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Primary Care Physicians' Attitude Toward Diagnosis and Treatment of Late-life Depression

Published online by Cambridge University Press:  07 November 2014

Abstract

Underdiagnosis and undertreatment of late-life depression is common, especially in primary care settings. To help assess whether physicians' attitude and confidence in diagnosing and managing depression serve as barriers to care, a total of 176 physicians employed in 18 primary care groups were administered surveys to assess attitudes towards diagnosis, treatment, and management of depression in elderly patients, (individuals over 65 years of age). Logistic regression was performed to assess the association of physician characteristics on attitudes. Nearly all of the physicians surveyed felt that depression in the elderly was a primary care problem, and 41% reported late-life depression as the most common problem seen in older patients. Physicians were confident in their ability to diagnose and manage depression, yet 45% had no medical education on depression in the previous three years. Physicians' confidence in their ability to diagnose, treat, and manage depression, and their reported adequacy of training, do not appear to correspond to the amount of continuing medical education in depression, suggesting that physician overconfidence may potentially be serving as a barrier to care.

Type
Original Research
Copyright
Copyright © Cambridge University Press 2002

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References

REFERENCES

1.Unutzer, J, Katon, W, Sullivan, M, Miranda, J. Treating depressed older adults in primary care: narrowing the gap between efficacy and effectiveness. Milbank Q. 1999;77:225256.CrossRefGoogle Scholar
2.Unutzer, J, Patrick, D, Simon, G, et al.Depressive symptoms and the cost of health services in HMO patients aged 65 and older. A 4-year prospective study. JAMA. 1997;277:16181623.CrossRefGoogle Scholar
3.Penninx, W, Guralnik, J, Ferruci, L, et al.Depressive symptoms and physical decline in community dwelling older persons. JAMA. 1998;279:17201726.CrossRefGoogle ScholarPubMed
4.Rovner, BW, German, PS, Brant, LJ, Clark, R, Burton, L, Folstein, MF. Depression and mortality in nursing homes. JAMA. 1991;265:993996.CrossRefGoogle ScholarPubMed
5.Penninx, BW, Geerlings, SW, Deeg, DJ, Eijk, JT, van Tilburg, W, Beekman, AT. Minor and major depression and the risk of death in older persons. Arch Gen Psychiatry. 1999;56:889895.CrossRefGoogle ScholarPubMed
6.Lebowitz, B. Diagnosis and treatment of depression in late life: an overview of the NIH consensus statement. Am J Geriatr Psychiatry. 1996;4(suppl):S3S6.Google Scholar
7.Gurland, B, Cross, P, Katz, S. Epidemiological perspectives on opportunities for treatment of depression. Am J Geriatr Psychiatry. 1996;4:714.Google Scholar
8.Oxman, TE, Barrett, JE, Barrett, J, Gerber, P. Symptomatology of late-life minor depression among primary care patients. Psychosomatics. 1990;31:174180.CrossRefGoogle ScholarPubMed
9.Lyness, JM, Noel, TK, Cox, C, King, DA, Conwell, Y, Caine, ED. Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriartic Depression Scale. Arch Inter Med. 1997;157:449454.CrossRefGoogle Scholar
10.Koenig, HG, Blazer, DG. Minor depression in late life. Am J Geriatr Psychiatry. 1996;4:514521.Google Scholar
11. United States Department of Health and Human Services. Mental Health: A report of the surgeon general. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institutes of Mental Health.; 1999.Google Scholar
12.Wells, K, Sturm, R, Sherbourne, C, Meridith, L. Caring for Depression. Cambridge, MA: Harvard University Press.; 1996.Google Scholar
13.Harman, JS, Schulberg, HC, Mulsant, BH, Reynolds, CF. Effect of patient and visit characteristics on diagnosis of depression in primary care. J Fam Prac. 2001;50:1068.Google ScholarPubMed
14.Katon, W, von Korff, M, Lin, E. Adequacy and duration of antidepressant treatment in primary care. Medical Care. 1992;30:6776.CrossRefGoogle ScholarPubMed
15.Unutzer, J, Simon, G, Belin, TR, Datt, M, Katon, W, Patrick, D. Care for depression in HMO patients age 65 and older. J Am Geriatr Soc. 2000;48:871878.CrossRefGoogle Scholar
16.Unutzer, J, Katon, W, Russo, J, et al.Patterns of care for depressed older adults in a large-staff model HMO. Am J Geriatr Psychiatry. 1999;7:235243.CrossRefGoogle Scholar
17.Olfson, M, Pincus, H. Measuring outpatient mental health care in the united states. Health Aff. 1994;13:172180.CrossRefGoogle ScholarPubMed
18.Depression Guideline Panel. Depression in Primary Care: Volume 1. Detection and Diagnosis. Clincial Practice Guideline Number 5. Rockville, MD. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93-0550. April 1993.Google Scholar
19.Depression Guideline Panel. Depression in Primary Care: Volume 1. Detection and Diagnosis. Clincial Practice Guideline Number 5. Rockville, MD. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93-0551. April 1993.Google Scholar
20.American Psychiatric Association. Practice guidelines for major depressive disorder in adults. Am J Psychiatry. 1993;150:S1S26.CrossRefGoogle Scholar
21.Lebowitz, BD, Pearson, J, Schneider, L, et al.Diagnosis and treatment of depression in late life: consensus statement update. JAMA. 1997;278:11861190.CrossRefGoogle ScholarPubMed
22.Harman, JS, Mulsant, B, Kelleher, KJ, Schulberg, HC, Kupfer, DJ, Reynolds, CF. Narrowing the gap in treatment of depression. Int J Psychiatry Med. 2001;31:255269.CrossRefGoogle Scholar
23.Mulsant, B, Alexopoulos, G, Reynolds, C, et al.Pharmacalogical treatment of depression in older primary care patients: the PROSPECT algorithm. Int J Geriatr Psychiatry. 2001;16:585592.CrossRefGoogle Scholar
24. Stata Corp. Stata statistical software: release 6.0. College Station, TX: Stata Corporation; 1999.Google Scholar
25.McCullagh, P, Nelder, JA. Generalized Linear Models. 2nd ed. New York, NY: Chapman and Hall; 1989.CrossRefGoogle Scholar
26.Callahan, CM, Nienaber, NA, Hendrie, HC, Tierney WM. Depression of elderly patients: primary care physicians' attitudes and practice patterns. J Gen Int Med. 1992;7:2631.CrossRefGoogle ScholarPubMed
27.Young, WS, Klap, R, Sherbourne, CD, Wells, KB. The quality of care for depressive and anxiety disorders in the united states. Arch Gen Psychiatry. 2001;58:5561.CrossRefGoogle ScholarPubMed
28.Callahan, C, Dittus, R, Tierney, W. Primary care physician's medical decision making for late-life depression. J Gen Int Med. 1996;11:218225.CrossRefGoogle ScholarPubMed
29.Rost, K, Nutting, P, Smith, J, Coyne, JC, Cooper-Patrick, L, Rubenstein, L. The role of competing demands in the treatment provided primary care patients with major depression. Arch Fam Med. 2000;9:150154.CrossRefGoogle ScholarPubMed
30.Gallo, JJ, Rabins, PJ, Anthony, JC. Sadness in older persons: 13-year follow-up of a community sample in Baltimore, MD. Psychol Med. 1999;29:341350.CrossRefGoogle Scholar
31.Caine, E, Lyness, J, King, D, Connors, L. Clinical and etiological heterogeneity of mood disorders in elderly patients. In: Schneider, L, Reynolds, C, Lebowitz, B, Friedhoff, A, eds. Diagnosis and Treatment of Depression in Late Life: Results of the NIH Consensus Development Conference. Washington, DC: American Psychiatric Association; 1994:2154.Google Scholar