A Qualitative Analysis of the Impact of Preoperative Mindfulness-Based Stress Reduction on Total Knee Arthroplasty Surgical Experiences.

We qualitatively explored the impact of preoperative mindfulness-based stress reduction (MBSR) on total knee arthroplasty (TKA) experiences. Participants (n = 10) who received MBSR prior to TKA participated in semi-structured interviews concerning their experiences with MBSR and its perceived impact on surgery. We analyzed interviews according to reflexive thematic analysis, and coded data into three main themes: 1) Impact of MBSR on surgery experiences; 2) Contributors to change; and 3) Motivations for participation. Participants noted they were able to relax, feel more confident, and cope more effectively during the preoperative period, and that others in their lives noticed positive changes following their participation in MBSR. Participants' openness to mindfulness and health-related beliefs and may have contributed to the positive impacts they experienced from MBSR. Participants described being motivated to participate in MBSR to help them prepare for their surgery and to learn new coping strategies. Participants described a strong level of commitment to the intervention. With further research, integration of MBSR into prehabilitation for TKA may be appropriate.

Perceived control moderates the internalized stigma model of seeking mental health services in distressed older adults.

Older adults are especially unlikely to seek mental health services, and internalized stigma is a key reason why. However, little research has investigated which older adults are particularly likely to have stigma influence help-seeking. To address this, we tested whether perceived control (PC) moderates an internalized stigma model in which public stigma is internalized as self-stigma, which negatively predicts help-seeking attitudes and help-seeking intentions. We employed moderated mediation analysis of cross-sectional, secondary data from 348 psychologically distressed Canadian adults aged 65 years and older. Participants completed an online survey that included measures of public stigma of help-seeking, self-stigma of help-seeking, help-seeking attitudes, conditional help-seeking intentions, psychological distress, and PC. PC emerged as a moderator of the internalized stigma model. Those lower in PC were more likely to have public stigma negatively predict help-seeking intentions through the serial mediation of (a) self-stigma and (b) help-seeking attitudes. Further, those lower in PC were more likely to have public stigma internalized as self-stigma and more likely to have negative help-seeking attitudes predict lower help-seeking intentions. Finally, those lower in PC also had lower help-seeking intentions in the face of low levels of self-stigma. These results contribute to a nuanced understanding of which older adults are unlikely to seek help. Identifying PC as a moderator of the internalized stigma model suggests that interventions that enhance PC should protect against public stigma's internalization and improve help-seeking behaviors for older adults who need such help. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development, feasibility, and acceptability of a process based intervention to decrease internalized ageism.

A lifetime of exposure to ageism may be internalized in older adults, and these ageist beliefs that are directed inwards can have severe consequences. However, research on reducing internalized ageism is scarce. To address this, we designed and implemented a six-week online process-based intervention to reduce internalized ageism and to assess its feasibility. The intervention utilized a process-based therapy approach targeting psychological, behavioral, and physiological pathways through which internalized ageism negatively impacts health, as specified by stereotype embodiment theory. Intervention components included education, acceptance and commitment therapy techniques, and attributional retraining. A total of 81 older adult participants participated in the feasibility study. Most participants rated each session and the overall program as very useful after each session (average program usefulness rating of 4.54/5). Participants also attributed a wide range of novel behaviors to this intervention and stated that they felt it changed their perspectives on ageism and/or internalized ageism. Results from this study provide a promising foundation from which to advance research on interventions that address internalized ageism - a problem that has severe consequences on the health and well-being of growing numbers of older adults globally.

Reimagine Aging: A Process-Based Intervention to Decrease Internalized Ageism.

OBJECTIVES: Exposure to ageism may be internalized in older adults, and this can have severe consequences. However, little research has addressed reducing internalized ageism. Thus, Reimagine Aging, a 6-week process-based intervention to reduce internalized ageism, was designed and implemented, using education, acceptance and commitment therapy, and attributional retraining to target theoretically based mechanisms of change. METHODS: Seventy-two older adults (M = 70.4 years, SD = 6.4 years) participated in Reimagine Aging, consented to participate in this robust single-sample pilot study, and provided valid data. Participants completed questionnaires prior to, immediately following, and 2 months after the intervention. RESULTS: Participants' self-perceptions of aging (ηp2=0.37, p < .001) and perceptions of older adults (ηp2=0.27, p < .001) became significantly more positive, associated with large effect sizes. Furthermore, these positive gains were mediated by increases in psychological flexibility, mindfulness, and perceived control. DISCUSSION: This study provides initial support for this process-based intervention targeting a reduction of internalized ageism. CLINICAL IMPLICATIONS: This program has the potential to reduce the negative impact internalized ageism has on the health of older adults. Furthermore, it provides novel insights into intervention targets and tools that may be useful in achieving this reduction.

How initial policy responses to COVID-19 contributed to shaping dying at home preferences and care provision: key informant perspectives from Canada.

OBJECTIVES: In response to COVID-19's first wave, provincial governments rapidly implemented several public health directives, including isolation measures and care facility visitor restrictions, which profoundly affected healthcare delivery at the end of life and dying experiences and perceptions. The objective of this study was to identify implications of early policy changes for dying at home. METHODS: Analysis of interviews with 29 key informants with expertise in the policy and practice context of dying at home and care for those dying at home was conducted as part of a larger mixed-methods study on dying at home in Canada. RESULTS: Initial pandemic policy responses, especially visitor restrictions and limitations to home care services, shaped dying at home in relation to three themes: (1) increasing preferences and demand for, yet constrained system ability to support dying at home; (2) reinforcing and illuminating systemic reliance on and need for family/friend caregivers and community organizations, while constraining their abilities to help people die at home; and (3) illuminating challenges in developing and implementing policy changes during a pandemic, including equity-related implications. CONCLUSION: This study contributes to broader understanding of the multifaceted impacts of COVID-19 policy responses in various areas within Canadian healthcare systems. Implications for healthcare delivery and policy development include (1) recognizing the role of family/friend caregivers and community organizations in end-of-life care, (2) recognizing health inequities at the end of life, and (3) considering possible changes in future end-of-life preferences and public attitudes about dying at home and responsibility for end-of-life care.

Neuroticism as a moderator of symptom-related distress and depression in 4 noncancer end-of-life populations.

OBJECTIVES: Neuroticism is a significant predictor of adverse psychological outcomes in patients with cancer. Less is known about how this relationship manifests in those with noncancer illness at the end-of-life (EOL). The objective of this study was to examine the impact of neuroticism as a moderator of physical symptoms and development of depression in patients with amyotrophic lateral sclerosis (ALS), chronic obstructive pulmonary disease (COPD), end-stage renal disease (ESRD), and frailty in the last 6 months of life. METHODS: We met this objective using secondary data collected in the Dignity and Distress across End-of-Life Populations study. The data included N = 404 patients with ALS (N = 101), COPD (N = 100), ESRD (N = 101), and frailty (N = 102) in the estimated last 6 months of life, with a range of illness-related symptoms, assessed longitudinally at 2 time points. We examined neuroticism as a moderator of illness-related symptoms at Time 1 (∼6 months before death) and depression at Time 2 (∼3 months before death) using ordinary least squares regression. RESULTS: Results revealed that neuroticism significantly moderated the relationship between the following symptoms and depression measured 3 months later: drowsiness, fatigue, shortness of breath, wellbeing (ALS); drowsiness, trouble sleeping, will to live, activity (COPD); constipation (ESRD); and weakness and will to live (frailty). SIGNIFICANCE OF RESULTS: These findings suggest that neuroticism represents a vulnerability factor that either attenuates or amplifies the relationship of specific illness and depressive symptoms in these noncancer illness groups at the EOL. Identifying those high in neuroticism may provide insight into patient populations that require special care at the EOL.

Where would Canadians prefer to die? Variation by situational severity, support for family obligations, and age in a national study.

BACKGROUND: Death at home has been identified as a key quality indicator for Canadian health care systems and is often assumed to reflect the wishes of the entire Canadian public. Although research in other countries has begun to question this assumption, there is a dearth of rigorous evidence of a national scope in Canada. This study addresses this gap and extends it by exploring three factors that moderate preferences for setting of death: situational severity (entailing both symptoms and supports), perceptions of family obligation, and respondent age. METHODS: Two thousand five hundred adult respondents from the general population were recruited using online panels between August 2019 and January 2020. The online survey included three vignettes, representing distinct dying scenarios which increased in severity based on symptom management alongside availability of formal and informal support. Following each vignette respondents rated their preference for each setting of death (home, acute/intensive care, palliative care unit, nursing home) for that scenario. They also provided sociodemographic information and completed a measure of beliefs about family obligations for end-of-life care. RESULTS: Home was the clearly preferred setting only for respondents in the mild severity scenario. As the dying scenario worsened, preferences fell for home death and increased for the other options, such that in the severe scenario, most respondents preferred a palliative care or hospice setting. This pattern was particularly distinct among respondents who also were less supportive of family obligation norms, and for adults 65 years of age and older. CONCLUSIONS: Home is not universally the preferred setting for dying. The public, especially older persons and those expressing lower expectations of families in general, express greater preference for palliative care settings in situations where they might have less family or formal supports accompanied by more severe and uncontrolled symptoms. Findings suggest a) the need for public policy and health system quality indicators to reflect the nuances of public preferences, b) the need for adequate investment in hospices and palliative care settings, and c) continuing efforts to ensure that home-based formal services are available to help people manage symptoms and meet their preferences for setting of death.

Perceived Need, Mental Health Literacy, Neuroticism and Self- Stigma Predict Mental Health Service Use Among Older Adults.

OBJECTIVES: Older adults are the least likely age group to seek mental health services. However, few studies have explored a comprehensive range of sociodemographic, psychological, and social barriers and facilitators to seeking treatment in later life. METHODS: A cross-sectional, national sample of Canadian older adults (55+, N = 2,745) completed an online survey including reliable and valid measures of predisposing, enabling, and need characteristics, based on Andersen's behavioral model of health, as well as self-reported use of mental health services. Univariate and hierarchical logistic regressions predicted past 5-year mental health service use. RESULTS: Mental health service use was most strongly and consistently associated with greater perceived need (OR = 11.48) and mental health literacy (OR = 2.16). Less self-stigma of seeking help (OR = .65) and greater neuroticism (OR = 1.57) also predicted help-seeking in our final model, although their effects were not as strong or consistent across gender, marital status, and age subgroups. CONCLUSIONS: The need category was crucial to seeking help, but predisposing psychological factors were also significant barriers to treatment. CLINICAL IMPLICATIONS: Interventions that target older adults high in neuroticism by improving perceptions of need for treatment, mental health literacy, and self-stigma of seeking help may be particularly effective ways of improving access to mental health services.

Rationale and Methodology of the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS): A 16-year Follow-up Survey: Raison D'être Et Méthodologie De L'enquête De Suivi Sur La Santé Mentale Des Membres Des Forces Armées Canadiennes Et Des Anciens Combattants, 2018 (ESSMFACM).

OBJECTIVE: Knowledge is limited regarding the longitudinal course and predictors of mental health problems, suicide, and physical health outcomes among military and veterans. Statistics Canada, in collaboration with researchers at the University of Manitoba and an international team, conducted the Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Herein, we describe the rationale and methods of this important survey. METHOD: The CAFVMHS is a longitudinal survey design with 2 time points (2002 and 2018). Regular Force military personnel who participated in the first Canadian Community Health Survey Cycle 1.2-Mental Health and Well-Being, Canadian Forces Supplement (CCHS-CFS) in 2002 (N = 5,155) were reinterviewed in 2018 (n = 2,941). The World Mental Health Survey-Composite International Diagnostic Interview was used with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. RESULTS: The CAFVMHS includes 2,941 respondents (66% veterans; 34% active duty) and includes data on mental disorder diagnoses, physical health conditions, substance use, medication use, general health, mental health services, perceived need for care, social support, moral injury, deployment experiences, stress, physical activity, military-related sexual assault, childhood experiences, and military and sociodemographic information. CONCLUSIONS: The CAFVMHS provides a unique opportunity to further understand the health and well-being of military personnel in Canada over time to inform intervention and prevention strategies and improve outcomes. The data are available through the Statistics Canada Research Data Centres across Canada and can be used cross-sectionally or be longitudinally linked to the 2002 CCHS-CFS data.

Social engagement mediates the relationship between participation in social activities and psychological distress among older adults.

OBJECTIVE: Participation in social activities often has beneficial effects on mental health among older adults, although the reasons why this is true (i.e., mechanisms or mediators) have received less empirical attention. The objective of this study is to examine whether involvement in social activities is associated with less psychological distress because it fosters social engagement. METHOD: We explored this hypothesis with a sample of 1089 community dwelling Canadians ranging in age from 65 to 93 who completed a cross-sectional online survey that included measures of social participation (i.e., number of activities, time spent in them, and volunteerism), social engagement (i.e., the number of friends and family they see, feel close to, and can discuss personal matters with), and psychological distress. RESULTS: Mediation analyses confirmed our hypothesis that participation in social activities had beneficial effects on psychological distress through social engagement. That is, individuals who participated in greater numbers of social activities were more likely to report social engagement, and greater social engagement was associated with less psychological distress. In addition, when we controlled for the effect of social engagement, involvement in greater numbers of social activities was associated with greater distress. CONCLUSION: Our findings suggest that social engagement is a reason why participation in social activities has benefits for older adults' mental health, and that increasing engagement, both within and outside of typical social activities, is a worthwhile target for efforts to improve mental health among the growing older adult population.

Associations between physical health conditions and posttraumatic stress disorder according to age.

OBJECTIVES: Posttraumatic stress disorder (PTSD) is associated with various physical health conditions. However, it is unclear whether the relationship between PTSD and physical health conditions differs according to age. This study aims to examine the associations between PTSD and physical health conditions across four adult age categories. METHODS: We analyzed data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed past-year DSM-5 PTSD. Multiple regression analyses examined associations between PTSD (reference = no PTSD) with number and type of physical health conditions in each age category (18-34: "younger adults," 35-49: "middle-aged adults," 50-64: "young-old adults," 65+: "older adults"). RESULTS: The prevalence of nearly all physical health conditions increased according to age, whereas the prevalence of PTSD tended to decrease with age. After adjustment, PTSD was associated with a greater number of physical health conditions among all age categories (b range: 0.62-1.29). Regardless of age category, PTSD was associated with increased odds of cardiovascular and musculoskeletal conditions (AOR range: 1.54-2.34). PTSD was also associated with increased odds of gastrointestinal, hepatobiliary, endocrine/metabolic, respiratory, neurologic conditions, cancer, sleep disorders, and anemia among select age categories (AOR range: 1.70-3.31). For most physical health conditions, the largest effect sizes emerged for younger and middle-aged adults. CONCLUSIONS: PTSD is associated with many physical health conditions across the age spectrum, particularly among younger and middle-aged adults. Results may inform targeted screening and intervention strategies to mitigate risk of physical health conditions among adults with PTSD.

Does Age Impact the Clinical Presentation of Adult Women Seeking Specialty Eating Disorder Treatment?

Recent evidence suggests that eating disorders (EDs) are becoming increasingly common in older women. Previous research examining differences between younger and older women with EDs has been mixed, making it unclear whether older women with EDs represent a distinct group. We sought to determine whether there are age differences in the clinical presentation of women seeking specialty treatment for an ED. We examined the linear relationship between age and clinical constructs among adult women (N = 436) diagnosed with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, ED. Across analyses, there was no impact of age on most measures of ED symptoms, comorbid psychopathology, self-esteem, quality of life, and motivation to change. However, older age was associated with fewer interoceptive awareness difficulties, maturity fears, anxiety symptoms, and body image concerns. These findings suggest that the clinical presentation of older ED cases is largely similar, although somewhat less severe than in younger women. The implications of this research for future research and treatment are discussed.

Older Adults' Narratives of Seeking Mental Health Treatment: Making Sense of Mental Health Challenges and "Muddling Through" to Care.

Older adults who experience challenges related to mental health are unlikely to seek professional help. The voices of older adults who have navigated through mental health issues and systems of care to arrive at psychological treatment are less well understood. We conducted individual interviews with 15 adults aged 61 to 86 who sought psychological treatment. Interviews were audio-recorded, transcribed, and analyzed using narrative methods. We identified several main storylines that describe the meaning-making and treatment-seeking journeys of older adults: resistance to being labeled with mental health problems (telling stories of resistance, defining mental health issues in mysterious and uncontrollable terms, and experiencing internal role conflict); muddling through the help-seeking process (manifestations of chaos and system-level barriers); and emotional reactions to psychological treatment (hope, fear, and mistrust). Findings add to the literature base in the area of narrative gerontology, and highlight the complex experiences that older adults face when seeking psychological treatment.

Is the association between social network types, depressive symptoms and life satisfaction mediated by the perceived availability of social support? A cross-sectional analysis using the Canadian Longitudinal Study on Aging.

Objectives: The objectives of this study were to examine: 1) whether the relationship between social network types, depressive symptoms and life satisfaction is mediated by different types of perceived social support; and, 2) whether social support plays a mediational role for married versus unmarried older adults. Methods: The study was based on national, baseline data (Tracking Cohort) from the Canadian Longitudinal Study on Aging for participants aged 65 to 85 (N = 8782). Five social network types derived from cluster analysis were used as predictors in the mediation analyses, with the four social support subscales of the Medical Outcomes Survey (MOS) Social Support Survey (tangible, emotional, positive social interactions, and affectionate) included as mediators, and depressive symptoms and life satisfaction as outcome variables. Socio-demographic and physical health variables were included as covariates. Results: Significant indirect effects emerged, with less diverse social network structures generally associated with less social support which, in turn, was related to more depressive symptoms and lower life satisfaction. However, different findings emerged for different types of social support, for participants who were married and unmarried, and for depressive symptoms versus life satisfaction. Conclusion: Our findings suggest that restricted social networks that are reflective of social isolation, as well as those that are intermediate in terms of their diversity can create gaps in perceived social support and, consequently, can negatively impact mental health and life satisfaction.

Effects of Gambling Diagnostic Criteria Changes from DSM-IV to DSM-5 on Mental Disorder Comorbidity Across Younger, Middle-Aged, and Older Adults in a Nationally Representative Sample.

Changes in Diagnostic and Statistical Manual (DSM) criteria for a gambling disorder from DSM-IV to DSM-5 included a drop in the minimum number of criteria required to qualify for a diagnosis. This threshold reduction resulted in a near doubling of prevalence in non-gambling focused populations. However, the impact of this change on psychiatric comorbidity with gambling is unknown. The current study aimed to: (a) examine whether the diagnostic change affected the severity of those diagnosed with a gambling disorder with respect to mental disorder comorbidity, and (b) determine whether this relationship differed across younger (18-34 years old), middle-aged (35-54 years old), and older (55 years old and over) age groups. This study utilized data from the National Epidemiological Survey for Alcohol and Related Conditions. Results indicated that the prevalence of comorbid mental health/substance use disorders did not significantly change between the DSM-IV pathological gambling group and DSM-5 gambling disorder group in the overall sample. However, among older adults, the DSM-5 gambling disorder were more likely to exhibit any anxiety disorder as well as any comorbid mental health/substance-use disorder compared to the DSM-IV pathological gamblers. No other significant differences were observed in mental health or substance-use disorders within age-specific groupings. Findings suggest that the new, less restrictive DSM-5 criteria for gambling addiction capture older gamblers with more severe clinical presentations in terms of co-occurring mental disorders, contrary to our expectation that the lowered threshold for diagnosis would result in less severe clinical cases.

An Examination of Comorbid Psychiatric Disorders in Disordered Gamblers Versus Other Substance-Related Disorders.

Substantial changes were made with the creation of the Substance Related and Addictive Disorders category in the fifth edition of the Diagnostic and Statistical Manual (DSM-5; APA in Diagnostic and statistical manual of mental disorders, 5th edn, American Psychiatric Publishing, Arlington, 2013a), including the addition of gambling disorder to the category and a reduction in the minimum threshold of diagnostic criteria required for a gambling disorder. As gambling shares many similarities with substance use disorders, it stands to reason that comorbidity rates of other psychiatric disorders would be similar among gambling and substance use disorders. The current study examines whether changes in gambling diagnostic criteria from DSM-IV to DSM-5 correspond to changes in prevalence of comorbid psychiatric disorders among disordered gamblers that result in prevalence rates more similar to those observed in alcohol and cannabis use disorders. This study utilized data from the National Epidemiological Survey for Alcohol and Related Conditions (NESARC). Results suggested that the prevalence for any comorbid disorder among disordered gamblers appeared to be similar from DSM-IV (56.7%) to DSM-5 (53.7%). Comorbidity using DSM-5 criteria were just slightly closer to, but still noticeably higher than, comorbidity prevalence observed in alcohol (25.3%) and cannabis (37.7%) disorders, with similar trends across addictions observed in most examined comorbid disorders/groupings. Our findings suggest that lowering the threshold for minimum diagnosis of gambling disorder resulted in a slight decrease in comorbidity rates though substantial differences remain between comorbid rates of disordered gambling and substance use disorders. Future DSM editions may consider a further diagnostic threshold reduction, which might result in comorbidity rates being more similar to other substance use disorders and increasing disorder similarity within the Substance Related and Addictive Disorders category.

Age differences in public stigma, self-stigma, and attitudes toward seeking help: A moderated mediation model.

OBJECTIVE: Stigma is commonly identified as a key reason that older adults are especially unlikely to seek mental health services, although few studies have tested this assumption. Our objectives were to: (a) examine age differences in public and self-stigma of seeking help, and attitudes toward seeking help, and (b) see whether age moderates an internalized stigma of seeking help model. METHODS: A total of 5,712 Canadians ranging in age from 18 to 101 completed self-report measures of public stigma of seeking help, self-stigma of seeking help, and help-seeking attitudes. RESULTS: Older participants had the lowest levels of stigma and the most positive help-seeking attitudes. Age also moderated the mediation model, such that the indirect effect of public stigma on help-seeking attitudes through self-stigma was strongest for older participants. CONCLUSION: Our findings have implications for the influence of stigma and attitudes as barriers to treatment across the adult lifespan, and for stigma reduction interventions.

The effect of time perspectives on mental health information processing and help-seeking attitudes and intentions in younger versus older adults.

Socioemotional selectivity theory posits that changes in time perspective over the lifespan are associated with distinct goals and motivations. Time perspectives and their associated socioemotional motivations have been shown to influence information processing and memory, such that motivation-consistent information is more likely to be remembered and evaluated more positively. OBJECTIVE: The aim of this study was to examine the effect of motivation-consistent mental health information on memory for and evaluations of this information, as well as help-seeking attitudes and intentions to seek mental health services. METHOD: We randomly assigned an Internet-based sample of 160 younger (18-25) and 175 older (60-89) adults to read a mental health information pamphlet that emphasized time perspectives and motivations relevant to either young adulthood (future-focused) or late adulthood (present-focused). Participants completed measures assessing their time perspective, memory for and subjective evaluation of the pamphlet, and help-seeking attitudes and intentions. RESULTS: The time perspective manipulation had no effect on memory for pamphlet information or help-seeking attitudes and intentions. There was, however, a significant interaction between time perspective and pamphlet version on the rated liking of the pamphlet. CONCLUSION: Although motivation-consistent information only affected perceptions of that information for present-focused (mostly older) individuals, this finding has important implications for enhancing older adults' mental health literacy.

Post-Traumatic Stress Disorder Across the Adult Lifespan: Findings From a Nationally Representative Survey.

OBJECTIVE: There is a dearth of community-based epidemiologic literature that examines post-traumatic stress disorder (PTSD) across the adult lifespan. In the current study the authors address this gap by examining the ways in which PTSD differs among young (ages 20-34), middle-aged (ages 35-64), and older (age 65+) adults with respect to past-year prevalence, nature of "worst" stressful experience ever experienced before the onset of PTSD, all traumatic experiences, symptom expression, psychiatric comorbidities, and mental health-related quality of life. METHODS: We analyzed Wave 2 data from the National Epidemiologic Survey on Alcohol and Related Conditions, including adults with past-year diagnoses of PTSD (N = 1,715). RESULTS: The prevalence of past-year PTSD was significantly higher for young (4.3% [SE: 0.3]) and middle-aged (5.2% [SE: 0.2]) adults compared with older adults (2.6% [SE: 0.2]). Respondents in the three age groups differed with regard to their "worst" stressful experience ever experienced before the onset of PTSD and to all traumatic experiences. Older adults experienced significantly fewer traumatic experiences (mean: 5.2; SE: 0.2) compared with young (mean: 5.7; SE: 0.2) and middle-aged adults (mean: 6.4; SE: 0.1). Young and middle-aged adults had significantly greater symptom counts and greater odds of comorbid psychiatric disorders when compared with older adults. PTSD had similar effects on mental health-related quality of life across the adult lifespan. CONCLUSION: Results highlight key differences in the characteristics of PTSD across the adult lifespan. The overall pattern of findings indicates that increasing age is associated with less severe PTSD profiles, including lower prevalence, fewer traumatic experiences, lower symptom counts, and lower odds of psychiatric comorbidity.

EDUCATIONAL ATTAINMENT AS A PROTECTIVE FACTOR FOR PSYCHIATRIC DISORDERS: FINDINGS FROM A NATIONALLY REPRESENTATIVE LONGITUDINAL STUDY.

OBJECTIVE: This study examined cross-sectional and longitudinal relationships between educational attainment and psychiatric disorders (i.e., mood, anxiety, substance use, and personality disorders) using a nationally representative survey of US adults. METHOD: We used data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N = 34,653). Bivariate and multiple logistic regressions examined cross-sectional and longitudinal associations between educational attainment and a variety of past-year and incident anxiety, mood, and substance use disorders, controlling for sociodemographics and psychiatric disorder comorbidity. RESULTS: Adjusted cross-sectional data indicated that educational attainment below a graduate or professional degree at Wave 2 was associated with significantly higher odds of substance use and/or dependence disorders (adjusted odds ratio range (AORR = 1.55-2.55, P < 0.001). Longitudinal adjusted regression analyses indicated that individuals reporting less than a college education at Wave 1 were at significantly higher odds of experiencing any incident mood (AORR 1.49-1.64, P < 0.01), anxiety (AORR 1.35-1.69, P < 0.01), and substance use disorder (AORR 1.50-2.02, P < 0.01) at Wave 2 even after controlling for other sociodemographic variables and psychiatric comorbidity. CONCLUSION: Findings lend support to other published research demonstrating that educational attainment is protective against developing a spectrum of psychiatric disorders. Mechanisms underlying this relationship are speculative and in need of additional research.