Interventions for depressed elderly primary care patients

✍ Scribed by George S. Alexopoulos

• Publisher: John Wiley and Sons
• Year: 2001
• Tongue: English
• Weight: 74 KB
• Volume: 16
• Category: Article
• ISSN: 0885-6230
• DOI: 10.1002/gps.464

✦ Synopsis

THE FOCUS ON DEPRESSION

An increasing number of studies are devoted to interventions seeking to improve the care of psychiatric disorders in primary care patients. Most of these studies are focusing on geriatric depression. One of the reasons is the high prevalence of depression in elderly medical populations. Depressive symptoms and signs or depressive syndromes have been identi®ed in 17.1±37% of primary care patients (Alexopoulos, 1996). Differences in the prevalence of depression depend in part on how a diagnosis is made. The majority of depressed elderly patients treated in primary care do not meet diagnostic criteria for depressive disorders. Katon and Schulberg (1992) estimated that 6±8% of primary care patients met criteria for major depression and Oxman et al. (1990) observed that major depression occurred in 9% of elderly primary care patients. The remainder had clinically signi®cant depressive symptomatology. In medical populations, 25% of minor depressions evolve into major depression within a 2 year period (Katon and Schulberg, 1992). Minor depression has often been the diagnosis of elderly suicide victims (Conwell, 1994).

Another important reason for focusing primary care research on depression is the underdiagnosis of depression in medical settings. Only 35±43% of mixed-age depressed patients are identi®ed by their physicians (Simon et al., 1995). We reported that general internists identi®ed depression in 6.2% of elderly patients (Luber et al., 2000). This percentage is at least three times lower that that expected from systematic studies (