Substance Use and Psychological Distress as Correlates of Mental Illness in Older Adults: A Nationally Representative Analysis

Abstract

Purpose: Mental illness (MI) is a substantial and under-recognized burden among older adults in the United States. Despite this, limited research has examined how specific behavioral risk factors, including binge drinking, prescription misuse, and psychological distress, are associated with MI among adults aged 65 and older. Grounded in the stress-vulnerability model and the life course perspective, this study examines these associations using nationally representative data. Methodology: This study analyzed national survey data to investigate the relationship between substance use, distress, and the presence of MI among individuals aged 65 and older. Using data from the 2023 National Survey on Drug Use and Health (NSDUH), the analysis was restricted to adults aged 65 and older (N = 5,060) and estimated four logistic regression models on a common specification: a complete-case weighted model, a primary Taylor-linearized survey design model (strata VESTR_