Innovative Research on Prevention of Common Mental Disorders in Older Adults

Abstract

Prevention of mental disorders refers to improvement in a wide range of outcomes, including the incidence and prevalence of a disorder, its relapse or recurrence, the disability associated with it, the risks for a disorder, or the impact of a disorder on the person, the families, and the community. 1 Life expectancy for older adults is increasing, and risk factors for mental illness such as disability, medical morbidity, functional deficits, and cognitive impairment, which are associated with older age, are also increasing. 2 Targeted preventive interventions are needed to reduce incidence and prevalence as well as adverse outcomes of mental disorders in older adults. 2 Five articles in the current issue, from Canada, the Netherlands, Spain, and the United States, focus on significant and innovative research on prevention of onset or exacerbation of suicidal ideation, the differential impact of young versus late-onset dementia on caregivers, and prevention of depression in three populations: in nonprofessional caregivers with elevated depressive symptoms, in older adults with pain and emotional distress, and in older adults with mild cognitive impairment (MCI), a growing group of older adults at risk of developing dementia. Reducing suicide risk is significant for public health and a National Institutes of Health priority. Suicidal ideation is a risk factor for compromised quality of life, suicide attempts, nonsuicide mortality, and suicide. 3,4 In Canada, Heisel and Flett 5 developed a conceptual framework of older adults’ suicide ideation incorporating risk, resiliency factors, and precipitating events. According to their theory, perception of meaning in life is important in promoting mental health and potentially conferring resiliency to contemplation of suicide in older adults. 5 Meaning in life is influenced by Frankl’s existential theory, which proposes that individuals who discover meaning in life (including in arts, life experiences, or a sense of purpose) are protected against existential despair and suicide risk. 5 Heisel and Flett 5 found that recognition of meaning of life at baseline was negatively associated with the onset or exacerbation of suicide ideation over a 6- to 22-month period of follow-up, after controlling for critical covariates such as baseline depression, suicide ideation, self-rated health, and physical functioning. The authors’ theory and findings highlight the importance of developing or sustaining meaning and purpose in life and paves the way for future research. First, creating personalized ways to sustain meaning in life becomes a critical target of psychosocial interventions. For example, investigations may concentrate on how to help older adults find a new meaning or purpose in life when previously meaningful areas or rewarding activities are restricted because of disability, losses, and cognitive impairment. Second, future studies may examine the longitudinal association of meaning in life with strong negative emotions (such as sadness, anxiety, irritability, hopelessness, or helplessness). These negative emotions are prevalent during an episode of major depression, which is the most frequent diagnosis in studies of suicide. 4 Strong negative emotions may adversely influence perceived meaning and purpose of life, and, alternatively, lack of meaning in life may further exacerbate negative emotions and promote suicide ideation. Caregiving may contribute to adverse outcomes in dementiacaregivers.IntheNetherlandsMillenaaretal. 6 investigated the course of well-being in caregivers of