Negotiating depression treatment with older adults: Primary care providers' perspectives

Wittink, Marsha N.; Givens, Jane L.; Knott, Kathryn; Coyne, James C.; Barg, Frances K.

doi:10.3109/09638237.2011.556164

Cited by 9 publications

(13 citation statements)

References 38 publications

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“…As previously documented in studies of provider-patient communication 46–47 , our study found that patients’ conceptual models of depression and preferences play a key role in the decision making process. Findings from our study further underscore the importance of providing culturally competent care for African Americans and Latinos during mental health treatment with a particular emphasis on techniques to foster shared decision making during each stage of the process.…”

Section: Discussionsupporting

confidence: 72%

Primary Care Professional’s Perspectives on Treatment Decision Making for Depression with African Americans and Latinos in Primary Care Practice

Patel

Schnall

Little

et al. 2013

J Immigrant Minority Health

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Increasing interest has been shown in shared decision making (SDM) to improve mental health care communication between underserved immigrant minorities and their providers. Nonetheless, very little is known about this process. The following is a qualitative study of fifteen primary care providers at two Federally Qualified Health Centers in New York and their experience during depression treatment decision making. Respondents described a process characterized in between shared and paternalistic models of treatment decision making. Barriers to shared decision making included discordant models of illness, stigma, varying role expectations and decision readiness. Respondents reported strategies used to overcome barriers including understanding illness perceptions and the role of the community in the treatment process, dispelling stigma using cultural terms, orienting patients to treatment and remaining available regarding the treatment decision. Findings from this study have implications for planning SDM interventions to guide primary care providers through treatment engagement for depression.

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Section: Discussionsupporting

confidence: 72%

Primary Care Professional’s Perspectives on Treatment Decision Making for Depression with African Americans and Latinos in Primary Care Practice

Patel

Schnall

Little

et al. 2013

J Immigrant Minority Health

View full text Add to dashboard Cite

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“…39,40 Lower treatment initiation among older patients has been attributed to a common misconception of depression as a natural part of the aging process, a generational culture of personal responsibility, attribution of depression to nonmedical causes, and stigma. 39,41,42 Resistance to AD treatment has also been identified in this population. 43 Comorbid medical conditions among older patients may compete for the attention of primary care providers and potentially mask or overlap with depression symptoms.…”

Section: Depression Treatment Initiation In Primary Carementioning

confidence: 84%

Treatment Initiation for New Episodes of Depression in Primary Care Settings

et al. 2018

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Screening for depression in primary care is a positive step towards improving detection, treatment, and outcomes for depression. However, study results indicate that treatment initiation remains suboptimal, and disparities persist. A better understanding of patient factors, and particularly system-level factors, that influence treatment initiation is needed to inform efforts by heath care systems to improve depression treatment engagement and to reduce disparities.

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“…Studies reflected both publicly funded and insurance-based systems. Qualitative data were mostly collected via interviews 18,19,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] and/or focus groups 34,39,[43][44][45][46] with two ethnographic studies, 47,48 one conference and nominal group technique, 49 one mixedmethods survey, 50 and one multiple case study. 51 Two-thirds of studies were of good/ very good overall quality (Table 1); most met the checklist criteria and the vast majority were well reported ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Most HCPs were sampled from primary and community healthcare (for example GPs, practice nurses, or home health nurses), 18,19,28,29,31,32,34,[39][40][41][42]44,47,48,50 with six studies sampling both primary and secondary care professionals, 27,35,45,46,49,51 and a small number studying HCPs in care settings. 33,38,43 One study sampled community psychiatric nurses (CPNs) 36 and one included practice counsellors.…”

Section: Resultsmentioning

confidence: 99%

Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies

et al. 2019

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BackgroundDepressive symptoms are common in later life and increase both the risk of functional and cognitive decline and the use of healthcare services. Despite older people expressing preferences for talking therapies, they are less likely to be referred than younger adults, particularly when aged ≥80 years.AimTo explore how healthcare professionals (HCPs) manage older people in relation to depression and referrals to psychological therapies.Design and settingSystematic review and thematic synthesis of qualitative studies.MethodMEDLINE, Embase, PsycINFO, CINAHL, and the Social Sciences Citation Index (inception–March 2018) were searched for studies exploring HCPs’ views regarding management of late-life depression across all settings. Studies of older people’s views or depression management across all ages were excluded.ResultsIn total, 27 studies, were included; these predominantly focused on the views of GPs and primary and community care nurses. Many HCPs felt that late-life depression was mainly attributable to social isolation and functional decline, but treatments appropriate for this were limited. Clinicians perceived depression to have associated stigma for older adults, which required time to negotiate. Limited time in consultations and the complexity of needs in later life meant physical health was often prioritised over mental health, particularly in people with frailty. Good management of late-life depression appeared to depend more on the skills and interest of individual GPs and nurses than on any structured approach.ConclusionMental ill health needs to be a more-prominent concern in the care of older adults, with greater provision of psychological services tailored to later life. This may facilitate future identification and management of depression.

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Negotiating depression treatment with older adults: Primary care providers' perspectives

Abstract: BACKGROUND-Whether and how primary care providers consider older patients' perceptions of depression may have an impact on patients' acceptance of treatment.

Cited by 9 publications

References 38 publications

Primary Care Professional’s Perspectives on Treatment Decision Making for Depression with African Americans and Latinos in Primary Care Practice

Primary Care Professional’s Perspectives on Treatment Decision Making for Depression with African Americans and Latinos in Primary Care Practice

Treatment Initiation for New Episodes of Depression in Primary Care Settings

Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies

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