Depression and Anxiety in Older People in Viet Nam: From Early Recognition to Safe, Integrated and Person-Centred Care Across Settings

AGE-FRIENDLY CARE QUALITY · INTEGRATED CARE & CARE TRANSITIONS

Last reviewed: October 2026

An older person stops joining family meals and no longer takes interest in activities they once enjoyed. They complain more often of fatigue, poor sleep and persistent aches, but never say that they feel sad. Another person repeatedly worries that a minor physical symptom means something serious, becomes afraid to leave the house and seeks reassurance from several clinicians. Someone recovering from a stroke seems physically stable enough to continue rehabilitation but has lost motivation, sleeps badly and increasingly refuses therapy. In each case, a mental-health problem may be easy to miss because it appears through the body, through function or through changes in everyday behavior rather than through a direct statement of depression or anxiety.

Depression and anxiety in later life should not be dismissed as inevitable consequences of aging. WHO estimated that in 2023, 14.75% of adults aged 70 years and older globally were living with a mental disorder, most commonly anxiety or depression. Mental-health conditions in older people are often under-recognized and undertreated, while stigma may make some people less willing to seek help. WHO also highlights bereavement, loss of income or purpose, declining functional ability, loneliness, social isolation, abuse, chronic disease and caregiving responsibilities among the factors that can affect mental health in later life. These are global estimates and should not be presented as prevalence figures for Viet Nam.

For older-person care, the practical question is therefore not simply “Is this person depressed or anxious?” A more useful question is:

“Has this person's mood, worry or distress begun to affect function, relationships, physical health, safety or participation—and does the care system know how to recognize, assess and respond to it?”

Depression and anxiety can look different in later life

Not every period of sadness is depression, and not every worry is an anxiety disorder. Bereavement, uncertainty after illness, fear of falling, financial worries and distress following loss are understandable human responses. What matters clinically is their pattern, persistence, severity, associated symptoms and effect on everyday functioning.

Depression in an older person may include persistent low mood, but it can also appear through loss of interest or pleasure, reduced energy, social withdrawal, impaired concentration, sleep or appetite disturbance, hopelessness or feelings of worthlessness. Some older people focus mainly on physical complaints such as fatigue, pain or persistent bodily discomfort and may never describe themselves as “sad.”

Ministry of Health Decision No. 1976/QĐ-BYT of 1 July 2026 explicitly recognizes this problem. Its professional guidance on home and community care for older people describes depression as sometimes presenting through fatigue and persistent physical discomfort rather than an overt complaint of sadness. It also addresses loss of interest, social withdrawal, worry, irritability, concentration problems and other psychological changes.

Anxiety can be similarly difficult to recognize. Palpitations, shortness of breath, dizziness, gastrointestinal discomfort, sleep disturbance or repeated concerns about physical health can accompany anxiety, but they can also arise from cardiovascular, respiratory, endocrine or neurological disease, medication effects and other medical conditions. New anxiety in later life should therefore not automatically be given a psychiatric explanation before relevant physical causes and medicines have been considered.

The challenge is not to choose between “mental” and “physical.” In older-person care, the two are often intertwined.

What does the Vietnamese evidence actually tell us?

Viet Nam now has better evidence on depressive symptoms in older people than it did only a few years ago, but the numbers still require careful interpretation.

A study published in PLOS One in 2024 analyzed the 2022 Viet Nam National Aging Survey, which included a nationally representative sample of 3,006 adults aged 60 years and older from 12 provinces. Using the 15-item Geriatric Depression Scale, 20.2% of participants scored at or above the study's threshold for depressive symptoms. Of the total sample, 14.3% were classified as having mild symptoms and 5.9% as moderate or severe symptoms according to the study's scoring approach.

That distinction is important. The GDS-15 is a screening instrument, not a structured psychiatric diagnostic interview. The 20.2% figure should therefore be described as the prevalence of depressive symptoms according to the study's screening definition, not the national prevalence of clinically diagnosed depressive disorder.

The same study found higher odds of depressive symptoms among women, people living in rural areas, those in the poorest wealth group, people reporting poor health, those with limitations in activities of daily living or instrumental activities of daily living and those reporting domestic violence during the previous year. Because the study was cross-sectional, these findings show associations; they do not demonstrate that any one factor caused depression.

Recent local studies show how strongly estimates can vary by setting. A 2026 study involving 265 community-dwelling older adults in two Hanoi wards found that 20.4% screened positive for depressive symptoms using the GDS-15. In contrast, a study published on 5 October 2026 involving 322 older adults attending the Geriatrics Outpatient Clinic at University Medical Center Ho Chi Minh City found that 39.4% screened positive under the study's GDS-15 definition. Financial difficulty, frailty, polypharmacy and chronic kidney disease were among the factors independently associated with screening positive in that selected clinical population.

Those figures should not be compared as though they represent the same underlying population. One study involved residents of two Hanoi communities; the other involved older people already seeking care at a specialist geriatric outpatient clinic.

Evidence on anxiety among older Vietnamese people is less complete at population level. A study published in 2026 examined 255 adults aged 60 years and older admitted to the Mental Health Department of the National Geriatric Hospital, using data collected in 2022 and the Hamilton Anxiety Rating Scale. Female sex, lower educational attainment, economic difficulty and psychological trauma were among the associated factors identified. HAM-A is a clinician-rated measure of anxiety symptoms and severity; this highly selected inpatient study should not be used to estimate the national prevalence of anxiety disorders among older Vietnamese people.

The most defensible conclusion is therefore that depressive symptoms have been documented at substantial levels in national and local Vietnamese samples, while contemporary population-level evidence on late-life anxiety remains considerably more limited.

Viet Nam now has a practical pathway for early recognition

Decision 1976/QĐ-BYT is important because it brings psychological health into routine older-person care at home and in the community rather than leaving it solely to specialist mental-health services.

The guidance includes a specific section on depression and a structured section on screening for depressive symptoms within assessment of psychological capacity. It distinguishes depressive symptoms from depressive disorder and recognizes that their management implications differ. Its screening content considers core depressive symptoms together with changes in sleep, energy, appetite, self-worth, concentration and psychomotor activity, as well as marked restlessness and thoughts of death or self-harm.

The guidance should nevertheless be used for what it is: professional guidance supporting older-person care at home and in the community. Its screening content should not substitute for a comprehensive psychiatric assessment when a depressive disorder, anxiety disorder or significant safety concern is suspected.

Decision 1976 also links psychological health with other domains of intrinsic capacity. Cognitive impairment can coexist with depressive symptoms; deterioration in mobility, hearing or vision can reduce function and participation and contribute to psychological distress. These interactions are intended to inform an individualized care plan rather than being treated as separate problems.

This is closely aligned with WHO's ICOPE model. The second edition of the ICOPE handbook, published in 2025, organizes basic assessment around six domains of intrinsic capacity: cognition, mobility, vitality, vision, hearing and psychological capacity, alongside social-support needs, caregiver support and other areas of care. ICOPE moves from basic assessment to more detailed assessment, development of a personalized care plan, implementation and monitoring.

One limitation should remain clear: ICOPE's dedicated psychological-capacity pathway focuses primarily on depressive symptoms. It should not be described as though WHO ICOPE provides an equivalent comprehensive clinical pathway for anxiety disorders.

Circular No. 34/2026/TT-BYT gives Decision 1976 additional implementation relevance. It directs training and guidance on older-person self-care and caregiving skills at provincial and commune levels to use the professional content of Decision 1976. This creates a practical route through which early recognition of psychological problems can become part of community-based older-person care rather than remain only a policy recommendation.

Screening is a starting point, not a diagnosis

A screening score can identify someone who may need further attention. It cannot by itself establish a psychiatric diagnosis.

Depressive and anxiety symptoms can occur in the context of grief, chronic pain, sleep disorders, medication effects, thyroid disease, anemia, malnutrition, neurological disease, substance use, dementia or acute illness. Polypharmacy can complicate the picture further. A comprehensive assessment therefore needs to ask what changed, when it changed and what else was happening at the time.

Has the person lost interest in activities? Is worry present on most days and difficult to control? Have they stopped leaving home? Is sleep disrupted? Are they eating less? Have they stopped participating in rehabilitation? Can they still manage medicines, money and other everyday activities? Has cognition changed? Did the symptoms begin after bereavement, hospitalization, financial loss, abuse or a change in living arrangements?

The person's own explanation also matters. An older person who says, “I am not depressed; I am just useless now that I cannot walk” may be describing something clinically important about the relationship between functional loss, identity and meaning.

The aim is not merely to assign a label. It is to understand the whole problem.

Depression, dementia and delirium also need to be distinguished carefully. Depression can impair motivation, concentration and memory and may resemble cognitive decline. Dementia can cause apathy, withdrawal, sleep changes and emotional symptoms that resemble depression. The two can also coexist.

Delirium is different. It typically involves an acute change in attention and cognition, often with fluctuation, and should trigger assessment for underlying medical causes such as infection, metabolic disturbance, dehydration, medication effects or another acute illness. A person who becomes confused over hours or days should not simply be labeled “depressed” because they appear withdrawn.

Conversely, persistent low motivation or cognitive complaints should not automatically be attributed to dementia without asking about mood.

Good care therefore asks:

“Is this primarily depression, anxiety, cognitive decline, delirium, physical illness—or some combination of them?”

Sometimes the answer is more than one.

Mental health and function should be assessed together

A mental-health assessment that ignores function misses much of what matters to an older person.

Depression and anxiety can affect mobility, rehabilitation, nutrition, medication adherence, sleep, self-care and social participation. Someone who is physically capable of walking may stop walking because fear of falling has become overwhelming. Someone recovering from surgery may stop participating in rehabilitation because depression has removed motivation and hope. A person with several chronic diseases may become increasingly anxious about every bodily sensation and repeatedly seek urgent medical reassurance.

The Viet Nam National Aging Survey reinforces this connection: limitations in ADLs and IADLs were independently associated with depressive symptoms.

The relationship can also work in the opposite direction. Loss of mobility, independence or valued roles may contribute to depression, while depression itself can make physical activity, rehabilitation and self-care more difficult. Cross-sectional studies cannot determine which came first for a particular individual.

For quality care, the practical question is therefore:

“What has this person's mood or anxiety stopped them from doing, and what loss of function may be worsening their mental health?”

That question creates a bridge between mental-health care and rehabilitation rather than placing them in separate services.

Safety assessment cannot be optional

Most older people experiencing depression or anxiety will not attempt suicide, but thoughts of death, hopelessness and self-harm must never be ignored.

WHO reported in 2026 that approximately 16.6% of suicide deaths globally occur among people aged 70 years and older. This statistic does not describe the risk of any individual older person in Viet Nam, but it demonstrates why suicide prevention remains relevant in later life.

Decision 1976/QĐ-BYT includes thoughts of death or self-harm among the symptoms that should be explored when depressive symptoms are being assessed.

If an older person reports current suicidal thoughts together with intent, a plan, recent self-harm or other indicators of immediate risk, the response should not stop at completing a screening questionnaire. Prompt clinical assessment and a clear safety and escalation pathway are required. Severe self-neglect, psychotic symptoms, inability to maintain adequate food or fluids because of severe depression or other acute behavioral and safety concerns also warrant timely assessment.

Families need to know whom to contact and what to do if risk escalates. Telling relatives simply to “watch the person” without an assessment and response plan transfers responsibility without creating a safety system.

Effective care usually involves more than medication

Psychological and psychosocial interventions have an important role in late-life depression.

A 2026 network meta-analysis of 86 randomized trials involving 10,165 older adults with depression found that cognitive behavioral therapy, behavioral activation, problem-solving therapy and life-review therapy were effective compared with usual care or waiting-list controls. After sensitivity analyses, these established approaches appeared broadly comparable in their effects.

A separate 2026 review of psychotherapy in older adults also found particularly strong evidence for CBT-based approaches, including problem-solving therapy and behavioral activation, alongside consistent evidence for interpersonal, reminiscence and life-review therapies. Importantly for integrated care, these approaches have been adapted for older people with physical or cognitive comorbidity and delivered through primary care, aging services and residential settings as well as conventional mental-health services.

WHO's ICOPE psychological-capacity materials similarly emphasize psychological interventions, health and lifestyle advice, community-based care and attention to the person's social and physical environment.

This matters for Viet Nam because specialist psychiatrists and psychologists cannot realistically be the only entry point for every older person with depressive or anxiety symptoms. Primary care, community health services, rehabilitation teams and appropriately trained health workers can contribute to recognition, basic supportive interventions, activation, follow-up and referral within their competencies.

The goal is not to turn every primary-care consultation into specialist psychotherapy. It is to create a system in which distress is noticed, appropriate support is available and people who require more intensive or specialist treatment can reach it.

Mental health is also shaped by the life around the person. Untreated pain can disrupt sleep and motivation. Hearing loss can make conversation exhausting. Falls can create fear that gradually confines someone to the home. Urinary incontinence can lead to embarrassment and withdrawal. Frailty and malnutrition reduce energy and participation. Family conflict, financial difficulty, abuse or bereavement may deepen distress.

A person-centered care plan therefore needs to ask not only “What mental-health treatment does this person need?” but also “What is making this person's life harder than it needs to be?”

Sometimes treatment requires psychotherapy or medication. Sometimes it also requires better pain management, rehabilitation, hearing support, safeguarding, caregiver assistance, financial or social support, or reconnection with meaningful activities.

This is where mental-health care becomes part of healthy aging rather than a separate psychiatric silo.

Anxiety deserves attention in its own right

Late-life anxiety should not be treated merely as an appendix to depression.

An older person may experience persistent worry, fear of being alone, fear of falling, health anxiety, panic symptoms or anxiety related to caregiving, finances or declining function. Depression and anxiety often coexist, but they are not the same condition and do not always require the same response.

New-onset anxiety deserves particular attention because physical illness, medicines, substance use and other mental-health conditions may contribute. International geriatric prescribing guidance emphasizes the importance of considering those underlying contributors rather than reflexively prescribing sedatives.

Non-pharmacological approaches are supported by a growing evidence base, although it needs to be interpreted carefully. A 2026 systematic review and network meta-analysis included 83 randomized trials involving 6,646 adults aged 55 years and older and found improvements in depression or anxiety symptoms across several structured non-pharmacological interventions. However, the included populations and interventions were heterogeneous, many participants did not have formally diagnosed anxiety disorders and the certainty of comparative evidence varied.

The practical principle is straightforward:

Treatment should be matched to the actual anxiety problem and to the older person's preferences rather than treating every form of worry with a sedative.

Medication can help, but geriatric safety matters

Medication may be appropriate for some older people with depressive or anxiety disorders, but treatment requires the same geriatric discipline applied to other medicines.

WHO's mhGAP recommendations for adults with moderate-to-severe depression include selected SSRIs and amitriptyline among medicines that may be considered. However, WHO separately advises that when antidepressant drug treatment is required in older people, tricyclic antidepressants should be avoided where possible because of their poorer safety and tolerability profile. Antidepressants are also not recommended as the initial treatment for a mild depressive episode.

WHO's broader recommendation for moderate-to-severe depression is also important: psychological interventions or combined treatment should be considered according to individual preferences and the balance of benefits and harms, while antidepressant medication alone should generally be considered when psychological interventions are not available.

For generalized anxiety disorder and panic disorder, WHO supports psychological interventions and, when pharmacological treatment is appropriate, SSRIs. WHO does not recommend benzodiazepines as routine treatment for GAD or panic disorder. For emergency management of acute and severe anxiety symptoms, they may be considered only as a very short-term measure, 3 to 7 days maximum under the WHO recommendation.

These are general adult recommendations and do not replace individualized geriatric prescribing. Older people may be especially vulnerable to treatment-related problems because of multimorbidity, polypharmacy, altered pharmacokinetics and interactions with other medicines.

The 2023 AGS Beers Criteria, although developed for the United States rather than Viet Nam, illustrate several relevant risks. Benzodiazepines are associated in older adults with cognitive impairment, delirium, falls, fractures and dependence. Several antidepressant classes also require caution in people with falls risk, and antidepressant treatment may contribute to hyponatremia in susceptible individuals. SSRIs can also increase bleeding risk in some circumstances, particularly when combined with other medicines affecting hemostasis.

These international tools should inform risk awareness. They do not replace Vietnamese prescribing requirements or individualized clinical judgment.

Medication review should therefore ask more than:

“Is the person less depressed or anxious?”

It should also ask:

“Is treatment affecting balance, cognition, falls risk, sodium levels, appetite, sleep, bleeding risk, adherence or interactions with other medicines?”

Hospitalization and care transitions are mental-health transitions too

Hospitalization changes more than physical health.

An older person may suddenly lose privacy, sleep, mobility and control over familiar routines. Acute illness, surgery and unfamiliar surroundings can create fear. A new diagnosis may change how someone imagines their future. Functional decline can turn an independent person into someone who now needs assistance with dressing, eating or toileting.

Mental-health symptoms may therefore emerge or worsen during hospitalization, while acute-care teams understandably focus on the condition that caused admission.

Vietnamese evidence reinforces the importance of this transition. A 2025 study of 117 older patients with acute coronary syndrome discharged from Thong Nhat Hospital found that 15.4% screened positive for depression using the GDS-30 at discharge. This was a selected hospital population and should not be generalized to older people nationally, but it demonstrates that psychological distress may remain important precisely when acute physical treatment appears complete.

Before discharge, the team should therefore consider whether mood, anxiety, cognition, sleep and motivation have changed enough to affect recovery. If someone leaves hospital with substantial functional loss but has become hopeless or too frightened to mobilize, rehabilitation planning is incomplete unless that psychological barrier is considered.

Mental-health information also needs to survive the transition. A rehabilitation service, primary-care clinician, family or long-term-care team may need to know about significant depressive or anxiety symptoms, current safety concerns, psychotropic medicines, psychological or psychosocial interventions, functional impact and follow-up arrangements.

A sedative started during hospitalization should not quietly become a permanent medicine simply because nobody revisited the indication. An antidepressant started shortly before discharge should not be judged ineffective after only a few days and should have a clear review plan.

Continuity means carrying forward the problem, the treatment goal and the follow-up plan, not merely copying the medication list.

Home and long-term care should recognize distress without normalizing it

Families are often the first to notice meaningful change.

A son may see that his father has stopped leaving the bedroom. A spouse may notice increasing insomnia and repeated reassurance-seeking. A daughter may become concerned because her mother repeatedly says that she is “a burden.”

These observations matter, but families should not be expected to diagnose psychiatric disorders. Decision 1976 gives home and community care an appropriate role in recognition, psychological support, meaningful activity, physical activity, nutrition, sleep, maintaining relationships and helping an older person obtain professional assessment when needed.

The aim is not to medicalize normal grief or every difficult day. It is to recognize when distress persists, function deteriorates, social withdrawal deepens or safety concerns emerge.

Family involvement should support the older person, not replace their voice. Relatives can provide valuable information about change from baseline, but the older person's own experience, priorities and preferences should remain central whenever possible.

The same principle applies in residential long-term care. Depressive or anxiety symptoms can easily be mistaken for normal aging or someone's “personality.” A resident stops attending meals and is described as preferring to stay alone. Another sleeps much of the day and staff assume this is simply frailty. Someone repeatedly calls staff because of anxiety and is labeled “demanding.”

A quality service should ask whether something has changed.

Moving into residential care can itself involve losses of home, routine, privacy, neighborhood, familiar roles and sometimes a spouse or caregiver. Even when the move is appropriate and well managed, emotional adjustment deserves attention.

Mental-health quality is not measured by whether residents are quiet.

A resident can be very quiet and still be suffering.

Caregiver well-being also matters. WHO recognizes caregiving responsibilities, particularly caring for a spouse with chronic disease or dementia, as a potential source of mental-health strain in later life. Families can provide reassurance and continuity, but caregivers may themselves become exhausted, anxious or depressed.

A sustainable plan therefore needs to consider whether caregivers understand what is happening, whether expectations are realistic and whether they also need support.

Supporting caregivers does not mean making them responsible for treatment. It means recognizing that care delivered at home depends partly on whether the care arrangement itself remains sustainable.

Measurement should move beyond screening rates

A service can screen every older person for depression and still provide poor mental-health care.

Screening is useful only if there is a pathway for assessment, response and follow-up.

A stronger quality system should examine whether people with clinically significant symptoms receive timely assessment, whether urgent safety concerns are addressed, whether physical and medication-related contributors are reviewed, whether care plans include functional and social goals and whether follow-up actually occurs.

Outcomes should extend beyond depression or anxiety scores. Is the person sleeping better? Eating adequately? Leaving the house again? Returning to rehabilitation? Participating in family life? Managing more everyday activities independently? Has unnecessary sedative use decreased?

The ultimate outcome is not simply:

“Screen negative.”

It is whether the person's life has improved.

A practical integrated-care framework for Viet Nam

Viet Nam does not need to wait for one stand-alone national geriatric mental-health guideline before improving care. Decision 1976/QĐ-BYT, the implementation pathway under Circular 34/2026/TT-BYT, WHO ICOPE, WHO mhGAP and the growing Vietnamese evidence base already provide useful building blocks.

Recognition should make depression and anxiety visible without assuming that aging itself explains withdrawal, fatigue or worry. Screening can identify people who need further assessment but should not be treated as diagnosis. Clinical assessment should consider physical illness, medicines, cognition, delirium, substance use, psychosocial stressors, functional change and safety.

Person-centered management should combine psychological, psychosocial and pharmacological approaches according to diagnosis, severity, preferences, function and available resources. Medication safety should take polypharmacy, cognition, falls and other geriatric vulnerabilities into account. Functional care should connect mental-health treatment with mobility, rehabilitation, nutrition, pain, hearing, vision and sleep.

Safety planning should establish a clear response when self-harm, severe self-neglect or other urgent concerns are identified. Caregiver support should enable families to contribute without transferring clinical responsibility onto them. Transition management should ensure that mental-health needs, goals and treatment plans follow the person between hospital, rehabilitation, home, community and long-term care. Measurement and learning should show whether recognition actually results in meaningful improvement.

These elements need to operate together. A screening questionnaire without a response pathway adds documentation. Medication without reassessment can add harm. Rehabilitation may fail if depression remains unrecognized. Psychological treatment may have limited effect if severe pain, hearing loss, abuse or overwhelming social problems are ignored. And a good hospital plan can disappear within days if nobody is responsible for follow-up after discharge.

From treating symptoms to restoring participation

For an older person, good mental-health care is not simply about lowering a depression or anxiety score. It may mean having enough motivation to get out of bed, feeling safe enough to walk outside again, sleeping through the night, enjoying food, returning to rehabilitation, talking with family or believing that life still contains things worth looking forward to.

For families, it means recognizing meaningful change without being expected to become psychiatrists. For hospitals, it means treating psychological recovery as part of clinical recovery. For primary and community care, it means identifying problems early and connecting people with appropriate support. For long-term care, it means refusing to accept withdrawal, hopelessness or chronic distress as inevitable parts of aging.

As Viet Nam develops more age-friendly, integrated and long-term care, the question should therefore not simply be:

“Did we screen this older person for depression or anxiety?”

A more meaningful question is:

“Did we understand what was changing in this person's emotional life, function and relationships, respond safely and appropriately, and help them regain the ability and confidence to participate in what matters to them?”

That is the difference between detecting mental-health symptoms and delivering high-quality, person-centered care for the whole older person.

References

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