Cross-National Comparisons of Antidepressant Use Among Institutionalized Older Persons Based on the Minimum Data Set (MDS)

Abstract

RÉSUMÉOn a examiné l'usage des antidépresseurs dans des échantillons provenant d'établissements de soins de longue durée de Toronto (Canada), Sapporo et Naie (Japon), Reykjavik (Islande) et Prague (République tchéque). C'est seulement en Islande que la majorité des résidents souffrant de dépression recevaient des antidépresseurs. Le taux de dépression et l'usage des antidépresseurs sont généralement faibles au Japon. On a constaté un écart important entre le diagnostic de dépression et le comportement dépressif en République tchèque. Dans tous les pays examinés, environ la moitié des utilisateurs d'antidépresseurs ne présentent pas de symptômes évidents de dépression. Dans certains pays, l'usage des antidépresseurs était moins élevé chez les résidentes, chez les aîné(e)s plus âgés ou plus handicapés. La dépression est clairement sous-diagnostiqué en République tchèque mais les faibles taux de dépression au Japon sont plus difficiles à interpréter. Étant donné l'opinion largement répandue voulant que la dépressione passe souvent inaperçue et soit done mal soignée, les résultats de l'étude laissent entendre que l'on pourrait améliorer les mesures prises dans les cas de dépression grâce à des outils comme le MDS.

Predicting Diagnosed Depression and Anti-depressant Treatment in Institutionalized Older Adults by Symptom Profiles: A Closer Look at Anhedonia and Dysphoria

“…In most respects, the sample studied showed consistency with other reports on long-term care residents. Although the prevalence of diagnosed depression of approximately 30 per cent is higher than in earlier large-scale studies (Canadian Institute of Health Information, 1998;Hirdes et al, 2000;Jones et al, 2003), it is consistent with some other findings (Anderson, Buckwalter, Buchanan, Maas, & Imhof, 2003). Anti-depressant medication is the usual treatment for depression in long-term care, with approximately 40 per cent of residents using anti-depressants in the study sample and only a few receiving other mood interventions.…”

“…Under-diagnosis includes a failure of formal diagnostic criteria to classify persons with potentially treatable symptoms (Heston et al, 1992;Bagley et al, 2000;Teresi, Abrams, Holmes, Ramirez, & Eimicke, 2001;Brown, Lapane, & Luisi, 2002). The findings include large-scale studies in the United States and Canada, where fewer than half of cases with frequent depressive symptoms had an active diagnosis of depression (Canadian Institute of Health Information, 1998;Hirdes et al, 2000;Jones, Marcantonio, & Rabinowitz, 2003). Under-treatment includes a failure to treat depression aggressively or effectively in long-term care.…”

Mood Disturbances Across the Continuum of Care Based on Self-Report and Clinician Rated Measures in the interRAI Suite of Assessment Instruments

“…One observation of concern was the low c statistics and odds for prediction of depression diagnosis in nursing home settings. This might simply be a function of error variance when computing nine different comparisons; however, it is worth noting that depression is often under-detected in that setting ( 16 , 94 ). The robust c statistic value in community mental health settings suggest that the problem may be with inadequate recognition in nursing homes rather than with the performance of the scale itself.…”

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

“…All interRAI mental health assessments include items on intellectual disability, since persons with dual psychiatric and ID diagnoses are an important subpopulation in mental health settings. Several interRAI papers have examined persons with intellectual disabilities in trans-institutional settings (179,(185)(186)(187)(188)(189).…”