Depressive symptom complexes of community-dwelling older adults: a latent network model.

Late-life depression has multiple, heterogeneous clinical presentations. The aim of the study was to identify higher-order homogeneous clinical features (symptom complexes), while accounting for their potential causal interactions within the network approach to psychopathology. We analyzed cross-sectional data from community-dwelling adults aged 65-85 years recruited by the European MentDis_ICF65+ study (n = 2623, mean age 74, 49% females). The severity of 33 depressive symptoms was derived from the age-adapted Composite International Diagnostic Interview. Symptom complexes were identified using multiple detection algorithms for symptom networks, and their fit to data was assessed with latent network models (LNMs) in exploratory and confirmatory analyses. Sensitivity analyses included the Partial Correlation Likelihood Test (PCLT) to investigate the data-generating structure. Depressive symptoms were organized by the Walktrap algorithm into eight symptom complexes, namely sadness/hopelessness, anhedonia/lack of energy, anxiety/irritability, self-reproach, disturbed sleep, agitation/increased appetite, concentration/decision making, and thoughts of death. An LNM adequately fit the distribution of individual symptoms' data in the population. The model suggested the presence of reciprocal interactions between the symptom complexes of sadness and anxiety, concentration and self-reproach and between self-reproach and thoughts of death. Results of the PCLT confirmed that symptom complex data were more likely generated by a network, rather than a latent-variable structure. In conclusion, late-life depressive symptoms are organized into eight interacting symptom complexes. Identification of the symptom complexes of late-life depression may streamline clinical assessment, provide targets for personalization of treatment, and aid the search for biomarkers and for predictors of outcomes of late-life depression.

Incidence and risk factors of mental disorders in the elderly: The European MentDis_ICF65+ study.

OBJECTIVE: While incidence rates of depression and anxiety disorders in the elderly have been comprehensively investigated, the incidence rates of other mental disorders have rarely been researched. The incidence rate and predictors of various mental disorders in the elderly were evaluated in different European and associated countries. METHODS: A cross-sectional and longitudinal multi-centre survey of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnoses was conducted in different European and associated countries (Germany, Italy, Spain, Switzerland, the United Kingdom and Israel) to collect data on the prevalence and incidence of mental disorders in the elderly. The sample size of the longitudinal wave was N = 2592 elderly. RESULTS: The overall 1-year incidence rate for any mental disorder in the elderly is 8.65%. At 5.18%, any anxiety disorder had the highest incidence rate across all diagnostic groups. The incidence rate for any affective disorder was 2.97%. The lowest incidence rates were found for agoraphobia (1.37%) and panic disorder (1.30%). Risk factors for the development of any mental disorder were never having been married, no religious affiliation, a higher number of physical illnesses and a lower quality of life. CONCLUSION: In comparison to other studies, lower incidence rates for any affective disorder and middle-range incidence for any anxiety disorder were found. To the authors' knowledge, no prior studies have reported 1-year incidence rates for somatoform disorder, bipolar disorder and substance misuse in community-dwelling elderly. These findings indicate the need to raise awareness of psychosocial problems in the elderly and to ensure adequate availability of mental health services.

Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain.

The pandemic caused by Covid-19 has been an unprecedented social and health emergency worldwide. This is the first study in the scientific literature reporting the psychological impact of the Covid-19 outbreak in a sample of the Spanish population. A cross-sectional study was conducted through an online survey of 3480 people. The presence of depression, anxiety and post-traumatic stress disorder (PTSD) was evaluated with screening tests from 14 March. Sociodemographic and Covid-19-related data was collected. Additionally, spiritual well-being, loneliness, social support, discrimination and sense of belonging were assessed. Descriptive analyses were carried out and linear regression models compiled. The 18.7% of the sample revealed depressive, 21.6% anxiety and 15.8% PTSD symptoms. Being in the older age group, having economic stability and the belief that adequate information had been provided about the pandemic were negatively related to depression, anxiety and PTSD. However, female gender, previous diagnoses of mental health problems or neurological disorders, having symptoms associated with the virus, or those with a close relative infected were associated with greater symptomatology in all three variables. Predictive models revealed that the greatest protector for symptomatology was spiritual well-being, while loneliness was the strongest predictor of depression, anxiety and PTSD. The impact on our mental health caused by the pandemic and the measures adopted during the first weeks to deal with it are evident. In addition, it is possible to identify the need of greater psychological support in general and in certain particularly vulnerable groups.

Quality of life, level of functioning, and its relationship with mental and physical disorders in the elderly: results from the MentDis_ICF65+ study.

BACKGROUND: An ageing population worldwide needs to investigate quality of life (QoL) and level of functioning (LoF) in the elderly and its associated variables. We aimed to study the relationship between Quality of Life (QoL) and Level of Functioning (LoF) in an elderly population in Europe. METHOD: As part of the Ment_Dis65+ European Project, 3142 community-dwelling adults aged 65-84 years in six countries were assessed by using the adaptation for the elderly of the Composite International Diagnostic Interview (CIDI65+) to provide psychiatric diagnosis according to the International Classification of Diseases (10th edition) (ICD-10 Classification of Mental and Behavioural Disorders). Socio-demographic and clinical interviews, and two self-report tools, the World Health Organization QoL assessment (WHO QoL BREF), to assess QoL, and the WHO Disability Assessment Schedule -II (WHODAS-II), to assess LoF, were also administered. RESULTS: Most subjects reported good levels of QoL (56.6%) and self-rated health (62%), with no or mild disability (58.8%). There was a linear decrease of the QoL and the LoF by increase of age. Elderly with ICD-10 mental disorder (e.g. somatoform, affective and anxiety disorders) had poorer QoL and lower LoF. There were a number of predictors of lower levels of QoL and disability, including both socio-demographic variables (e.g. male gender, increase in age, poor financial situation, retirement, reduced number of close significant others), ICD-10 psychiatric diagnosis (mainly anxiety, somatoform disorders) and presence of medical disorders (mainly heart and respiratory diseases). CONCLUSIONS: The study indicates that QoL and LoF were quite acceptable in European elderly people. A series of variables, including psychiatric and somatic disorders, as well as socio-demographic factor influenced in a negative way both QoL and LoF. More specific links between mental health, social and health services dedicated to this segment of the population, should be implemented in order to provide better care for elderly people with conditions impacting their QoL and functioning.

Confirmatory factor analysis of the Revised UCLA Loneliness Scale (UCLA LS-R) in individuals over 65.

GOALS: The UCLA LS-R is the most extensively used scale to assess loneliness. However, few studies examine the scale's use on older individuals. The goal of the study is to analyse the suitability of the scale´s structure for assessing older individuals. METHOD: The UCLA LS-R scale was administered to a random sample of 409 community-dwelling residents of Madrid (53% women) aged 65-84 years (obtained from the MentDis_ICF65+ study). Confirmatory factor analysis was used to assess the factor structure of the UCLA LS-R. RESULTS: The internal consistency of the scale obtained a Cronbach's alpha of .85. All the analysed models of factor structure of the UCLA LS-R achieved a fairly good fit and RMSEA values over .80. The models that best fit the empirical data are those of Hojat (1982) and Borges et al. (2008). CONCLUSION: The data suggest an equivalent effectiveness of UCLA LS-R in adults under 65 and over 65, which may indicate a similar structure of the loneliness construct in both populations. This outcome is consistent with the idea that loneliness has two dimensions: emotional loneliness and social loneliness. The use of short measures that are easy to apply and interpret should help primary care professionals identify loneliness problems in older individuals sooner and more accurately.

The role of meaning in life in community-dwelling older adults with depression and relationship to other risk factors.

OBJECTIVES: The aims of this study were to examine the association of Meaning in Life (MiL) with sociodemographic and physical factors, and its association with depression in older people. METHOD: A cross-sectional survey with a sample of N = 2104 older adults from communities of four European countries was conducted, using an age-appropriate interview for the diagnosis of depression and the Schedule for Meaning in Life Evaluation (SMiLE) questionnaire to assess MiL. RESULTS: Overall, MiL was particularly low in old male participants, in older people from Ferrara (Italy), those with a lower religious affiliation, fewer social contacts, and poorer physical health. Furthermore, younger old age (65-69 compared to 80-84 year olds), female gender, being married, living in Geneva and poorer physical health were significantly associated with a higher risk for depression. In addition, lower MiL significantly increased the likelihood to suffer from depression in older people. An interaction effect of study center and MiL also emerged: with decreasing MiL the risk for depression significantly increases in Hamburg compared to the other study centers. CONCLUSION: This study underlines the association of MiL and depression in old age. Integration of meaning-specific aspects in treatment for older adults with depression may be promising.

Anxiety Disorders in Old Age: Psychiatric Comorbidities, Quality of Life, and Prevalence According to Age, Gender, and Country.

OBJECTIVES: Previous estimates of the prevalence of anxiety disorders in late life vary greatly due to the lack of reliable diagnostic tools. This MentDis_ICF65+ study assessed 12-month prevalence rates of anxiety disorders and age- and gender-related differences in comorbidities, as well as impact on quality of life. DESIGN: The study used a cross-sectional multicenter survey. PARTICIPANTS: The study sample comprised 3,142 men and women aged 65 to 84 years, living in five European countries and Israel. MEASUREMENTS: Anxiety disorders were assessed using computer-assisted face-to-face interviews with an age-appropriate diagnostic interview (CIDI65+). RESULTS: The prevalence of anxiety disorders was 17.2%. Agoraphobia was the most frequent disorder (4.9%), followed by panic disorder (3.8%), animal phobia (3.5%), general anxiety disorder (3.1%), post-traumatic stress disorder (1.4%), social phobia (1.3%), and obsessive-compulsive disorder (0.8%). The prevalence rate of any anxiety disorder dropped by 40% to 47% in adults aged 75-84 years compared with those aged 65-74 years. Women were twice as likely to present with agoraphobia or general anxiety disorder as men. Only panic disorder and phobia were associated with comorbid major depression. The negative relationship with quality of life was limited to agoraphobia and generalized anxiety disorder. CONCLUSIONS: The age-appropriate CIDI65+ led to higher prevalence rates of anxiety disorders in the elderly, yet to weaker associations with comorbidities and impaired quality of life compared with previous studies.

Predisposing, enabling, and need factors of service utilization in the elderly with mental health problems.

ABSTRACTBackground:Empirical data on the use of services due to mental health problems in older adults in Europe is lacking. The objective of this study is to identify factors associated with service utilization in the elderly. METHODS: As part of the MentDis_ICF65+ study, N = 3,142 people aged 65-84 living in the community in six European and associated countries were interviewed. Based on Andersen's behavioral model predisposing, enabling, and need factors were analyzed with logistic regression analyses. RESULTS: Overall, 7% of elderly and 11% of those with a mental disorder had used a service due to mental health problems in the last 12 months. Factors significantly associated with underuse were male sex, lower education, living in the London catchment area, higher functional impairment and more comorbid mental disorders. The most frequently reported barrier to service use was personal beliefs, e.g. "I can deal with my problem on my own" (90%). CONCLUSION: Underutilization of mental health services among older people in the European community is common and interventions are needed to achieve an adequate use of services.

Age-related self-stigma of people over 65 years old: adaptation of the Internalized Stigma of Mental Illness scale (ISMI) for use in age-related self-stigma (IS65+) in a Spanish sample.

OBJECTIVES: To adapt the Internalized Stigma of Mental Illness scale (ISMI) to examine self-stigma associated with aging and to study the psychometric properties of this adapted version (IS65+). Finally, self-stigma associated with age in older people is studied. METHOD: The IS65+ was administered to a random sample of 419 people over 65 years from Madrid (Spain) to study the psychometric properties of this adapted version. A regression model was estimated to identify the variables that best predict self-stigma associated with old age. RESULTS: The IS65+ showed good internal consistency (α = .89) and a factorial structure of five factors. The data showed lower levels of self-stigma related to age in the sample than the levels of mental illness self-stigma in people with mental illness. The variables associated with age-related self-stigma are: high levels of perceived loneliness, low levels of coping strategies, gender (female), mental disorder, major depressive disorder, low levels of optimism and quality of life, and high levels of functional impairment. CONCLUSION: A new version of ISMI (IS65+) with acceptable psychometric criteria has been developed for use in people over 65 years old.

Prevalence of mental disorders in elderly people: the European MentDis_ICF65+ study.

BACKGROUND: Except for dementia and depression, little is known about common mental disorders in elderly people. AIMS: To estimate current, 12-month and lifetime prevalence rates of mental disorders in different European and associated countries using a standardised diagnostic interview adapted to measure the cognitive needs of elderly people. METHOD: The MentDis_ICF65+ study is based on an age-stratified, random sample of 3142 older men and women (65-84 years) living in selected catchment community areas of participating countries. RESULTS: One in two individuals had experienced a mental disorder in their lifetime, one in three within the past year and nearly one in four currently had a mental disorder. The most prevalent disorders were anxiety disorders, followed by affective and substance-related disorders. CONCLUSIONS: Compared with previous studies we found substantially higher prevalence rates for most mental disorders. These findings underscore the need for improving diagnostic assessments adapted to the cognitive capacity of elderly people. There is a need to raise awareness of psychosocial problems in elderly people and to deliver high-quality mental health services to these individuals.

Study approach and field work procedures of the MentDis_ICF65+ project on the prevalence of mental disorders in the older adult European population.

BACKGROUND: This study describes the study approach and field procedures of the MentDis_ICF65+ study, which aims to assess the prevalence of mental disorders in older adults. METHODS: An age-appropriate version of the Composite International Diagnostic Interview (CIDI65+) was developed and tested with regard to its feasibility and psychometric properties in a pre-test and pilot phase. In the cross-sectional survey an age-stratified, random sample of older adults (65-84 years) living in selected catchment areas of five European countries and Israel was recruited. RESULTS: N = 3142 participants (mean age 73.7 years, 50.7% female) took part in face-to-face interviews. The mean response rate was 20% and varied significantly between centres, age and gender groups. Sociodemographic differences between the study centres appeared for the place of birth, number of grandchildren, close significants, retirement and self-rated financial situation. The comparison of the MentDis_ICF65+ sample with the catchment area and country population of the study centres revealed significant differences, although most of these were numerically small. CONCLUSIONS: The study will generate new information on the prevalence of common mental disorders among older adults across Europe using an age-appropriate, standardized diagnostic instrument and a harmonized approach to sampling. Generalizability of the findings and a potentially limited representativeness are discussed.

The MentDis_ICF65+ study protocol: prevalence, 1-year incidence and symptom severity of mental disorders in the elderly and their relationship to impairment, functioning (ICF) and service utilisation.

BACKGROUND: The EU currently lacks reliable data on the prevalence and incidence of mental disorders in older people. Despite the availability of several national and international epidemiological studies, the size and burden of mental disorders in the elderly remain unclear due to various reasons. Therefore, the aims of the MentDis_ICF65+ study are (1) to adapt existing assessment instruments, and (2) to collect data on the prevalence, the incidence, and the natural course and prognosis of mental disorders in the elderly. METHOD/DESIGN: Using a cross-sectional and prospective longitudinal design, this multi-centre study from six European countries and associated states (Germany, Great Britain, Israel, Italy, Spain, and Switzerland) is based on age-stratified, random samples of elderly people living in the community. The study program consists of three phases: (1) a methodological phase devoted primarily to the adaptation of age- and gender-specific assessment tools for older people (e.g., the Composite International Diagnostic Interview, CIDI) as well as psychometric evaluations including translation, back translation; (2) a baseline community study in all participating countries to assess the lifetime, 12 month and 1 month prevalence and comorbidity of mental disorders, including prior course, quality of life, health care utilization and helpseeking, impairments and participation and, (3) a 12 month follow-up of all baseline participants to monitor course and outcome as well as examine predictors. DISCUSSION: The study is an essential step forward towards the further development and improvement of harmonised instruments for the assessment of mental disorders as well as the evaluation of activity impairment and participation in older adults. This study will also facilitate the comparison of cross-cultural results. These results will have bearing on mental health care in the EU and will offer a starting point for necessary structural changes to be initiated for mental health care policy at the level of mental health care politics.

People over 65 Years Old in Social Isolation: Description of an Effective Community Intervention in the City of Madrid (Spain).

Loneliness and social isolation in the elderly population can be shown to be a significant independent risk factor for several conditions, such as poor health behaviours, physical health problems and psychiatric conditions. Although, in the last 20 years, several interventions have been developed to reduce the impact of social isolation and loneliness on the health of older people. However, only a small proportion of these interventions are effective. This study aims to describe the components of the Psychological Support Service for Socially Isolated Elderly People (PSIE), in addition to analysing the effectiveness of a community intervention based on an outreach strategy to combat situations of social isolation in the elderly population. The sample consisted of 63 people over 65 years of age from the city of Madrid (Spain), detected by the socio-health services as people at risk of social isolation. Sociodemographic, mental health, health and psychosocial functioning, global functioning, disability and socio-sanitary needs were evaluated with observational scales. Descriptive statistics were calculated for sociodemographic and mental health variables. An analysis was carried out to study the possible influence of gender in the initial sample on the different variables assessed, using Chi-squared and Student's t-tests for independent samples, with measures of effect size in each case. A study of the effectiveness of PSIE was carried out with an analysis of pre- and post-treatment measures. A Student's t-test was used for related samples, as well as the effect size of Cohen's d statistic. For the assessment of the possible influence of gender on the results of the intervention, a 2 × 2 repeated-measures ANOVA (pre-/post-measures × gender) was conducted. Regarding mental health, 65.2% of the sample presented symptoms compatible with a severe mental disorder, the most frequent being psychotic disorder (22.7%), alcohol use disorder (16.7%), personality disorder (15.2%), anxiety disorders (10.4%) and mood disorders (10.4%). The gender variable does not seem to have an influence on any of the outcome measures studied. The results of the effectiveness study indicate that the PSIE is an intervention programme that serves to improve the scores of people in the sample in all variables that the programme studied. Some of the components of PSIE that could explain its effectiveness are individualized interventions, with a home-based approach by professionals, serving as a link between the older person and the normalized social-sanitary network. Further research is required to provide more robust data on the effectiveness of interventions.

Mental health in a heterogeneous clinical sample. A cross-sectional study of predictors and gender differences.

Introduction: Women have been shown to be a vulnerable group in relation to mental health problems over time. Despite this, gender-focused studies are uncommon. The aim of this research is to study mental health in a sample of people with mental health problems and to analyze the differences and predictors focusing on gender. Methods: A cross-sectional study is conducted in a heterogeneous clinical sample in terms of mental health problems (N = 160). Interviews with hetero-reported standardized questionnaires to collect the data are conducted. Descriptive analyses, mean difference and a regression analysis on mental health are carried out taking into account different sociodemographic, clinical and psychosocial variables. Results: Women in the study present worse levels of mental health and subjective severity of the disorder. The main predictors of mental health are being female, followed by severity, shorter time with the diagnosis and internalized stigma. Conclusion: Being female is the most robust predictor of worse mental health and symptomatology. Recommendations according to the results found proposing a gender perspective are suggested.

The Psychological Impact of the COVID-19 Pandemic in Spain: A Longitudinal Study.

BACKGROUND: This study aims to longitudinally assess the psychological impact of the COVID-19 pandemic in the general Spanish population. It uses four assessment points: two weeks after the start of confinement, one month after, two months after, and one year after the first evaluation. METHODS: Evaluations were conducted through an online survey, with a sample of 3,480 people at the first data collection and 1,041, 569, and 550 people at successive evaluation points. Depressive symptoms (PHQ-2), anxiety (GAD-2), post-traumatic stress (PCL-C-2), social support (EMAS), loneliness (UCLA-3), and discrimination (InDI-d) were evaluated. RESULTS: Significant changes were found in the variables depression and anxiety with a greater presence of this kind of symptomatology after one year (p < .01). There were also significant changes in the variable social support, which showed a substantial reduction after one year (p < .001). Similarly, there were significant variations in the variable intersectional discrimination (p < .001), with greater levels of discrimination. The temporal models show no significant differences in terms of post-traumatic symptomatology (p = .12) or loneliness (p = .19). CONCLUSIONS: The pandemic had a negative impact on mental health and these effects were further exacerbated one year later.

Evolution of intersectional perceived discrimination and internalized stigma during COVID-19 lockdown among the general population in Spain.

BACKGROUND: Stigma and discrimination have been associated with different diseases and pandemics, with negative consequences for the people who suffered them and for their communities. Currently, COVID-19 has become a new source of stigmatization. AIMS: The aim of the present study is to analyze longitudinally the evolution of intersectional perceived discrimination and internalized stigma among the general population of Spain, at three points in time throughout the confinement. METHOD: Participants completed an online survey. RESULTS: Results show an increase in both variables from the first to the second evaluation, and a slight decrease from the second to the third evaluation. Moreover, these changes are explained by depression, anxiety and family support. CONCLUSIONS: These findings indicate the factors that need to be considered to reduce the perception of discrimination and the internalization of stigma, and their detrimental consequences, during an especially stressful event such as the current pandemic outbreak.

The Role of the Sense of Belonging During the Alarm Situation and Return to the New Normality of the 2020 Coronavirus Pandemic (COVID-19) in Spain.

In this study we intend to understand the impact of the COVID-19 crisis and the subsequent stay-at-home orders, on the Spanish population's sense of belonging at three moments in time: at the beginning of the lockdown, after one month of lockdown and with the return to the "new normality". A cross-sectional study was conducted through an online survey (N0 = 3480; N1 = 1041; N2 = 569). The sense of belonging was evaluated by means of four Likert-type items. These questions included membership in different groups: work/studies, friends, family and neighborhood or community. Sociodemographic and COVID-19-related data were collected. Additionally, mental health, spiritual well-being, loneliness, social support and discrimination were assessed. Descriptive analyses were carried out and linear regression models compiled. The sense of belonging increased significantly during confinement, dropping dramatically with the start of the return to the "new normality" process. The only variable that showed interaction with time and sense of belonging was discrimination. Work condition (not working providing the lowest sense of belonging scores), social support from friends and loneliness were the main predictors of the sense of belonging. The impact caused by the pandemic and the actions adopted during the first weeks regarding the sense of belonging is evident. It has been a key variable in dealing with COVID-19. Actions are now needed to increase our sense of belonging to face the post-epidemic crisis and avoid a greater impact in other areas.

Effects of COVID-19 lockdown on perceived discrimination and internalized stigma in people with previous mental disorder diagnoses in Spain.

COVID-19 disease control efforts and consequences are likely to be complicated by the impact of fear and stigmatization of the novel coronavirus. These complications may also worsen due to the potential compounding of COVID-19 related stigma with stigmatization associated with previously diagnosed conditions. This exploratory study analyzes the experiences of the stigma associated with COVID-19 lockdown in people with different previous diagnoses 2 and 5 weeks after the beginning of the state of emergency in Spain. Gender and age were controlled as covariables and 1,052 people participated in the study. The diagnosis groups were: Psychiatry and mental health (n = 71), Cardiovascular disease (n = 42), Neurological disease (n = 23), Lung disease (n = 53), and No diagnosis (n = 863). The instruments used to measure the stigma were the Intersectional Day-to-Day Discrimination Index and two items of the Internalized Stigma of Mental Illness scale. Analysis of covariance of repeated measures and analysis of variance, including Scheffe's post hoc test, were performed. We found significant differences in stigma among the first and second evaluation. Regarding the previous diagnosis, no differences were found at Time 1, but significant differences were found at Time 2, with those having a previous psychiatric or mental health diagnosis reporting higher levels of perceived discrimination and internalized stigmatization. Our results suggest that people with previous stigmatizing conditions might be more vulnerable to experiencing stigma in a confinement situation. In order to reduce the burden of the COVID-19 stigma, health interventions should also consider the resulting intersection of effects on internalized stigma and perceived discrimination. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Relationship between Quality of Life and Sociodemographic, Physical and Mental Health Variables in People over 65 in the Community of Madrid.

Except in the case of depression, there are few studies that analyze mental health variables related to quality of life (QoL) in people over 65 years of age. The objective of this study is to analyze the relationship between QoL and the following variables: sociodemographic and physical and mental health of people over 65 years of age. The sample was randomly selected and consists of men and women between 65 and 84 years of age (N = 555) from the Community of Madrid. Mental disorders were evaluated with the CIDI65+ interview and QoL with the WHOQoL-BREF scale. Means, ANOVA and multiple linear regression analyses were performed. Women have worse QoL than men and QoL worsens with age. The regression model for the dependent variable "WHOQoL BREF Scale" explains 41.43% of the variance (R2 = 0.413). The variables that have the greatest impact on QoL are as follows: a greater number of physical and psychological symptoms, experiencing financial difficulties and the presence of a psychological disorder, while continuing to work has a positive effect on QoL. Physical and mental disorders have a similar impact on QoL. The presence of a greater number of psychological symptoms (without necessarily fulfilling the criteria of a mental disorder) is a predictive variable of worse QoL. Mental health has a burden on the QoL of people over 65 years of age that is as powerful as physical health.

Prevalence and Characterization of Specific Phobia Disorder in People over 65 Years Old in a Madrid Community Sample (Spain) and its Relationship to Quality of Life.

The prevalence of anxiety disorders over the last year among seniors ranged from 3.6% to 17.2%. The most prevalent disorders are specific phobias. Data are needed concerning the consequences of specific phobia disorder on the level of functioning and quality of life of older people, the age of onset of specific phobia disorder, and the duration of episodes. In total, 555 community-dwelling people aged between 65 and 84 years who lived in Madrid (Spain) were assessed (Composite International Diagnostic Interview for people over 65 years (CIDI65+), WHO Disability Assessment Schedule (WHODAS II), Health of the Nation Outcome Scales for Older Adults (HoNOS65+), World Health Organization Quality of Life Brief (WHOQOL-BREF). Prevalence rates and odds ratio, t-tests, binary logistic regression, and point-biserial correlations were calculated. A total of 12.07% of the sample suffered a specific phobia disorder over the last year. The average age at onset of the specific phobia was 38.78 (sd = 21.61) years. The mean duration of the phobia was approximately 20 (sd = 20) years. A significant effect of the specific phobia was found for the current levels of functioning and quality of life: WHOQOL-BREF total score (p < 0.05), WHODAS II overall score (p < 0.01), and HoNOS65+ total score (p < 0.001). Having specific phobia disorder decreased the level of functioning and negatively affected the quality of life. These data suggest the need for primary healthcare professionals to include the detection of specific phobia disorders in their protocols because people do not receive treatment for this problem, and they might carry it throughout their lives.