The prevalence of depression amongst outpatients with multimorbidity

Abstract

<p style="text-align:justify;"> <span style="font-size:10pt;font-family:Verdana;">Objectives: Depression may be under-diagnosed and under-treated amongst older adults with multiple chronic illnesses. The current study explores the prevalence of depression diagnosis and Geriatric Depression Scale (GDS) symptoms amongst older multimorbid outpatients, and agreement between GDS scores and doctor-diagnosed depression. Method: Deidentified data from the files of 452 patients aged over 64, with chronic conditions present in two or more organ domains, were extracted from the clinical database of a tertiary referral hospital multidisciplinary outpatient clinic in South Australia between 2005 and 2011. Frequency calculations determined the prevalence of depression diagnosis and GDS categories. Logistic regression, cross-tabulation, kappa and ROC graphs explored relationships between variables. Results: A depression diagnosis had been recorded for 71 (15.7%) patients. Using the recommended cut-off scores for the GDS, 225 (49.8%) patients met criteria for mild-severe depressive symptoms, and 96 (21.3%) met criteria for moderate-severe symptoms. Poor agreement was found between doctor diagnosis of depression and a positive screen for depression using a GDS cut-off score of either 5, k = 0.112 (p = 0.001), or 9, k = 0.189 (p < 0.001), although logistic regression found an association between severity of depression and depression diagnosis, OR = 1.15, p < 0.001 (CI = 1.08 - 1.22). Con-clusion: A much higher proportion of patients with multimorbidities reported threshold level depression symptoms than had a recorded diagnosis of depression, suggesting that although likelihood of diagnosis increases with symptom </span><span style="font-family:Verdana;font-size:10pt;line-height:1.5;">severity, depression often goes undetected in this population. Depressions’ negative impact on prognosis calls for further investigation of the barriers to screening and diagnosis of depression in multimorbid patients.</span> </p

Physical multimorbidity and subjective cognitive complaints among adults in the United Kingdom: a cross-sectional community-based study

“…Interestingly, in our study, depression was not a mediator in the association between multimorbidity and SCC. This was an unexpected finding given the previous reports that depression is highly prevalent in individuals with somatic disorders 51 and that depression and cognitive impairment are highly comorbid 52 . The reason for this is unclear and future studies are warranted to assess whether our results can be corroborated.…”

Depression diagnosis and treatment amongst multimorbid patients: a thematic analysis

“…Depression has a substantive negative impact on quality of life. Research over the last twenty years suggests that depression is under-diagnosed and under-treated amongst older people in Western nations [ 1 - 4 ], and the literature suggests that general practitioners (GPs) are less successful at identifying depression in older patients than younger patients [ 5 ].…”

Chronic Illnesses and Depressive Symptoms Among Older People: Functional Limitations as a Mediator and Self-Perceptions of Aging as a Moderator

“…In all, 23% experienced a chronic course of depressive symptoms (Luppa et al, 2012). Depression often goes underdiagnosed and undertreated among older people with multiple chronic illnesses because complex physical symptoms that are similar to depressive symptoms make it difficult to detect and manage depression (Stanners, Barton, Shakib, & Winefield, 2013). Depression not only has a negative impact on quality of life, but also older people with depression are more likely to experience longer episodes of the physical disease and hospitalization (Adamson, Price, Breeze, Bulpitt, & Fletcher, 2005).…”