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Becker and Kleinman (July 4 issue)1 highlight the burden of mental diseases worldwide. Major concerns are for people living in less-developed countries (because of the low level of resources devoted to neuropsychiatric illnesses) and for young people (because of the difficulty accessing mental care).
We would like to emphasize the enormous suffering associated with mental disorders in older people. The prevalence of mental diseases in older people has increased dramatically in the past decades, not only because of aging itself (e.g., Alzheimer's disease), but also because of new emotional and sociodemographic situations to which the elderly are exposed.2 Moreover, disorders such as depression and dysthymia often become chronic, and the link between mental and physical health (ultimately leading to disability) is extremely strong.3 Finally, the use of psychotropic medications without fair evidence of safety, efficacy, and effectiveness in persons who are already receiving many other medications is fraught with danger. Training primary care clinicians in the care of elderly patients with mental illness should be a priority.
Alessandra Marengoni, M.D., Ph.D. Sergio Pecorelli, M.D., Ph.D. University of Brescia, Brescia, Italy email@example.com