Treatment adequacy and remission of depression and anxiety disorders and quality of life in primary care older adults

Abstract

Background Studies on the long-term outcomes of receiving adequate treatment for depression and anxiety disorders are scarce. The aims of this study were to assess the association between adequacy of care and remission of common mental disorders (CMD) and change in quality of life among a population of older adults consulting in primary care. Methods The study was conducted among 225 older adults with a CMD who participated in the longitudinal ESA-Services study. Adequacy of care was assessed using administrative and self-reported data and was based on Canadian guidelines and relevant literature. CMD were measured at baseline and follow-up using self-reported measures (DSM-5 criteria) and physician diagnostic codes (International Classification of Diseases, 9th and 10th revisions) for depression and anxiety disorders. The remission of CMD was defined by the presence of at least one disorder at baseline and absence at follow-up. Quality of life was measured at baseline and follow-up using a visual analog scale and the Satisfaction With Life Scale. To estimate the probability to receive adequate/inadequate care, a propensity score was calculated, and analyses were weighted by the inverse probability. Weighted multivariable analyses were carried out to assess the remission of CMD and change in quality of life as a function of adequacy of care controlling for individual and health system factors. Results Results showed that 40% of older adults received adequate care for CMD and 55% were in remission at follow-up. Adequacy of care was associated with remission of CMD (AOR: 0.66; CI 0.45–0.97; p-value: 0.032). Participants receiving adequate care had an improvement between baseline and follow-up of 0.7 (beta: 0.69, CI 0.18; 1.20, p = 0.008) point on the Satisfaction With Life Scale, while a marginal association was observed with improvement in HRQOL (beta: 2.83, CI 0.12; 5.79, p = 0.060). Conclusion The findings contribute to the rare observational studies on the association between adequacy of care for CMD and long-term treatment effects. Future studies on population effectiveness should focus on patient indicators of quality of care which may better predict long-term outcomes for patients with depression and anxiety.

Quality of Life in Community-Dwelling Older People with Functional and Nutritional Impairment and Depressive Symptoms: A Comparative Cross-Sectional Study in Brazil and Portugal

“…This behavior between the groups can be explained by the negative impact that malnutrition has on all domains and dimensions of QoL [ 35 ]. In addition, data indicate that nutrition has a greater impact on QoL than depressive symptoms [ 36 ].…”

“…However, the results found in Canada [ 36 ], Spain [ 37 ], China [ 28 ] and Ethiopia [ 8 ] can be considered valid, which show that depression is a strong predictor of worse QoL scores. In our study, we observed results that point to a similar association, with emphasis on subjects from Portugal who showed greater depressive symptoms.…”

Mental health service use and associated predisposing, enabling and need factors in community living adults and older adults across Canada

“…Although the cross-sectional nature of the current study design precludes concluding on causality, these findings suggest the importance of receipt of mental health services in improving perceived mental health. In a recent longitudinal study in community primary care older adults, minimally adequate care for depression and anxiety was associated with improved self-reported mental health outcomes, such as life satisfaction and health related quality of life [ 31 ].…”

Minimally Adequate Treatment for Depression and Anxiety Associated With Mortality in Primary Care Older Adults

“…Since pharmacological treatment is not recommended for specific phobia, MAT was defined as the presence of five psychotherapy sessions within a year. The detailed description of MAT for depression and anxiety disorders has previously been described elsewhere 39 .…”