Mental Health Problems and Treatment Among Older Adults in Latin America and the Caribbean Elizabeth M Bertera, PhD, LCSW-C, BCD Associate Professor of Social Work Jeannette Mendoza, MSW Doctoral Candidate Howard University School of Social Work Washington DC Presented at the American Public Health Association Conference Washington, D.C. Nov 2007

2 Purpose Describe key indicators of mental health and cognitive functioning in relation to social, demographic and lifestyle factors. Compare two Caribbean and two Latin American countries

3 Project SABE The Survey of Health, Well-Being and Aging in Latin America and the Caribbean (SABE) was conducted during 1999 and Designed to examine health conditions and functional limitations of persons aged 60 and older in the countries of Argentina, Barbados, Brazil, Chile, Cuba, Mexico and Uruguay.

4 Methods and Materials N = 1905 for Cuba N = 1505 for Barbados N = 1247 for Mexico N = 2143 for Brazil Depression Index based on 15 items in the General Depression Scale (GDS) Cognitive Function based on Mini Mental (Impaired = 12 or less)

Social and Demographic Characteristics Cuba, Barbados, Mexico and Brazil

6 Percent Female

7 Mean Age of Older Population

8 Mean Years of Education

9 Percent of Older Population Living Alone

General Indicators of Mental Health, Physical Health and Cognitive Functioning Cuba, Barbados, Mexico and Brazil

11 Percent Who Ever Had a Nervous Problem

12 Percent Receiving Psychiatric Treatment If Diagnosed

13 Mean Depression Index Scores

14 Percent Taking Medication for Depression if Diagnosed

15 General Physical Health Status

16 Percent with Regular Physical Activity

17 Percent with Impaired Cognitive Functioning Status

Social and Health Correlates of Depression Cuba, Barbados, Mexico, Brazil

19 Regression with Depression Index Scores VariableCubaBarbadosMexicoBrazil Age -.16*** *** Yrs Education -.06***-.15***-.17***-.03 Female.07***.02.06** Psych Treatment *** Depression Medications *** # Helping Relatives -.08**-.11**.24***-.09** Help Lives in *** Yrs of Help -.11*** **-.25*** R2R2 8%4%7%15%

20 Summary of Findings The countries are similar in terms of age but not years of education. The countries differ in Major Psychiatric conditions Cuba has the most with older adults with nervous problems, followed by Brazil Mexico has significantly higher Mean Depression scores compared to other countries Cuba and Barbados have significantly higher treatment rates compared to Mexico and Brazil

21 Summary of Findings Cognitive impairment was significantly higher in Mexico and Brazil compared with Cuba and Barbados. Barbados had the highest General Physical Health status and highest percent with regular physical activity. Cuba and Brazil had the lowest rates of regular physical activity.

22 Summary of Findings Regression of Depression Index scores on social and demographic variables worked best with Brazil (15% of variance in Depression scores). Lower education was consistently associated with higher Depression scores. Shorter duration of help with ADLs was also associated with higher Depression scores.

23 Implications These findings describe associations but not causal relationships. Since treatment levels for psychiatric problems was less than 50%, the mental health systems in these countries need to look for additional ways for identifying and treating those who are untreated. More research is needed to examine causal relationships.

24 Implications Lifestyle factors such as exercise and involvement in Arts and Crafts may be protective for cognitive decline. More research needs to be done on ways to integrate these activities in treatment plans and programs for older adults. More research also needs to examine cultural, economic and social differences in the 4 countries studied.