Identification and treatment of depression of older adults in primary care: findings from the São Paulo Ageing and Health Study

Scazufca, Márcia; Menezes, Paulo Rossi; Tabb, Karen M.; Kester, Rachel; Rössler, Wulf; Huang, Hsiang

doi:10.1093/fampra/cmv062

Cited by 15 publications

(12 citation statements)

References 30 publications

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“…Screening may be a useful tool for identifying depressed persons with diabetes, because previous research has shown that the uptake of depression care is low, due to poor depression recognition by healthcare professionals in standard care [15–17]. Another possibility for the low uptake of depression care is that many depressed persons with diabetes do not have a need for psychological care.…”

Section: Introductionmentioning

confidence: 99%

Is type of depressive symptoms associated with patient-perceived need for professional psychological care in depressed individuals with diabetes?

et al. 2019

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Aims The objective of this study is to investigate whether type of depressive symptoms (i.e. cognitive-affective or somatic) is related to a patient-perceived need for professional psychological care in individuals with diabetes. Methods In total 2266 participants were recruited as part of the screening procedure for a multi-center randomized controlled trial on the treatment of depressive symptoms among individuals with diabetes. Individuals were invited to complete Beck Depression Inventory-II (BDI-II). Patients with elevated depressive symptoms (BDI-II ≥14) were interviewed about their psychological care need. Based on their care needs patients were categorized into: unmet need, no need, met need and unclear need. These groups were compared on type of depressive symptoms, as categorized into cognitive-affective symptoms and somatic symptoms. Results 568 eligible individuals had elevated depressive symptoms, of whom 519 were reached. Among these depressed individuals, 19.7% (102 of 519) had an unmet need for psychological care. Participants with an unmet need were younger ( p <0.001) and had higher total depression scores compared to the group with no need ( p <0.001). They also scored higher on cognitive-affective symptoms ( p <0.001), whereas somatic symptoms did not significantly differ ( p = 0.232). Logistic regression revealed that cognitive-affective symptoms predicted an unmet need ( p = 0.001). However, overall predictive capacity of type of depressive symptoms on care needs was weak. Conclusions Cognitive-affective symptoms of depression—but not somatic symptoms—were associated with an unmet need for psychological care among depressed individuals with diabetes. Future research is needed to reveal better predictors explaining the discrepancy between distress and low care needs in order to optimize screening procedures.

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Section: Introductionmentioning

confidence: 99%

Is type of depressive symptoms associated with patient-perceived need for professional psychological care in depressed individuals with diabetes?

et al. 2019

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“…A National Health Survey-Brazil (2013) found a higher prevalence of depression diagnosis in people aged between 60 and 64 years (11.1%) and 65 and 74 years (9.9%) compared with the other age groups over 18 years (3.9–8.8%) [ 5 , 6 ]. Moreover, a study with older adults living in poor neighbourhoods in São Paulo, Brazil, found that 5% of this population met the criteria for a depressive episode and that identification of depression symptoms was low, with less than 5% of those who met these criteria being diagnosed by primary care services [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, mental health care is still not adequately integrated into the primary care services, and there is a scarcity of trained mental health resources working in the public system [ 8 ]. Thus, depression in later life is often unidentified and left untreated despite the vast array of adverse social, economic and health consequences [ 7 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

A collaborative care psychosocial intervention to improve late life depression in socioeconomically deprived areas of Guarulhos, Brazil: the PROACTIVE cluster randomised controlled trial protocol

Scazufca

Nakamura

Peters

et al. 2020

Trials

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Background The elderly population has been growing in most low- and middle-income countries (LMIC), and depression is a common condition among these populations. The lack of integration between mental health and primary healthcare services and the shortage of mental health specialists in the public health system contribute to underdiagnosis and undertreatment of depression. One of the strategies to reduce this gap is task shifting and collaborative care treatments. This study therefore aims to evaluate the effectiveness and cost-effectiveness of a collaborative care psychosocial intervention to improve the clinical management of depression among elderly people in poor neighbourhoods in Guarulhos, Brazil. Methods Two-arm, cluster randomised controlled trial with Basic Health Units as the clusters and a 1:1 allocation ratio. Twenty Basic Health Units have been randomly selected and randomised to control or intervention arms. We aim to recruit 1440 adults (72 per cluster) aged 60 years or over identified with depression (9-item Patient Health Questionnaire (PHQ-9) score ≥ 10). The control arm participants will receive an enhanced usual care, while the intervention arm participants will receive an enhanced usual care and a 17-week psychosocial intervention programme delivered at home by community health workers with the help of an application installed on tablet computers. The primary outcome is the proportion with depression recovery (PHQ-9 < 10) at 8 months’ follow-up. We will also assess the maintenance of any earlier clinical gains and the cost-effectiveness of the intervention at 12 months. Discussion This is the first randomised trial to investigate a collaborative care intervention to treat depression among poor elderly in LMIC/Latin America. This is a major public health problem worldwide, but in these countries, there are no locally tested, evidence-based interventions available to date. Trial registration International Standard Randomised Controlled Trial Number ISRCTN57805470. Registered on 25 April 2019

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“…Scazufa et al [24] compared the depression identification and treatment rates with those of diabetes and hypertension among elderly individuals served in primary care [25]. Of 1558 participants, 4.8 % were diagnosed with depression based on ICD-10 criteria.…”

Section: Hypertensionmentioning

confidence: 99%

Psychiatric and Medical Comorbidity in the Primary Care Geriatric Patient—An Update

Kennedy

Castro

Chang

et al. 2016

Curr Psychiatry Rep

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The mental health needs of older primary care patients are now widely recognized if not widely addressed. The range of behavioral health approaches including co-locating psychiatrists and integrating mental health professionals as care managers into primary care sites is extensive and growing. Nonetheless the primary care provider remains the first line of defense against mental disorders, most commonly depression and anxiety that accompany and exacerbate common physical conditions. The excess, potentially avoidable disability that results from comorbidity makes it imperative that early recognition and evidence based intervention occur. Multi-morbidity and polypharmacy make intervention a challenge. Psychotherapy can help overcome comorbidity depression however the most accessible intervention would be an antidepressant FDA approved for both anxiety and depressive disorders. For all these reasons, a focus on physical conditions most commonly associated with mental disorders can foster early recognition before the older patient's care becomes overwhelmingly complicated.

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Identification and treatment of depression of older adults in primary care: findings from the São Paulo Ageing and Health Study

Cited by 15 publications

References 30 publications

Is type of depressive symptoms associated with patient-perceived need for professional psychological care in depressed individuals with diabetes?

Is type of depressive symptoms associated with patient-perceived need for professional psychological care in depressed individuals with diabetes?

A collaborative care psychosocial intervention to improve late life depression in socioeconomically deprived areas of Guarulhos, Brazil: the PROACTIVE cluster randomised controlled trial protocol

Psychiatric and Medical Comorbidity in the Primary Care Geriatric Patient—An Update

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