Depression in Primary Care 2: General Practitioners' Recognition of Major Depression in Elderly Patients

Abstract

Background: It is important that serious depressive illness be recognized and treated appropriately by primary care practitioners. This and the preceding article in this issue examine (a) factors responsible for older patients' decision to report depressive symptoms to their doctor and (b) general practitioners' (GPs') recognition of depression 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, using the Canberra Interview for the Elderly, which generates rigorous ICD-10 research diagnoses. Results: GPs' ratings of depression were best predicted in descending order of importance by patients' past contact with a psychiatrist, the doctor's view that a patient did not have dementia, the number of current depressive symptoms, patients' disclosure of these symptoms, and current physical pain. Physicians' assessments of patients' mood concurred with research diagnoses in 23 of 35 (66%) cases of ICD-10 mild depressive episode and 23 of 26 (88%) cases of moderate or severe depressive episode. GPs were unaware, however, of many depressive symptoms and often rated patients as being depressed when they were not. Conclusion: The use of a simple checklist of depressive symptoms would lead to a dramatic improvement in doctors' knowledge of patients' current psychiatric status.

Do Primary Care Physicians Have Particular Difficulty Identifying Late-Life Depression? A Meta-Analysis Stratified by Age

“…Nineteen studies recruited older patients and examined defined late-life depression, but of these only 12 considered both sensitivity and specificity [34,35,36,37,38,39,40,41,42,43,44,45]. Twenty-seven recruited younger adults and of these 12 examined both sensitivity and specificity [46,47,48,49,50,51,52,53,54,55,56].…”

“…The median number of depressed patients per study was 293.5 (SD = 750.2). The criterion methods of establishing depression consisted of a structured or semi-structured interview in 13 studies [34,35,36,37,38,39,46,47,48,49,50,57,58] and severity scales in 18 [40,41,42,43,44,45,51,52,53,54,55,56,59,60,61,62,63]. Of the 13 interview methods, 5 used a DSM-based definition of depression, 6 an ICD-10 definition, 1 the Schedule for Affective Disorder and Schizophrenia and 1 the Short Comprehensive Assessment and Referral Evaluation Interview.…”

“…For example patients with multiple conditions may be overlooked due to focus on physical rather than mental symptoms. However, this ‘crowding out’ hypothesis has been refuted [36,69,70,71]. …”

International comparison of clinicians' ability to identify depression in primary care: meta-analysis and meta-regression of predictors

“…There were four studies from Australia, [42][43][44][45] four from Italy, [46][47][48][49] six from the Netherlands, [50][51][52][53][54][55] three from the UK, [56][57][58] and eight from the US, [59][60][61][62][63][64][65][66] all reporting diagnostic sensitivity (Table 1).…”

L’effet de l’âge, du genre et du statut socioéconomique sur l’utilisation des services de médecine générale pour des symptômes de détresse psychologique

“…Plusieurs études ont montré qu'il y avait un nombre important de troubles dépressifs et anxieux masqués dans la population âgée (Beekman, Deeg, Braam, Smit et van Tilburg, 1997 ;German, Shapiro et Skinner, 1985 ;Klap, Unroe et Unützer, 2003 ;Lebowitz et al, 1997 ;O'Connor, Rosewarne et Bruce, 2001 ;Pfaff et Almeida, 2005 ;Sussman et al, 2011 ;Volkers, Nuyen, Verhaak Schellevis, 2004 ;Waxman, Carrier et Klein, 1984). L'étude ESA a montré que seulement 40 % des personnes âgées répondant aux critères d'un trouble de l'humeur ou d'anxiété du DSM-IV avaient consulté pour leurs symptômes (Préville et al, 2009).…”