old and 74 years or older. The adjusted
mail, standardised interviewer training, implementation of a lifetime, 12-month and current prevalence rates and 95%
standardised study protocol for all test centres, and using confidence limits were estimated as marginal means from a
stringent, high-quality data-control procedures. weighted logistic regression adjusting for age in 5-year intervals,
The response rate was defined as the total percentage of gender and test centre.27 Group differences were tested using the
participants who completed interviews in the study compared main effect P-value of the model. Odds ratios (OR) and 95%
with who were contacted with a written invitation letter.22 In most confidence limits were also reported. All analyses were computed
of the study centres, a written invitation letter was followed by a using Stata 12.1.
phone call to ask potential participants if they were willing to take
part in the study. As a result of ethical regulations in some Results
countries, potential participants had to write back to indicate their
interest in participating; phone calls were not acceptable. The Sample characteristics
response rates varied by country, age and gender. Responder The mean age of the n = 3142 MentDis_ICF65+ participants was
analyses showed significant differences in the response rate 73.7 years after stratification (s.d. = 5.6), and half of the sample
between the centres (P50.001) and age groups (P50.001) but was female (50.7%). Participants had attended school for a mean
not between genders (P = 0.738). The age effect indicates that of 10.3 years (s.d. = 3.2). The majority of participants were
the response rate was significantly higher for younger participants married (61%), 35% were separated, divorced or widowed and
than for older participants. The overall response rate of our study 5% had never been married (Table 1). Approximately 85% of
was 20%, which is comparable with that of previous studies with participants were retired. About half of the participants rated their
similar recruitment procedures.23 Furthermore, representativeness financial situation as good or very good (55%), with 8% rating it
analysis showed that the differences were small between the as poor or very poor.
catchment areas in our study compared with catchment areas of
the overall population of the participating countries with regard 12-month and lifetime prevalence
to sociodemographic characteristics (such as work status, marital
One in two individuals aged 65–84 years had experienced a
status and education) according to the effect sizes by Somers’ d 24
mental disorder in their lifetime (Table 2). About one-third of
(all d50.01); however, these differences were significant because
the sample had a mental disorder within the past year (35.2%,
of the large size of the databases. Furthermore, the minor
95% CI 31.0–39.5) (Table 3). There were significant differences
differences that were identified are not clinically relevant.
between centres for all mental disorders in the past year except

Table 1 Demographic characteristics of the participants

Measures
Total sample
CIDI adaptation process, structure and training
Demographic characteristic (n = 3142)
Mental disorders were diagnosed with an adapted, age-sensitive
Age, n (%)
version of the CIDI, the CIDI65+.25 This fully structured lay
65–74 years 1715 (54.6)
interview generates diagnoses according to DSM-IV criteria.19 75–84 years 1427 (45.4)
The process of adapting the test to the unique conditions of Gender, n (%)
elderly people included several facets, including adding words, Women 1592 (50.7)
alternative questions and detailed section introductions, breaking Men 1550 (49.3)
down long questions into less complicated questions, sensitising Education, years of schooling (cut-off 13 years): mean (s.d.) 10.3 (3.2)
scales upfront and embedding a fuller spectrum of syndromes. Born in country of interview, n (%) 2519 (80.2)
The English paper and pencil version was translated into German, Marital status, n (%)
Spanish, Hebrew, Italian and French with a back-translation and Married 1915 (61.0)
then computerised. A pre-testing phase was conducted in Separated/divorced/widowed 1082 (34.5)
Germany and the UK to evaluate feasibility and verify the Never been married/other 142 (4.5)
acceptability of the CIDI65+ to respondents. To evaluate the Work status, retired: n (%)a 2640 (84.6)
usability and reliability of the CIDI65+, a pilot phase was Financial situation, n (%)a
conducted.25 Overall, the results on the reliability of the CIDI65+ Very good 356 (11.4)
were good for most diagnoses (such as depression (k = 0.79) and Good 1372 (43.8)
Just enough 1145 (36.6)
anxiety disorders (k = 0.69)). Lower k-scores were found for less
Poor 219 (7.0)
frequent disorders such as panic disorders (k = 0.37), similar to Very poor 37 (1.2)
other diagnostic instruments that also report lower reliability
a. n = 3128
scores26 or that have classification systems that are less precise.25

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 Table 2 Lifetime prevalence rates of frequent mental disorders a
Hamburg (Germany) Ferrara (Italy) London (England) Madrid (Spain) Geneva (Switzerland) Jerusalem (Israel) Over all

Affective disorder
Major depressive episode 11.6 (9.5–13.7) 9.2 (6.5–12.0) 14.6 (11.4–17.8) 10.5 (5.3–15.7) 23.3 (19.3–27.4) 14.8 (10.7–18.9) 11.8 (9.7–14.0)***
Dysthymia 2.5 (1.4–3.6) 3.1 (2.1–4.1) 3.4 (2.6–4.2) 2.5 (1.6–3.5) 4.0 (2.6–5.4) 5.2 (3.5–6.8) 2.9 (2.3–3.5)*
Any bipolar disorder 4.7 (3.2–6.2) 2.4 (1.4–3.5) 4.2 (2.9–5.5) 6.9 (4.0–9.7) 3.0 (2.2–3.7) 6.1 (4.8–7.4) 4.4 (3.3–5.5)*
Any affective disorder 13.2 (10.9–15.4) 11.9 (9.5–14.4) 18.0 (14.9–21.1) 13.0 (7.8–18.3) 26.5 (22.5–30.5) 18.5 (12.3–24.6) 14.3 (12.0–16.6)***
Anxiety
Agoraphobia 9.3 (7.3–11.4) 4.7 (2.8–6.5) 15.1 (11.8–18.4) 10.0 (8.1–12.0) 6.5 (4.3–8.7) 4.1 (3.4–4.7) 9.3 (6.7–12.0)
Panic disorder 3.9 (2.8–5.1) 5.0 (2.3–7.8) 7.5 (4.2–10.9) 1.3 (0.8–1.8) 3.5 (1.6–5.4) 3.0 (2.2–3.8) 4.5 (2.6–6.4)**
Post-traumatic stress disorder 2.0 (0.8–3.1) 1.3 (0.8–1.7) 6.3 (4.9–7.7) 0.3 (0.0–0.8) 2.0 (1.3–2.6) 8.4 (5.6–11.2) 2.5 (1.1–4.0)***
Any simple phobia 15.7 (12.7–18.6) 11.6 (9.3–14.0) 21.2 (17.3–25.2) 21.5 (16.4–26.7) 15.3 (13.0–17.5) 14.9 (11.8–17.9) 16.7 (13.4–20.1)***
Any anxiety disorder 24.1 (21.1–27.0) 20.1 (16.5–23.7) 32.6 (27.1–38.1) 29.3 (23.9–34.8) 20.7 (16.6–24.8) 21.5 (16.3–26.6) 25.6 (21.4–29.7)***
Substance misuse
Alcohol dependence or misuse 12.9 (9.8–16.1) 1.7 (0.9–2.4) 13.8 (10.5–17.1) 3.8 (1.5–6.1) 14.1 (9.5–18.8) 3.2 (2.4–3.9) 8.8 (4.5–13.2)***
Any substance-related disorder 21.3 (18.1–24.6) 12.9 (10.6–15.2) 20.6 (17.1–24.0) 16.3 (12.3–20.3) 21.8 (16.6–26.9) 12.8 (10.9–14.6) 18.2 (14.6–21.8)***
Any somatoform disorder 9.2 (7.4–11.0) 5.9 (3.6–8.2) 9.4 (7.2–11.5) 3.5 (2.1–4.8) 7.7 (6.6–8.8) 10.7 (9.3–12.0) 7.5 (5.7–9.3)***
Any mental disorder 47.0 (44.1–49.9) 38.8 (34.3–43.3) 56.3 (49.7–63.2) 46.3 (41.6–51.0) 55.7 (53.5–58.0) 46.0 (42.0–50.1) 47.0 (42.8–51.3)***

a. Rates are adjusted for age and gender and accompanied by 95% confidence intervals.
*P50.05, **P50.01, ***P50.001.

Table 3 Twelve-month prevalence rates of frequent mental disorders a

Hamburg (Germany) Ferrara (Italy) London (England) Madrid (Spain) Geneva (Switzerland) Jerusalem (Israel) Over all

Affective disorder

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Major depressive episode 11.1 (9.1–13.2) 9.1 (6.4–11.8) 14.5 (11.5–17.4) 10.3 (5.3–15.3) 23.1 (18.9–27.4) 14.6 (10.3–18.9) 11.6 (9.5–13.6)
Dysthymia 2.5 (1.4–3.6) 3.1 (2.1–4.1) 3.4 (2.6–4.2) 2.5 (1.6–3.5) 4.0 (2.6–5.4) 5.2 (3.5–6.8) 2.9 (2.3–3.5)*
Any bipolar disorder 2.1 (0.3–4.0) 1.2 (0.3–2.2) 2.9 (0.8–5.0) 4.9 (2.1–7.6) 1.2 (0.3–2.2) 4.7 (3.0–6.5) 2.5 (1.3– 3.7)*
Any affective disorder 12.7 (10.6–14.8) 11.1 (8.5–13.6) 17.6 (14.7–20.4) 12.4 (7.7–17.0) 25.7 (21.2–30.3) 17.8 (12.2–23.3) 13.7 (11.4–15.9)***
Anxiety
Agoraphobia 6.0 (4.6–7.4) 1.9 (0.2–3.5) 7.4 (5.5–9.2) 4.5 (2.7–6.2) 3.7 (2.3–5.1) 2.0 (1.5–2.5) 4.9 (3.3–6.6)***
Panic disorder 3.9 (2.9–5.0) 4.2 (2.1–6.4) 5.4 (3.3–7.4) 1.1 (0.7–1.6) 2.7 (1.6–3.9) 2.3 (1.8–2.8) 3.8 (2.6–5.0)
Post-traumatic stress disorder 1.0 (0.0–2.6) 0.7 (0.0–1.5) 2.4 (1.2–3.6) 0 1.1 (0.1–2.2) 5.9 (4.2–7.5) 1.4 (0.4–2.4)***
Any simple phobia 9.1 (7.3–10.9) 6.8 (5.5–8.1) 9.4 (6.1–12.7) 12.7 (9.4–16.1) 9.2 (7.4–11.1) 8.9 (7.1–10.6) 9.2 (7.2–11.1)*
Any anxiety disorder 16.8 (14.4–19.2) 14.4 (11.6–17.3) 20.8 (15.6–26.0) 18.3 (14.4–22.3) 14.1 (10.4–17.8) 14.7 (10.7–18.7) 17.2 (14.0–20.4)*
Substance misuse
Alcohol dependence or misuse 7.4 (5.5–9.2) 1.0 (0.5–1.5) 9.5 (6.4–12.6) 1.3 (0.4–2.2) 9.1 (5.7–12.5) 1.2 (0.2–2.2) 5.3 (2.3–8.2)***
Any substance-related disorder 11.2 (9.7–12.7) 5.8 (1.5–10.2) 11.2 (6.2–16.1) 5.6 (3.5–7.6) 12.7 (9.4–15.9) 3.7 (2.6–4.7) 8.9 (6.1–11.7)***
Any somatoform disorder 4.8 (4.0–5.7) 2.7 (1.3–4.2) 5.3 (3.0–7.6) 2.5 (1.3–3.8) 3.7 (3.0–4.5) 8.4 (5.4–11.5) 4.1 (3.1–5.1)*
Any mental disorder 35.4 (33.2–37.6) 27.7 (21.1–34.4) 44.4 (39.5–49.3) 32.2 (29.1–35.3) 47.1 (44.4–49.9) 36.7 (33.0–40.4) 35.2 (31.0–39.5)***

a. Rates are adjusted for age and gender and accompanied by 95% confidence intervals.
**P<0.05, **P<0.01, ***P<0.001.

127
Prevalence of mental disorders in elderly people
Andreas et al

for panic disorder and major depressive episodes, with the highest

23.3 (19.9–26.7)***
prevalence rates found in Geneva (Switzerland: 47.1%), London/

1.1 (0.5–1.7)***
4.6 (3.7–5.6)***
8.0 (6.3–9.6)***

(0.1–4.8)***
6.0 (4.7–7.3)***

(9.1–13.6)*
(0.4–2.4)**
(5.1–8.0)*
2.7 (2.1–3.4)*
Canterbury (England: 44.4%), Jerusalem (Israel: 36.7%) and

3.4 (2.5–4.4)
(0.6–1.4)
Overall
Hamburg (Germany: 35.4%). The lowest 1-year prevalence rates
were in Madrid (Spain: 32.2%) and Ferrara (Italy: 27.7%).

1.0
6.6

11.4
1.4
3.4
0b
The most prevalent mental disorders were anxiety disorders
(17.2%, 95% CI 14.0–20.4), affective disorders (13.7%, 95% CI
11.4–15.9) and substance-related disorders (8.9%, 95% CI 6.1–
11.7). Elderly people living in London/Canterbury and in Madrid

Jerusalem (Israel)
showed the highest prevalence rates for anxiety disorder in the

27.0 (20.0–33.9)
(7.3–13.1)
11.4 (5.2–17.7)
9.4 (3.8–15.0)

7.4 (5.0–9.7)
(4.0–7.1)
(3.8–7.4)

0.5 (0.1–0.9)
2.1 (1.2–3.0)
4.3 (3.2–5.4)

(0.6–1.0)
(1.1–2.0)
past year (England: 20.8%, 95% CI 15.6–26.0; Spain: 18.3, 95%
CI 14.4–22.3), whereas participants living in Ferrara and Geneva
reported the lowest prevalence rates (Italy: 14.4, 95% CI 11.6–

5.6
5.6
0.8

10.2
1.6
0b
17.3; Switzerland: 14.1, 95% CI 10.4–17.8). Participants living in
Jerusalem reported the highest lifetime and 12-month rates of
post-traumatic stress disorder (Israel: 5.9, 95% CI 4.2–7.5) (Tables

Geneva (Switzerland)
2 and 3). Elderly people in Geneva reported the highest prevalence

30.4 (27.1–33.6)
15.6 (11.5–19.7)
13.0 (10.1–16.0)
rate for affective disorder within the past year (Switzerland:

(5.5–10.1)

2.7 (1.7–3.7)
(3.9–6.7)
(0.1–2.2)

4.9 (3.5–6.3)
7.7 (7.0–8.4)
3.8 (2.6–5.1)

(0.0–1.1)
(1.9–3.5)
25.7%, 95% CI 21.2–30.3), followed by Jerusalem (Israel: 17.8%,
95% CI 12.2–23.3) and London/Canterbury (England: 17.6%,

5.3
1.1
0.6
2.7

7.8
95% CI 14.7–20.4). Lower prevalence rates were found in

0b
Hamburg (Germany: 12.7, 95% CI 10.6–14.8), Madrid (Spain:
12.4, 95% CI 7.7–17.0) and Ferrara (Italy: 11.1%, 95% CI 8.5–
13.6). The highest prevalence rates for substance–related disorders
were found in Geneva (Switzerland: 12.7%, 95% CI 9.4–15.9),

21.0 (17.0–25.3)
Madrid (Spain)

11.3 (8.5–14.0)

2.3 (1.3–3.4)
7.1 (5.1–9.2)

0.2 (0.0–0.5)
4.1 (2.0–6.2)
2.6 (1.8–3.4)

6.5 (4.7–8.3)

0.4 (0.1–0.6)
4.9 (2.2–7.5)

2.9 (0.9–3.9)
Hamburg (Germany: 11.2%, 95% CI 9.7–12.7) and London/
Canterbury (England: 11.2%, 95% CI 6.2–16.1). The lowest

0
prevalence rate for substance-related disorders was found in 0b
Jerusalem with 3.7% (Israel: 95% CI 2.6–4.7) (Table 3).

Current prevalence
Current prevalence rates are shown in Table 4. Nearly a quarter of
London (England)

28.4 (23.8–33.0)
(10.2–16.5)
10.3 (7.9–12.6)

(4.9–10.3)

4.7 (2.8–6.5)
(1.2–3.6)

1.4 (1.0–1.8)
3.4 (2.4–4.3)
2.9 (2.0–3.8)

(0.5–1.8)
8.0 (6.3–9.7)

(2.1–5.6)

the sample were diagnosed with any current mental disorder

(23.3%, 95% CI 19.9–26.7) with the highest prevalence rates
found in Geneva (30.4%), London/Canterbury (28.4%) and
2.4
1.2
3.8

7.6

13.4
0b

Jerusalem (27.0%). Lower prevalence rates for any current mental

disorder were found in Hamburg (23.3%), Madrid (21.0) and
Ferrara (19.5%).
The most prevalent category was anxiety disorders (11.4%, 19.5 (16.0–23.1)

95% CI 9.1–13.6), followed by affective disorders (8.0%, 95% CI

(7.5–11.4)
Ferrara (Italy)

2.0 (1.0–3.1)
(3.9–6.0)
(0.0–1.5)

0.2 (0.0–0.4)
4.8 (2.5–7.1)
7.5 (5.2–9.8)
5.5 (3.5–7.4)
2.9 (1.8–4.1)

(0.0–3.6)
(0.1–1.4)

6.3–9.6) and substance-related disorders (4.6%, 95% CI 3.7–

5.6). Elderly participants living in London/Canterbury or
a. Rates are adjusted for age and gender and accompanied by 95% confidence intervals.
5.0
0.7
1.5
0.7

9.4

Hamburg had the highest prevalence rates for anxiety disorders

Current prevalence rates of frequent mental disorder a

0b

in the past month (England: 13.4%, 95% CI 10.2–16.5; Germany:

12.0%, 95% CI 10.1–13.8). In contrast, elderly people living in
Ferrara and Geneva had the lowest current prevalence rates for
Hamburg (Germany)

anxiety disorders (Italy: 9.4%, 95% CI 7.5–11.4; Switzerland:

23.3 (21.2–25.6)
(10.1–13.8)

7.8%, 95% CI 5.5–10.1) (Table 4). The current prevalence rate for
5.4 (5.0–5.8)
4.0 (3.1–4.9)
(5.8–8.1)
(0.0–2.6)

1.8 (1.5–2.1)
5.0 (4.2–5.8)
2.5 (1.3–3.7)

6.9 (5.6–8.3)

(3.9–5.9)
(0.8–2.1)

affective disorders was markedly higher in Geneva (Switzerland:

15.6%, 95% CI 11.5–19.7) than in Ferrara (Italy: 7.5%, 95% CI
7.0
1.0
4.9
1.4

12.0
0b

5.2–9.8) and Madrid (Spain: 6.5%, 95% CI 4.7–8.3). The highest

prevalence rates for current substance-related disorders were 7.7%
in Geneva (Switzerland: 95% CI 7.0–8.4) and 5.4% in Hamburg
(Germany: 95% CI 5.0–5.8); the lowest rate was 2.1% in Jerusalem
Any substance-related disorder
Alcohol dependence or misuse
Post-traumatic stress disorder

(Israel: 95% CI 1.2–3.0) (Table 4).

*P50.05, **P50.01, ***P50.001.
Major depressive episode

Any somatoform disorder

b. Prevalence was below 0.5.

Any affective disorder

Discussion
Any anxiety disorder
Any bipolar disorder

Any simple phobia

Any mental disorder

Main findings
Substance misuse
Affective disorder

Panic disorder
Agoraphobia

Studies of mental disorders that do not focus on dementia or

Dysthymia

depression among elderly Europeans are very scarce. This is the

Table 4

Anxiety

first study to use a standardised and structured clinical interview

for mental disorders adapted to the needs of elderly people to
report lifetime, 12–month and current prevalence rates for a range

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 Prevalence of mental disorders in elderly people

of mental disorders in elderly people residing in different Eur- results are in line with previous European studies on substance
opean and associated countries. One in two individuals aged 65 misuse in adulthood.32,33
to 84 years had experienced at least one mental disorder in their
lifetime, one in three had done so within the past year, and nearly
one in four currently had a mental disorder. The most prevalent Strengths and limitations
disorders were anxiety disorders, followed by affective and sub- An advantage of the current study was the use of a reliable,
stance-related disorders. structured and standardised instrument that was adapted to the
needs of elderly people. Trained interviewers assessed participants
in catchment areas in Hamburg (Germany), in London/Canterbury
Comparison with findings from other studies (England), Geneva (Switzerland), Madrid (Spain), Ferrara (Italy)
and Jerusalem (Israel) face to face according to DSM-IV criteria,
In comparison with other epidemiological studies of old age9,27
and the reliability of the instrument was evaluated beforehand
and adulthood3,28 that used standardised interviews such as the
in a pilot phase of the study.
CIDI, our findings show higher prevalence rates, whereby the
Nevertheless, the study has some limitations. First, the size of
proportion of those affected is in accordance with the prevalence
the sample was limited per country and per catchment area.
rates in adulthood.3,28 Compared with other studies on old age,
Second, the representativeness of our study may be limited
we found higher current prevalence rates of major depression
because we found small but significant differences for some socio-
(6% in our study v. 3.3%),9,27 agoraphobia (3.4% v. 0.5%)9,27
demographic data between our sample and the total population of
and alcohol disorders (1.4% v. 0.96%).9,27 There was only one
the catchment area or country. Third, this study found higher
European study from the 1990s that found comparable rates for
prevalence rates of mental disorders in older people than did
current affective disorders, which also used an age-sensitive measure
previous studies; thus, the question arises of whether the response
for depression.29 It is plausible that previous epidemiological
rate in this study is associated with an overestimation or
studies underestimated the prevalence rates of mental disorders
underestimation of prevalence compared with previous studies.
in elderly people because they did not use an interview adapted
However, previous studies have found both higher34,35 and lower
to meet concerns specific to elderly people. The sentences in the
prevalence rates of mental disorders in non-responders.3 Kessler et
CIDI65+ were changed to make them easier for elderly people
al 36 found no evidence for a selection bias related to mental illness
to understand and respond to, and this may have contributed to
in the US National Comorbidity Survey Replication (NCS-R). The
more valid estimates of mental disorders.25 Another reason for
authors concluded that to the extent the bias exists, prevalence
the higher prevalence rates in our study could be that all countries
estimates may be regarded as more conservative. In addition,
used the same methodological approach, whereas previous studies
many authors have stated that non-response can, but need not,
may have underestimated prevalence through use of different
automatically mean there is a non-response bias in survey
instruments and possible measurement errors. Another important
estimates.37–39 Therefore, it may also be possible that the
point to consider is the use of categorical v. dimensional
prevalence of mental disorders in older people is still under-
instruments. There is an explicit difference in prevalence rates
estimated in our study. Furthermore, we were unable to include
obtained with dimensional and categorical instruments in
other important population variables such as educational level
affective disorders. Our study builds on established categorical
or financial situation. Another limiting factor regarding
criteria for mental disorders as defined by the DSM-IV.19
representativeness was our set of inclusion criteria: we did not
However, due to the multidimensional nature of psychopathology,
include people with severe cognitive impairment, homeless people
the criteria and thresholds of the DSM-IV are not without major
or people who did not have sufficient knowledge of the language
problems. Reviews that compare findings for dimensional
in which the interview was conducted. In addition, due to the
measures of current psychopathology with categorical current pre-
nature of epidemiological studies with elderly people, we were
valence typically reveal higher rates for dimensional measures that
unable to control for a possible recall bias, especially regarding
might vary depending on the choice of cut-offs that are used.9
lifetime symptoms.27
There is also a possibility that the presented rates are still under-
estimating the true prevalence of mental disorders in elderly peo-
ple because we excluded people with severe cognitive impairment Future directions for research
from the study.30
Our study showed a high prevalence rate of lifetime, 12-month
and current mental disorders in people aged 65 to 84 years in
different European and associated countries. The newly adapted
Prevalence rates in different countries CIDI65+ instrument shows the need for further research in the
The prevalence rates found in our study are comparable among diagnostics of mental disorders in elderly people, which is a
the participating countries except for fluctuations in the absolute crucial step towards more comprehensive mental health
size. Furthermore, there were several important differences approaches for these age groups. Future studies could investigate
between the six catchment areas. Interpreting those differences is the prevalence of mental disorders in even older people (of 85
complex because of the large differences between the countries years and above, as this age group is growing rapidly). However,
with regard to the availability of mental healthcare, the specific this group may require additional modifications in diagnostic
economic situation, immigration status, living circumstances, assessment, as additional challenges are associated with very old
attitudes towards mental disorders in elderly people, experience age (for example, cognitive impairment). Future European studies
of traumatic events and lifestyles.3,31 Such factors may be could also include more countries, such as those from the
associated with greater or lesser willingness and ability to express Scandinavian or Eastern European regions, and consider including
psychological symptoms during an interview. Another interesting nursing home residents or elderly people with cognitive
finding is the marked difference between the rates of substance impairments. Translations into further languages and extensions
misuse in the southern areas of Ferrara (Italy), and Madrid (Spain) to surveys in other continents would be a further milestone. In
and the more northern European areas of London/Canterbury addition, data about somatic diseases and their relationship with
(England), Hamburg (Germany), Geneva (Switzerland); these quality of life are needed. Additional studies could also integrate

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Andreas et al

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‘In The Spirit of Rivers’

poems
by Jo McFarlane
doctors
When I was 25,
a CPN referred me for psychotherapy
to cure my personality.

I was assessed and found wanting

but my need was so great, and my resilience weak,
so how could anybody sensibly take a chance with me?

The litany of traumas I disclosed,

like an automaton spitting toxic pellets,
didn’t penetrate its target audience.

Did the therapist think I was lying, perhaps?

Or was she thrown off guard
by the detachment in my voice?

The conclusion was predictable,

if, at the time, incomprehensible to me.
(The more help one needs, the less one gets).

Disproportionate equations abound in psychiatry:

If you ask for help, you mustn’t need it;
but refuse it and you’re certified psychotic

so they’ll throw away the key.

Side effects of medication are interpreted as symptoms;
blind compliance is a sign you’re in recovery.

Oh would that my brain could shut off so easily!

I was sent away to write a sonnet
Thank you Doctor for ‘saving the poet!’

Naively, at the age of 36, I thought I’d earned the right

to ditch my load, so cap in hand (with money for them)
I approached the Institute of Humorous Relations.

My life experience seemed alien and threatening

to the middle class arbiter of my fate.
On concluding the assessment,

she paused for reflection, then –

as though weighing up a bag of cherries in her hand –
had the cheek to say ‘Let’s not rock the boat’.

Didn’t she give a damn

about the massive hole in the bottom
sucking all the water in!

Selected by Femi Oyebode. From Stigma & Stones: Living with a Diagnosis of BPD, poems by Sally Fox & Jo McFarlane.
B Jo McFarlane. Reprinted with permission.

Through their collection Stigma & Stones, writers/performers/partners Sally Fox and Jo McFarlane seek to promote
understanding, improve treatment and reduce the stigma of living with a diagnosis of BPD.

The British Journal of Psychiatry (2017)

210, 131. doi: 10.1192/bjp.bp.116.181685

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