Gender differences in positive screen for depression and diagnosis among older adults in Chile

Abstract

Background Different factors are associated with late life depression and diagnosis, including gender. It has also been reported that depression among older people is underdiagnosed. As a result, the mental health needs of this group are insufficiently met. The aim of this study was to explore gender differences in the factors associated with positive screens for depression and self-reported diagnosis among older adults in Chile. Methods Data from 3786 older adults who participated in the Social Protection Survey in 2016 were analysed. PHQ-9 was used to identify screen-positive cases. Self-reported diagnosis of depression was used to determine the proportion of people with a screen-positive result who had received a diagnosis of depression. Logistic regression models were used to determine sociodemographic and health factors associated with depression and underdiagnosis in older men and women. Results The prevalence of a screen-positive result was 20.91% (5.83% major depressive disorder) among men, and 36.38% (12.43% major depressive disorder) among women. 18.77% of men and 34.11% of women with a positive depression screening had received a diagnosis. More educated men were more likely to receive a diagnosis. Older age was associated with a lower probability of diagnosis among older women. Conclusions Our results suggest that depressive disorders are undiagnosed in a high proportion of older adults in Chile. Gender is a relevant factor in the underdiagnosis of depression in this group. Further research is needed to understand the factors involved in these gaps, to improve detection and provide timely support and treatment.

Subjective Assessments of Quality of Life Are Independently Associated with Depressive Symptoms among Older Adults Enrolled in Primary Care in Chile

“…According to population studies, the prevalence of major depressive disorder among Chilean older adults has been estimated between 3.6 and 5.0 percent considering the DSM-IV and ICD-10 criteria [18,19]. Positive screening for severe depression among older women in Chile ranges between 5.4 and 6.3 percent and between 7.4 and 12.9 percent among older men, as reported by previous studies [16,17,20]. As a response to the high burden of disease attributable to depression, the Chilean national program for detecting, diagnosing, and treating depression was launched by the beginning of the century, and it was implemented in primary care by 2004 [21].…”

“…Research about the factors associated with depression in older adults in Chile is scarce. Associations with gender, age, education, living alone, region of residence, multimorbidity, disability, pain, feelings of loneliness, and spirituality have been found [16,17,[24][25][26]. Only two studies considered variables from different domains, including sociodemographic factors and health status indicators [16,17].…”

“…Associations with gender, age, education, living alone, region of residence, multimorbidity, disability, pain, feelings of loneliness, and spirituality have been found [16,17,[24][25][26]. Only two studies considered variables from different domains, including sociodemographic factors and health status indicators [16,17]. No previous study has analyzed a set of subjective assessments of quality of life along with sociodemographic and health variables.…”

“…The number of studies about late-life depression in Chile is limited, but the results show that the prevalence of depressive symptoms is high and that above 64% of older adults with mild to severe symptoms of depression have not received a diagnosis [ 16 , 17 ]. The adverse outcomes associated with depression in old age stress the need to determine which groups of older adults are more likely to experience depressive symptoms in Chile.…”

“…In the case of older adults enrolled in primary care in Chile, they undergo, at least once a year, an exam to identify people at risk of dependence, which includes a screening for depressive symptoms [ 23 ]. However, as described previously, a high proportion of older adults in Chile who screen positive for depression are not diagnosed [ 16 , 17 ].…”