Depression Treatment in a Sample of 1,801 Depressed Older Adults in Primary Care

Unützer, Jürgen; Katon, Wayne; Callahan, Christopher M.; Williams, John W; Hunkeler, Enid M.; Harpole, Linda H.; Hoffing, Marc; Penna, Richard Della; Noël, Polly Hitchcock; Lin, Elizabeth; Tang, Lingqi; Oishi, Sabine

doi:10.1046/j.1532-5415.2003.51159.x

Cited by 207 publications

(162 citation statements)

References 71 publications

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“…Although these results were not statistically significant and the number of depressed patients is small, the data are consistent with significant treatment differences observed in other settings. [22][23][24] Such differences may reflect differential access to treatment or patient and family preferences for treatment. Future studies will investigate these issues further.…”

Section: Discussionmentioning

confidence: 99%

Late-Life Depression Among Black and White Elderly Homecare Patients

Fyffe¹

2004

American Journal of Geriatric Psychiatry

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Objectives-The authors compared the prevalence of major depressive disorder (MDD) and the prescription rates of antidepressant medication, by race, among frail older homecare patients.Methods-A random sample of 56 black and 458 white newly admitted homecare patients age 65 and over were assessed for MDD with structured interviews and medical records, and antidepressant prescription rates were tallied.Results-The prevalence of MDD did not differ significantly across racial groups. Only 16.7% of black patients and 32.0% of white patients were prescribed antidepressant medication.Conclusions-Prevalence of MDD was similar among black and white elderly homecare patients. In both groups, depression is undertreated and contributes to the burden of this frail, older patient group. This study investigated the extent to which older black and white recipients of home healthcare nursing services differ in their prevalence of major depressive disorder (MDD) and specific depressive symptoms. Previous evidence about racial disparities in late-life depression is mixed. Some studies have demonstrated higher prevalence rates of depression in older white adults than in older black adults, 1,2 whereas other studies reported contrary results. 3 Still other studies have found no differences by racial group. 4,5 Similar discrepant findings have been reported in studies of symptom profiles across racial groups. For example, it has been suggested that older black adults report more somatic complaints than older white adults; 6 however, these results are not consistently observed across studies. 4,7 Elderly whites have been found to report more dysphoria and anhedonia than their black counterparts in some, 7,8 but not other studies. 4 One explanation for these seemingly contradictory results is that the relative distribution of key factors that may influence the prevalence of depression differs across racial groups. Medical illness and functional disability are of particular importance because they

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Section: Discussionmentioning

confidence: 99%

Late-Life Depression Among Black and White Elderly Homecare Patients

Fyffe¹

2004

American Journal of Geriatric Psychiatry

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“…Comparative work suggests that individuals with late-life depression are more disabled and have more co-morbidity than younger adults with depression [6,7]. In some circumstances the prognosis of late-life depression appears to be inferior to that of mid-life depressions [8,9]. Health care utilization is increased in late-life depression compared with mid-life depression [10,11,12] and yet under-treatment appears to be more significant in older than younger depressed patients [13].…”

Section: Introductionmentioning

confidence: 99%

Do Primary Care Physicians Have Particular Difficulty Identifying Late-Life Depression? A Meta-Analysis Stratified by Age

Mitchell

Rao

Vaze

2010

Psychother Psychosom

128

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Background: There is long-standing concern regarding poor recognition of depression in primary care, especially in older people. Methods: Studies that examined the unassisted (clinical) ability of general practitioners (GPs; primary care physicians) to identify depression were divided into those of older adults, younger adults and mixed populations. Data were extracted by 3 reviewers independently and pooled using a Bayesian meta-analysis. Results: We identified 31 valid studies that examined both sensitivity and specificity (or rule-in and rule-out accuracy), involving 52,513 individuals. Twelve studies recruited older individuals, 12 recruited younger adults and 7 recruited both younger and older adults (mixed populations). In the most robust studies the point prevalence of depression in late life was 13.2% (95% CI = 7.9–19.6). GPs were able to correctly identify 47.3% of the late-life depressions and 78.6% of the non-cases (71.0% overall accuracy). In younger adults GPs were able to identify 39.7% of the mid-life depressions and 85.1% of the non-depressed (77.8% overall accuracy). In mixed aged groups GPs we able to correctly identify 46.6% of the depressed individuals and 86.2% of the non-depressed (79.6% overall accuracy). The overall fraction correctly identified was significantly lower in older compared with younger adults. Correcting for differences in prevalence showed a statistically lower rule-in performance for older compared with younger adults. There was no difference in ability to identify non-depressed (healthy) individuals by age. Conclusions: In clinical practice GPs appear to be less successful in identifying depression in older people than in younger adults, however there have been few head-to-head studies stratified by age from one centre.

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“…Lower depression treatment rates are found among African Americans (Blazer et al, 2000;Brown et al, 1995), Hispanics (Unutzer et al, 2003) and men (Brown, Salive, Guralnik, Pahor, Chapman, and Blazer, 1995).…”

Section: Introductionmentioning

confidence: 99%