Age and Mental Health

Does mental health improve with age?

That’s the thesis of an article in the Journal of Clinical Psychiatry (1) suggesting that might be the case.  The argument is based on a survey of 1546 people between the ages of 21 and 100.

The thesis is based on two errors in design and analysis of data:

  • A single survey conducted at a single point in time can never establish any form of causality.  You need to follow a group of people over time to establish trends and what might underlie them.
  • The alternative hypothesis is that people who are mentally healthy live longer than do others.  The data in the study is consistent with that theory.  In fact, by virtue of the fact that the mentally healthy are less likely commit suicide, by definition, they live longer.

There are several questions that the article does not address that could be of vital importance:

(1) Does good mental health assist in the survival of diseases such as cancer and heart disease?  There is some evidence that could be the case.  There are articles on the relationship between psychological stress and cancer in both 2004 and 2012 (WebMD and NIH).  The National Cancer Institute concludes that there is no clear evidence that successful management of stress improves cancer outcomes.  However, the article  goes on to report that depression may be linked to fatal outcomes (2).  There was also a report of a study at Indiana University suggesting that depression and bipolar disorder could be linked to an increased risk of certain cancers at younger ages (3).

(2) What is the relationship between financial security and mental health?  We know three things about the US:

  • Medicare and Social Security no longer provide adequate safety nets for the elderly.  The average Social Security payment per month is $1,346.59 (4), which is less than poverty level.  Further, basic Medicare excludes doctors and prescriptions, requiring those who can afford it to purchase Medicare supplements or Medicare Advantage plans.
  • There is a correlation between income and life expectancy in the US.  Males with low incomes have a life expectance of 74 years.  Affluent males and females have a life expectancy of 88 years.  The US is the only industrialized country in which this extreme disparity based on wealth exists.
  • There is a documented link between financial problems and depression (5).

Basically, the US Congress has redefined the promise of “life, liberty and the pursuit of happiness” as being rights only of the wealthy.



(1) Thomas, Michael L., et. al., “Paradoxical Trend for Improvement in Mental Health With Aging: A Community-Based Study of 1,546 Adults Aged 21–100 Years,” Journal of Clinical Psychiatry 2016;77(8):e1019–e1025 10.4088/JCP.16m10671

(2) National Institutes of Health, National Cancer Institute, “Psychological Stress and Cancer,”

(3) Davis, Jeannie, “Mental Health Linked to Cancer Risk,” WebMD, 6 Oct 2004,

(4) Social Security Administration, Monthly Statistics, July 2016

(5) Renter, Elizabeth, “The Dark Link Between Financial Stress and Depression,” US News and World Reports, 25 February 2015.




  1. I haven’t read that study, but it also would have to somehow refute the fact that as life expectancy has risen, so have the rates of diagnosed dementias. All tissue, including brain tissue, has a sell-by date. If you survive to age 90, your chance of developing dementia is better than 15%. The rate rises rapidly with each year of survival past 80.


    • Good point. The author of the original article used a simple measure of association without considering any confounding factors. Mathematically, the problem with their analysis is simple. Say we create a “mental health scale”, and we have 10 people with MH ratings of 8, 8, 7, 7, 6, 6, 5, 5, 4 and 4. The average rating is 6. Now suppose that the bottom 5 die and the MH ratings for the top 5 all drop by 1 point. The average will be 6.2. The average has increased but all survivors have declines in their mental health score. A cross-sectional (single point in time) study cannot address what’s really happening in a population.


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