National and regional trends of mental health disorders among older adults treated in the U.S. state mental health system

Understanding national trends and regional variations in mental health disorders among older adults is essential for improving mental health services and guiding evidence-based policy. This study examined national and regional trends in major mental health disorders, including anxiety (ANXD), trauma and stressor (TSRD), bipolar (BIPD), depressive (DEPD), and schizophrenia or other psychotic (SOPD) disorders, among U.S. older adults (≥60 years) treated in the State Mental Health System. Ten years (2013−2022) of Mental Health Client-Level Data were analyzed for 4,195,615 U.S. adults. Unadjusted and adjusted logistic regression models, controlling for age, sex, and race/ethnicity, were used to assess temporal trends in each disorder nationally and by U.S. Census region. Nationally, ANXD and TSRD showed increasing trends, with ANXD prevalence rising from 13.29% to 22.62% (adjusted odds ratio (AOR): 1.90, 95% CI: 1.26–2.88) and TSRD from 8.73% to 14.30% (AOR: 1.70, CI: 1.30–2.23). In contrast, BIPD (17.03% to 14.23%; AOR: 0.79, CI: 0.68–0.92) and SCOD (27.19% to 24.29%; AOR: 0.78, CI: 0.70–0.87) declined. Regional variations were pronounced: the Midwest and South showed steep increases in ANXD and TSRD; the Northeast exhibited rising TSRD; and in the West, ANXD and TSRD rose while BIPD and DEPD declined. Anxiety and trauma-related disorders increased nationally and across most regions, whereas bipolar and psychotic disorders declined, with depressive disorders remaining persistently prevalent. These patterns highlight the need to investigate underlying drivers such as diagnostic, demographic, and service-related factors and to develop targeted interventions for each disorder. • Analyzed 10 years (2013–2022) of U.S. State Mental Health Client-Level Data ( n = 4.2 M). • Anxiety and trauma-related disorders increased nationally among older adults. • Bipolar and psychotic disorders showed declining trends across most regions. • Depressive disorders remained persistently prevalent over the study period. • Regional variations underscore need for targeted mental health strategies.