Managing Depressed and Suicidal Geriatric Patients: Differences Among Primary Care Physicians

Kaplan, Mark S.; Adamek, Margaret E.; Calderon, Alvin

doi:10.1093/geront/39.4.417

Cited by 32 publications

(26 citation statements)

References 46 publications

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“…Such an approach could increase patient access to CBT-I, which could be of particular benefit to older adults who also rely heavily on primary care clinics to address their mental health needs (Kaplan, Adamek, & Calderon, 1999). Mack and Rybarczyk (2011) recently proposed a four step treatment model tailored specifically for a primary care setting.…”

Section: Increasing Accessibility and Dissemination Of Cbt-imentioning

confidence: 99%

Cognitive Behavioral Therapy for Insomnia in Older Adults: Background, Evidence, and Overview of Treatment Protocol

Rybarczyk

Lund

Garroway

et al. 2013

Clinical Gerontologist

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Section: Increasing Accessibility and Dissemination Of Cbt-imentioning

confidence: 99%

Cognitive Behavioral Therapy for Insomnia in Older Adults: Background, Evidence, and Overview of Treatment Protocol

Rybarczyk

Lund

Garroway

et al. 2013

Clinical Gerontologist

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“…[29][30][31][32][33] Rather than increasing primary care physician vigilance to suicide potential in all patients, 31,34-39 a more targeted strategy would direct attention to patients with mental health problems among whom a large proportion of suicides occur. [40][41][42] Major depression, for example, accounts for 60% of suicides 42,44 and carries as much as a 20-fold increase in lifetime risk of suicide.…”

Section: Detection Of Suicidal Ideationmentioning

confidence: 99%

Improving Detection of Suicidal Ideation Among Depressed Patients in Primary Care

Nutting

Dickinson²,

Rubenstein³

et al. 2005

The Annals of Family Medicine

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PURPOSE Primary care clinicians have diffi culty detecting suicidal patients. This report evaluates the effect of 2 primary care interventions on the detection and subsequent referral or treatment of patients with depression and recent suicidal ideation.METHODS Adult patients in 12 mixed-payer primary care practices and 9 not-forprofi t staff model health maintenance organization (HMO) practices were screened for depression. Matched practices were randomized within plan type to intervention or usual care. The intervention for mixed-payer practices entailed brief training of physicians and offi ce nurses to provide care management. The intervention for HMO practices consisted of guided development of quality improvement teams for depression care. A total of 880 enrolled patients met study criteria for depression, 232 of whom met criteria for recent suicidal ideation. Intervention effects on suicide detection and referral to mental health specialty care were evaluated with mixed-effects multilevel models in intent-to-treat analyses.RESULTS Depressed patients with recent suicidal ideation were detected on 40.7% of index visits in intervention practices, compared with 20.5% in usual care practices (odds ratio = 2.64, 95% confi dence interval, 1.45-5.07), with HMO plan type and male sex associated with detection. The interventions had no effect on referral of patients, starting an antidepressant, or suicidal ideation reported at a 6-month follow-up, although power was limited for all 3 analyses.CONCLUSIONS Primary care interventions to improve depression care can improve detection of recent suicidal ideation. Further work is needed to improve physician response to detection, including referral to specialty care and more aggressive treatment, and to observe the effect on outcomes. INTRODUCTION Suicide represents a major social 1 and economic 2,3 burden on the health of the American people and ranks among the top 10 causes of death for Americans aged 10 years and older. 4 Suicide attempts are even more common, 5-7 increase morbidity and health care costs, 3 and further elevate the risk of individuals for a subsequent completed suicide. 8 Suicide prevention has been identifi ed as a national priority 9,10 and is now the target of a comprehensive national strategy. 4 Primary care physicians have an important role in detecting patients at higher risk for suicide, and for prevention. Many [11][12][13][14] but not all 15 studies report that individuals make primary care visits before completing suicide. Improving primary care for suicidal patients poses several critical challenges. Completed suicide is relatively infrequent in primary care practice. Although suicidal ideation is more frequent than suicidal behavior or completed suicide, 16-21 the relationships among ideation, suicide attempts, and completed suicide are uncertain. 5,6,8,[22][23][24][25][26][27] Patients rarely volunteer suicidal ideation, although many will acknowledge ideation if asked directly 13 Rather than increasing primary care physician vigi...

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“…When mental health problems are identified in primary care settings, treatment too often is of limited scope and intensity, not provided in accordance with practice guidelines, and ineffective (Moride et al, 2002;Reynolds, Cruz, Teh, & Rollman, 2007). Mental health interventions provided by primary care physicians are characterized by overreliance on psychopharmacologic treatments and underutilization of psychosocial interventions (Gallo, Ryan, & Ford, 1999;Harman, Veazie, & Lyness, 2006;Kaplan, Adamek, & Calderon, 1999). This occurs despite evidence that many older patients with depression prefer psychotherapy (Gum et al, 2006).…”

Section: Geriatric Specialization Of the Mental Health Workforcementioning

confidence: 99%

“…Many of these barriers are intrinsic to primary care practice, while others are patient-specific or related to limitations of the mental health system (Kaplan et al, 1999).…”

Section: Barriers In Primary Carementioning

confidence: 99%

Treatment of Late-Life Mental Disorders in Primary Care: We Can Do a Better Job

Moak¹

2011

Journal of Aging & Social Policy

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Health care services provided to older adults today are not as effective as they should be. The quality of care for late-life mental disorders often falls short of desired standards. The growth of the elderly population makes it imperative for the health care system to address late-life mental disorders more effectively. Intervention strategies based in primary care settings show the most promise, but effectiveness will depend on solving the geriatric psychiatry workforce crisis. Collaborative care is one promising model for improving geriatric mental health care delivery in primary care. Diffusion of collaborative care into the health care system and integrating geriatric psychiatry into other models such as geriatric medical homes will require redesign of the organization and financing of primary care and psychiatry to overcome current barriers. Public policy should reflect the essential role of psychiatry in geriatrics and promote the integration of geriatric psychiatry with primary care.

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Managing Depressed and Suicidal Geriatric Patients: Differences Among Primary Care Physicians

Cited by 32 publications

References 46 publications

Cognitive Behavioral Therapy for Insomnia in Older Adults: Background, Evidence, and Overview of Treatment Protocol

Cognitive Behavioral Therapy for Insomnia in Older Adults: Background, Evidence, and Overview of Treatment Protocol

Improving Detection of Suicidal Ideation Among Depressed Patients in Primary Care

Treatment of Late-Life Mental Disorders in Primary Care: We Can Do a Better Job

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