Depression in Primary Care 1: Elderly Patients' Disclosure of Depressive Symptoms to Their Doctors

Abstract

Background: This article examines some of the factors responsible for older patients' decision to report current depressive symptoms to their general medical practitioner. A companion article considers factors contributing to general practitioners' (GPs') recognition of major depressive episode when it was present. Methods: A survey was conducted of a stratified sample of 1,021 patients aged 70+ years of 30 GPs in Melbourne, Australia, to gauge the prevalence of depressive symptoms, the frequency with which patients had informed GPs of their symptoms, and GPs' recognition of major depressive episodes. Patients and informants were questioned using the Canberra Interview for the Elderly, which generates rigorous ICD-10 research diagnoses. Results: Logistic regression analysis showed that symptom disclosure was associated in descending order of importance with higher depressive scores, previous contact with a psychiatrist, and female gender. Even so, 48% of persons with ICD-10 moderate or severe depressive episode had not reported any current complaints to their doctor at the time of interview. Conclusion: Older patients often do not report depressive symptoms to their medical practitioner. Men and patients lacking “psychological mindedness” may be at special risk.

Outcome and Impact of Mental Disorders in Primary Care at 5 years

“…This is similar to studies that have found threshold disorders to be more persistent than subthreshold ones (28,45). Depression and anxiety have also been shown to frequently co-occur (44 -48), and this comorbidity is associated with more impairment and chronicity (48). In our study, comorbid mental disorders were a particularly poor prognostic finding and most patients with more than one disorder experienced persistence of their disorder at 5 years.…”

Family Support, Self-Rated Health, and Psychological Distress

“…As shown in one study, nearly half of elderly primary care patients with moderate or severe depression reported no depressive symptoms to their general practitioner, presumably because they felt uncomfortable discussing symptoms with their physicians. 42 Collaborative care between medical and mental health service providers in primary care settings may improve older patients' access to psychological help. 43 Understanding the context in which health problems occur in this population, including patient perceptions of support from family members and perceptions of their own health, can perhaps enhance these collaborative partnerships by providing physicians the unique opportunity to engage in fruitful discussions with patients about their overall health and well-being.…”

Family carers' responses to behavioural and psychological symptoms of dementia

“…To ensure that subjects and carers were truly representative, we approached persons with possible or probable dementia identified in an earlier study of the recognition and management of depression and dementia in general practice (O'Connor et al, 2001).…”