Complete Mental Health among Older Adults and Vulnerable Populations Esme Fuller-Thomson, MSW, PhD Director, Institute for Life Course & Aging Professor & Sandra Rotman Endowed Chair Factor-Inwentash Faculty of Social Work Cross-Appointed to Faculties of Medicine & Nursing
With many thanks to my co-authors Complete Mental Health & Older Adults Bailey Hollister & David Burnes Among Older Immigrants Hongmei Tong Among Formerly Suicidal Canadians Philip Baiden
Or is it “Freedom 55”? Photo by Elisa Costa
My Search for Inspiring Older Women How to age with grace? I could only find a few examples in the public record:
Who is this and why might she be inspiring?
Who is this and why might she be inspiring?
The Queen Mum
Who is this and why might she be inspiring?
What was Georgina Harwood doing on her 100 th birthday?
And of course, her skydiving took a toll ...
She rested for two days and then…
Many of us are lucky to have inspiring women in our lives
Lessons Learned from Inspiring Women? Outward focus – a sense of purpose in life Physically active & energetic Many are spiritual Sense of humour Tenacity – Sticking to their goals Invests in social relationships, particularly parenting.
Complete Mental Health: What does it comprise?
Mental Illness: The Whack-a-Mole Problem
Corey Keyes’ Definition of Complete Mental Health A. Happiness or Life Satisfaction B. Well Being Social Psychological C. Absence in last year of Mental Illness (depression, anxiety, bipolar) Substance Dependence Suicidal Thoughts/Attempts
Canadian Community Health Survey- Mental Health Participants: Sample of 20,465 Canadians community-dwellers Nationally representative sample (2012) 5,222 older adults Response Rate=68.9% Measures: Mental Health: WHO-CIDI Scales
How Are Older Adults Doing?
Percent in Complete Mental Health? Adults<65=?
Percent in Complete Mental Health? Adults<65=71.6%
Percent in Complete Mental Health? Adults<65=71.6% Older Adults=79.2% (p<.001)
Older Adults Adjusted Odds of Complete Mental Health? 55% higher odds OR=1.55; (95% CI=1.40-1.72) after controlling for 22 potential risk factors for CMH
What is Associated with Older Adults’ Complete Mental Health?
Women 39% higher odds than men OR=1.39 (1.17, 1.65)
Physically active older adults have 57% higher odds of CMH OR=1.57(95% CI=1.34, 1.83) Photo by Elisa Costa
Those who turn to religion to cope with difficulties have 56% higher odds of CMH
History of substance abuse associated with 40% low ower odds of CMH
Married older adults have 26% higher odds than unmarried/divorced OR=1.26 (95% CI=1.07, 1.48)
Those with a confidant have 5X the odds of CMH OR=5.19 (95% CI=3.73, 7.24) Photo by http://eastcoastclub.blogspot.ca/
Social Support (Marital status & confidant) explains 4.6% of variation in Complete Mental Health
Physical health characteristics explains 6.5% of variation in CMH Those with good to excellent health have 57% higher odds of CMH than those in fair or poor health Those in chronic pain have 17% low ower odds of CMH Those with chronic sleep problems have 36% low ower odds of CMH Those with functional limitations have 37% low ower odds of CMH
History of mental illness explain 3.8% of variance in CMH Those who ever had major Those who ever had depression have 66% lower Generalized Anxiety odds of CMH Disorder have 57% lower odds of CMH
Cumulatively, all these factors explained 19% of variation in CMH among Canadians aged 65+
Conclusions Older adults are more likely to be in Complete Mental Health than younger adults Current physical health & social support & history of mental illness are key factors in older adults’ mental health Corey Keyes scale is highly reliable and works in large surveys. Interventions to improve social support & decrease pain, insomnia and disability may hold promise for increasing CMH
Factors Associated with Complete Mental Health among Older Immigrants in Canada Esme Fuller-Thomson, PhD, MSW & Hongmei Tong, PhD. RSW
What % of older adults (65+) are immigrants? 30 % or 1.36 million of the 4.55 million older Canadians are immigrants
What % of Older Adults are Visible Minorities? 484,000=10% of older Canadians are visible minorities (and 95% of older visible minority Canadians are immigrants)
Research Objectives 1) To identify the prevalence of Complete Mental Health (CMH) among Canadian immigrants aged 55 and over in comparison to non-immigrants 2) To determine factors associated with CMH among older immigrants.
Canadian Community Health Survey- Mental Health Participants: Canadian Community Health Survey – Mental Health CCHS-MH 2012 Nationally representative sample (2012) sample of adults aged 55+ Total: 9, 524 older adults; Response Rate=68.9% Non-immigrants: 7947 Recent immigrants (19 years or less since immigration): 147 Long-term immigrants (20 years or more since immigration): 1530 Measures: Mental Health Mental Health Continuum Short Form (MHC-SF) WHO-CIDI Scales
Percent of those 55+ in Complete Mental Health? Non-Immigrants? • Recent immigrants (<20 years here)? • Long-term Immigrants (20+ yrs here)? •
Percent of those 55+ in Complete Mental Health? Non-Immigrants? 76.1% •
Percent of those 55+ in Complete Mental Health? Non-Immigrants? 76.1% • Recent immigrants 75.9% •
Percent of those 55+ in Complete Mental Health? Non-Immigrants? 76.1% • Recent immigrants 75.9% • Long-term Immigrants 79.8% •
Long-Term Immigrants 21% Higher Odds of Complete Mental Health than non-immigrants (95% CI=1.06-1.40) after controlling for 13 potential risk factors for CMH Recent Immigrants Comparable to Non-Immigrants (OR=0.97)
Immigrants earning >$80,000 per year have 76% higher odds of CMH than those with <$20,000
Immigrants without functional limitations 2.3 times higher odds of CMH than those with limitations
Immigrants without chronic pain have 51% higher odds of CMH than those with chronic pain
Immigrants without chronic insomnia have 2.8 times higher odds of CMH compared to those with insomnia
Physical health characteristics explains 9.3% of variation in CMH
Other Factors Associated with CMH among Older Immigrants Current physical health & martial status more likely to have CMH Those with a confidant have 5X the odds of CMH Those with a history of substance abuse are much less likely to be in CMH.
Implications? Interventions to Improve social support Decrease chronic pain Address insomnia and Decrease disability levels May hold promise for increasing CMH among older immigrants.
Formerly Suicidal Canadians CCHS-MH – 2,884 respondents had seriously considered suicide at some time. Baiden P, Fuller-Thomson E. (2016). Factors Associated with Achieving Complete Mental Health among Individuals with Lifetime Suicidal Ideation. Suicide Life Threat Behav .
What % of Formerly Suicidal Canadians are now in CMH?
What % of Formerly Suicidal Canadians are now in CMH? 38% Remember that CMH is a very high standard! – If you are only happy once a week, you would not qualify. -72% of all formerly suicidal had NO THOUGHTS OF SUICIDE in the past year.
Factors associated with HIGHER CMH among formerly suicidal Canadians : Being older Being a woman Having a higher income Turning to spirituality or religion to cope with problems
Those with a confidant have 7X the odds of CMH
Factors associated with LOWER CMH among formerly suicidal Canadians : Chronic pain Insomnia History of Alcohol Dependence
Projects Underway: Complete Mental Health Among Older widows Arthritis patients with disabling chronic pain Cancer patients and cancer survivors Canadians with former substance dependence problems. Formerly depressed Canadians (39% in CMH) Published in Psychiatry Research with Senyo Agbeyaka, Deb LaFond, Merc Bern-Klug Survivors of Childhood Maltreatment SSHRC grant with Deb Goodman and Barbara Fallon First Nations Canadians (small grant with Rose Cameron)
Researchers are happier when they study complete mental health rather than mental illness
Thank you: Michael Cummings for many of the photos Statistics Canada for use of the CCHS-MH Sandra Rotman Endowed Chair for funding & Thank you for listening!
Physical Health in the Later Years: How much progress have we made?
Life Expectancy In 1900 In 1950 In 2013 Canada 49 68 84 UK 46 69 83 Ukraine 37 62 76 66 83 Greece 40 36 69 India 23 45 77 China Not avail.
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