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Original Research

Three-Year Incidence and Predictors of First-Onset of DSM-IV Mood, Anxiety, and Substance Use Disorders in Older Adults: Results From Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions [CME]

Kee-Lee Chou, PhD; Corey S. Mackenzie, PhD; Kun Liang, MPhil; and Jitender Sareen, MD

Published: February 15, 2011

Article Abstract

Objective: The aim of this study was to determine the incidence rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mood disorders, anxiety disorders, and substance use disorders in older adults and to identify sociodemographic, psychopathological, health-related, and stress-related predictors of onset of these disorders.

Method: A nationally representative sample of 8,012 community-dwelling adults aged 60 and above was interviewed twice over a period of 3 years, in 2000-2001 and 2004-2005. First incidence of mood, anxiety, and substance use disorders was assessed over a period of 3 years using the Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM-IV Version.

Results: The 3-year incidence rates of DSM-IV mood, anxiety, and substance use disorders were highest for nicotine dependence (3.38%) and major depressive disorder ([MDD] 3.28%) and lowest for drug use disorder (0.29%) and bipolar II disorder (0.34%). Incidence rates were significantly greater among older women for MDD (99% CI, 1.22-3.13) and generalized anxiety disorder (GAD; 99% CI, 1.20-4.26) and greater among older men for nicotine dependence and alcohol abuse and dependence. Posttraumatic stress disorder predicted incidence of MDD, bipolar I disorder, panic disorder, specific phobia, and GAD, while Cluster B personality disorders predicted incident MDD, bipolar I and II disorders, panic disorder, social phobia, GAD, nicotine dependence, and alcohol dependence. Poor self-rated health increased the risk for the onset of MDD, whereas obesity decreased the incidence of nicotine dependence.

Conclusions: Information about disorders that are highly incident in late life and risk factors for the onset of psychiatric disorders among older adults are important for effective early intervention and prevention initiatives.

J Clin Psychiatry 2011;72(2):144-155

Submitted: August 14, 2009; accepted December 18, 2009(doi:10.4088/JCP.09m05618gry).

Corresponding author: Kee-Lee Chou, PhD, Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Rd, Hong Kong, China (

Volume: 72

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