Chapter 1: The Evolving Nature of Mental Health

As I approach my 24th birthday, I find that my mental well-being has improved significantly compared to when I was 20 or 21. I often ponder whether this change is attributed to better coping strategies, the effects of aging, or simply a reduction in life stressors. Research indicates that, for many individuals, mental health tends to enhance with age.

While I do not wish to exaggerate my personal experience, it is important to recognize that the ages of 20 and 21 are pivotal developmental stages for numerous reasons. My time in college was particularly challenging due to various personal circumstances. Moreover, the transition from 21 to 23 is markedly different from the transition from 23 to 70, indicating that my experience of aging is relatively limited. I still identify as a young adult.

According to Fran Lowry from Medscape, studies back the idea that mental health improves with age. Research involving over 1,000 adults shows that those in their senior years report higher happiness and satisfaction levels compared to younger adults in their 20s and 30s.

Thomas et al. published findings in the Journal of Clinical Psychiatry, suggesting a potential "linear improvement in mental health starting in young adulthood." They emphasized that further studies are needed to counter the belief that aging equates to decline. Although aging is often viewed as a time of physical and cognitive deterioration, the authors highlighted the positive trajectory of mental health as individuals grow older.

Nonetheless, this progression is not universal. Aging can be a source of stress, and one reason mood and anxiety disorders are less frequently observed in older adults, according to the Cleveland Clinic, is the lower detection rates among this demographic, which results in fewer individuals seeking help for mental health issues.

Dr. Justin Havemann notes that those with psychiatric disorders—particularly undiagnosed and untreated conditions like dementia, depression, and anxiety—tend to experience poorer medical outcomes and a diminished quality of life compared to their counterparts without such issues.

The CDC estimates that only about 1% to 5% of older adults in the community experience major depression, while the figure rises to 13.5% among elderly individuals requiring more consistent care. While older women are more susceptible to mood and anxiety disorders, older men are prone to substance abuse issues. Alarmingly, the CDC also reports that fewer than 30% of older adults in need of treatment actually receive it. Dr. Sophie Lazarus from Ohio State University Wexner Medical Center attributes the lower rates of diagnosed depression in older adults to early mortality and societal stigma.

"The false notion that feeling sad is a normal aspect of aging contributes to the underdiagnosis and inadequate treatment of depression in older adults," states Lazarus.

Risk factors for mood disorders in older adults often include age-related health issues, such as heart disease and high blood pressure.

Dr. Dilip Jeste, a senior author of the Thomas et al. paper, asserts that older individuals generally experience a "linear and significant improvement in psychological well-being." The study analyzed cross-sectional data on physical, cognitive, and mental health from 1,546 participants aged 21 to 99 in San Diego County. The findings indicated that as people age, they tend to feel better about themselves and their lives. Notably, the sample excluded individuals diagnosed with dementia, employing a sampling method similar to that of the Gallup poll to mitigate selection bias.

The average age of participants in the study was 66, with a balanced representation of men and women. However, it is worth mentioning that 60% of the participants held Bachelor's degrees, while only 36% of the general population has attained such an education level.

As participants aged, their scores improved on various mental health assessments, including the Happiness Subscale, Depression Scale, and Anxiety Scale. All indicators showed that "mental health distress peaks in younger adults and declines with age." Specifically, Jeste highlighted that individuals in their 20s and 30s experience the highest levels of stress and depressive and anxiety symptoms.

"We observe that the 20s and 30s are a time filled with choices, but also a period laden with concerns about making the right decisions and fears regarding potential mistakes. In contrast, as one grows older, there's an ability to reflect and recognize that things turned out well. The pressures faced by younger generations today are significantly greater than in the past, resulting in a more stressful existence," Dr. Jeste commented.

A study by Vahia et al. published in November 2020 in JAMA revealed that older adults demonstrate "lower stress reactivity" and generally exhibit better emotional regulation and overall well-being. Even during the COVID-19 pandemic, older adults experienced fewer adverse mental health outcomes compared to younger populations. They reported lower rates of increased substance abuse and suicidal thoughts. In the context of the pandemic, which disproportionately affected older individuals, it was noted that older adults coped with these challenges more effectively. Vahia et al. stated:

"Older adults, as a demographic, may possess greater resilience against the anxiety, depression, and stress-related mental health disorders that are characteristic of younger populations during the initial phase of the COVID-19 pandemic."

Takeaways

While the reasons may seem apparent, what explains the improvement in mental health with age? Dr. Brent Forester, who leads the Geriatric Mood Disorders Program at McLean Hospital, points out that a common misconception is that aging is synonymous with disability, loneliness, social isolation, and cognitive decline.

Jeste reiterates that older individuals generally possess superior emotional regulation skills and are adept at making complex decisions. Additionally, older adults typically hold onto fewer negative emotions and memories, and Forester emphasizes that they exhibit greater resilience when facing challenges.

Ageism—where individuals project their feelings about aging onto others—can lead to misconceptions about older adults. According to the World Health Organization, ageism refers to the stereotyping and discrimination against older individuals driven by prejudicial beliefs or institutional practices.

Depression in older adults is often simpler to treat, according to Forester, as it frequently coexists with other medical conditions. He suggests that many medical issues have biological links to mental health challenges. Given that 80% of older adults live with at least one chronic health condition and 50% with two or more, the prevalence of depression increases alongside these comorbidities.

Further investigation is required to fully grasp the intricate relationship between mental health and aging. Nonetheless, it is evident that the stereotype associating depression with normal aging must be challenged and dismantled.

Chapter 2: The Impact of Age on Mental Health

This video titled "Mental Health and Older Adults Q&A" delves into common questions and concerns regarding mental health in older adults, providing insights from experts in the field.

In this video, "Maintaining Mental Health As You Age," professionals discuss strategies and tips for sustaining mental well-being as one grows older, highlighting the importance of proactive mental health care.