The Prevalence of Late-Lifedepression and Physicians’ Attitude Toward it in Primary Care Settings of China

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
S. Chen
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Older People ◽  
Primary Care Physicians ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Late Life ◽  
Well Being ◽  
Late Life Depression ◽  
Primary Care Settings

Late-life depression is associated with physical and psychological comorbidity, functional and cognitive impairment, and increased mortality due to suicide and other causes. However, studies in the west show that the identification of depression in older people is problematic and consequently the illness is underdiagnosed and undertreated. We investigated the prevalence of late-life depression and physicians’ attitude toward it in primary care settings of China.The survey was performed in urban primary care settings of Hangzhou, China. 1000 patients aged ≥ 55 years and 300 primary care physicians were recruited, of which 689 patients and 247 physicians provided complete data. The Geriatric Depression Scale (GDS-30) was used for investigating the prevalence of late-life depression in patients, and the Depression Attitude Questionnaire (DAQ) for investigating physicians’ attitudes and knowledge about depression.Of the 689 patients, 23.4% (n=161) scored ≥ 11 on the GDS-30, including 3% (n=21) who scored ≥ 21. Among the physicians, 72% (n=178) endorsed that “Becoming depressed is a natural part of being old”, and 70% (n=173) of them thought “Working with depressed patients is heavy going”; in their clinical practice. Only 6.6% of physicians prescribed anti-depressants.Primary care physicians in China are ill prepared to diagnose and treat depression in older adults, which presents at high rates in primary care clinics. How to improve their attitudes and clinical practice is crucial to the well-being of older people in China.

Primary Care Physicians' Attitude Toward Diagnosis and Treatment of Late-life Depression

CNS Spectrums ◽  
2002 ◽  
Vol 7 (11) ◽  
pp. 784-790 ◽  
Author(s):  
Jeffrey S. Harman ◽  
Ellen L. Brown ◽  
Thomas Ten Have ◽  
Benoit H. Mulsant ◽  
Greg Brown ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Primary Care Physicians ◽  
Late Life ◽  
The Elderly ◽  
Late Life Depression ◽  
Primary Care Settings ◽  
Care Groups ◽  
Physician Characteristics ◽  
Barrier To Care

ABSTRACTUnderdiagnosis and undertreatment of late-life depression is common, especially in primary care settings. To help assess whether physicians' attitude and confidence in diagnosing and managing depression serve as barriers to care, a total of 176 physicians employed in 18 primary care groups were administered surveys to assess attitudes towards diagnosis, treatment, and management of depression in elderly patients, (individuals over 65 years of age). Logistic regression was performed to assess the association of physician characteristics on attitudes. Nearly all of the physicians surveyed felt that depression in the elderly was a primary care problem, and 41% reported late-life depression as the most common problem seen in older patients. Physicians were confident in their ability to diagnose and manage depression, yet 45% had no medical education on depression in the previous three years. Physicians' confidence in their ability to diagnose, treat, and manage depression, and their reported adequacy of training, do not appear to correspond to the amount of continuing medical education in depression, suggesting that physician overconfidence may potentially be serving as a barrier to care.

scholarly journals The prognosis of depression in late life versus mid-life: implications for the treatment of older adults

2005 ◽  
Vol 17 (4) ◽  
pp. 533-538 ◽  
Author(s):  
Hari Subramaniam ◽  
Alex J. Mitchell
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Nursing Homes ◽  
Late Life ◽  
Clinical Excellence ◽  
Late Life Depression ◽  
Medical Settings ◽  
Nice Guidelines ◽  
Primary Care Settings

Depression in late life is extremely common. Of those aged 65 years or older, 2–5% have syndromal depression, but up to 20% of elderly people have depressive symptoms (Horwath et al., 2002). Both syndromal and subsyndromal depression carry a high risk of long-term complications and both are associated with elevated risks of morbidity and mortality (Penninx et al., 1999). Despite repeated alerts, depression is consistently under-recognized in acute medical settings, in nursing homes and in primary care (Volkers et al., 2004). For reasons that are inadequately understood, late-life depression seems to be under-treated to an even greater extent than depression in mid-life (Mackenzie et al., 1999). This issue is particularly important, given that effective and safe treatments for depression are available (Bartels et al., 2003), even though the evidence regarding maintenance therapies in older people is inconsistent (Geddes et al., 2003; Wilson et al., 2003). Recent evidence suggests that a package of care can improve the care of older depressed patients in primary care settings (Bruce et al., 2004) and in nursing homes (Ciechanowski et al., 2004). This has led to the development of several clinical guidelines specifically for late-life depression (Baldwin et al., 2003; Charney et al., 2003; Lebowitzet al., 1997). Yet, in the recent National Institute of Clinical Excellence (NICE) guidelines for the management of depression in primary and secondary care, no distinction was made between early, middle and late-life depression (Malone and Mitchell, 2005).

Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

2012 ◽  
Vol 42 (12) ◽  
pp. 2619-2629 ◽  
Author(s):  
E. Scafato ◽  
L. Galluzzo ◽  
S. Ghirini ◽  
C. Gandin ◽  
A. Rossi ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Proportional Hazards ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Late Life ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Late Life Depression ◽  
Longitudinal Changes ◽  
The Impact

BackgroundDepression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.MethodAs part of a prospective, population-based study on a random sample of 5632 subjects aged 65–84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.ResultsSeverity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15–1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32–0.95; men MHR 0.59, 95% CI 0.37–0.93). Neither sociodemographic nor medical confounders significantly modified these associations.ConclusionsConsistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

scholarly journals Case-Finding for Depression in Elderly People: Balancing Ease of Administration With Validity in Varied Treatment Settings

2004 ◽  
Vol 59 (4) ◽  
pp. M378-M384 ◽  
Author(s):  
Karen Blank ◽  
Cynthia Gruman ◽  
Julie T. Robison
Keyword(s):  
Primary Care ◽  
Major Depression ◽  
Nursing Homes ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Diagnostic Interview ◽  
Case Finding ◽  
Late Life Depression ◽  
Cut Points

Abstract Background. Little is known about the performance of brief and ultrabrief (1- and 2-question) depression screens in older patients across varied treatment sites. This study (1) assesses their validity in clinics, hospitals, and nursing homes and (2) assesses cut-points for optimal clinical application. Methods. 360 patients aged 60 years and older from 2 urban primary care practices (n = 125), 1 general hospital (n = 150), and 8 nursing homes (n = 85) were assessed using the Yale 1-question screen, the 2-question instrument derived from the Primary Care Evaluation of Mental Disorders, and long and short versions of the Center for Epidemiologic Studies Depression (CES-D) scale and Geriatric Depression Scale (GDS). Sensitivity and specificity were calculated for each screen compared with the criterion standard Diagnostic Interview Schedule (DIS) depression diagnosis and receiver operating characteristic curves generated. Results. 9% of patients met DIS criteria for major depression and 7% for subsyndromal depression. Overall, the 10-item CES-D showed the best sensitivity/specificity for major depression in clinics (79%/81%) and hospitals (92%/77%), and the short GDS in nursing homes (86%/82%). Specificity of 1- and 2-question instruments was generally low. Established cut-points generally worked best for the short screens, while modifications were useful for longer versions. Conclusions. Consideration of site of use is important in selecting brief case-finding instruments for late-life depression, with the 10-item CES-D working best in medical settings and the 15-item GDS in nursing homes.

Primary care physicians’ medical decision making for late-life depression

1996 ◽  
Vol 11 (4) ◽  
pp. 218-225 ◽  
Author(s):  
Christopher M. Callahan ◽  
Robert S. Dittus ◽  
William M. Tierney
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Primary Care Physicians ◽  
Medical Decision Making ◽  
Late Life ◽  
Medical Decision ◽  
Late Life Depression

Treatment preferences for depression in the elderly

2016 ◽  
Vol 29 (3) ◽  
pp. 389-398 ◽  
Author(s):  
Claudia Luck-Sikorski ◽  
Janine Stein ◽  
Katharina Heilmann ◽  
Wolfgang Maier ◽  
Hanna Kaduszkiewicz ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Treatment Options ◽  
Treatment Success ◽  
Depression Scale ◽  
Late Life ◽  
Care Utilization ◽  
Treatment Preferences ◽  
Late Life Depression ◽  
Care Needs

ABSTRACTBackground:If patients are treated according to their personal preferences, depression treatment success is higher. It is not known which treatment options for late-life depression are preferred by patients aged 75 years and over and whether there are determinants of these preferences.Methods:The data were derived from the German “Late-life depression in primary care: needs, health care utilization, and costs (AgeMooDe)” study. Patients aged 75+ years (N = 1,230) were recruited from primary care practices. Depressive symptoms were determined using the Geriatric Depression Scale (GDS-15). Support for eight treatment options was determined.Results:Medication, psychotherapy, talking to friends and family, and exercise were the preferred treatment options. Having a GDS score ≥ 6 significantly lowered the endorsement of some treatment options. For each treatment option, the probability of choosing the indecisive category “I do not know” was significantly increased in participants with moderate depressive symptoms.Conclusions:Depressive symptoms influence the preference for certain treatment options and also increase indecision in patients. The high preference for psychotherapy suggests a much higher demand for late-life psychotherapy in the future. Healthcare systems should begin to prepare to meet this anticipated need. Future studies should include previous experience with treatment methods as a confounding variable.

scholarly journals Improving the Management of Late-Life Depression in Primary Care: Barriers and Facilitators

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Tamara Sussman ◽  
Mark Yaffe ◽  
Jane McCusker ◽  
David Parry ◽  
Maida Sewitch ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Family Physicians ◽  
Late Life ◽  
Late Life Depression ◽  
Primary Care Settings ◽  
Canadian Health ◽  
Mental Health Support ◽  
Health Support ◽  
Quantitative And Qualitative Methods

The objectives of this study were to elicit Canadian health professionals' views on the barriers to identifying and treating late-life depression in primary care settings and on the solutions felt to be most important and feasible to implement. A consensus development process was used to generate, rank, and discuss solutions. Twenty-three health professionals participated in the consensus process. Results were analysed using quantitative and qualitative methods. Participants generated 12 solutions. One solution, developing mechanisms to increase family physicians' awareness of resources, was highly ranked for importance and feasibility by most participants. Another solution, providing family physicians with direct mental health support, was highly ranked as important but not as feasible by most participants. Deliberations emphasized the importance of case specific, as needed support based on the principles of shared care. The results suggest that practitioners highly value collaborative care but question the feasibility of implementing these principles in current Canadian primary care contexts.

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