Mental health services in the treatment of late-life depression are critical in the primary care arena. A significant proportion of elderly patients experience depression, a problem causing a far-reaching impact on morbidity, mortality, and quality of life. A number of barriers may prevent effective depression treatment including negative physician and patient attitudes toward the stigma of depression, somatically focused clinical presentations, health care plan constraints, and competing medical demands, as well as gender and geographic isolation. Screening for depression in primary care settings is not always standard fare as physicians may feel confident in their diagnostic abilities. Research addressing effective depression treatment in the primary care setting has been limited to few clinical trials and physician-focused academic detailing. Future research should address real-world scenarios encountered by the primary care physician in their treatment of the “old-old” patient with complex medical comorbidities and functional decline.
Get full access to this article
View all access options for this article.
References
1.
1. Lebowitz BD., Diagnosis and treatment of depression in late life: an overview of the NIH consensus statement. Am J Geriatr Psychiatry1996; 4(Suppl 1): S3–S6.
2.
2. Oxman HM, Carner EA, Klein M., Underutilization of mental health professionals by community elderly. Gerontologist1984; 24: 23–30.
3.
3. Blazer DG, Bachar JR, Manton KG., The epidemiology of depression in an elderly community population. Gerontologist1987; 27: 281–287.
4.
4. Williams-Russo P., Barriers to diagnosis and treatment of depression in primary care settings. Am J Geriatr Psychiatry1996; 4(Suppl 1): S3–S6.
5.
5. Banazak DA, Wills C, Collins C., Late-life depression in primary care: where do we go from here?J Am Osteopath Assoc1998; 98: 489–497.
6.
6. Broadhead EW, Blazer DG, George LK., Depression, disability days and days lost from work in a prospective epidemiologic survey. JAMA1990; 264: 2524–2528.
7.
7. Callahan CM, Hui Sl, Nienaber NA, et al., Longitudinal study of depression and health services use among elderly primary care patients. J Am Geriatr Soc1997; 42: 833–838.
8.
8. Simon GE, von Korff M, Barlow W., Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry1995; 52: 850–856.
9.
9. Colenda CC, Bartels SC, Gottlieb GL., The North American System of CCUC. In: Copeland J, Abou-Sajeh M, Blazer D, eds., Principles and practice of geriatric psychiatry. 2nd ed.London: Wiley and Son, 2002: 689–696.
10.
10. Mickus M, Colenda C., Knowledge of mental health benefits and provider preference. Psychiatr Serv2000; 51: 199–203.
11.
11. Klausner EJ, Alexopoulos GS., The future of psychosocial treatments for elderly patients. Mental Health Aging reprint from Psychiatr Serv1999; 50: 1198–1204.
12.
12. Alarcon FJ, Isaacson JH, Franco-Bronson K., Diagnosing and treating depression in primary care patients: looking beyond physical complaints. Cleve Clin J Med1998; 65: 251–260.
13.
13. Reynolds CF, Kupfer DJ., Depression and aging. A look to the future. Psychiatr Serv1999; 50: 1167–1172.
14.
14. Brody DS, Thompson TL 2nd, Larson DB, et al., Recognizing and managing depression in primary care. Gen Hosp Psychiatry1995; 17: 92–107.
15.
15. Logan JR, Spitze G., Informal support and the use of formal services by older Americans. J Gerontol1994; 49(Suppl 1): S25–S34.
16.
16. Garrard J, Rolnick SJ, Nitz NM, et al., Clinical detection of depression among community-based elderly people with self-reported symptoms of depression. J Gerontol1998; 53: M92–M101.
17.
17. Unutzer J, Simon G, Belin TR, et al., Care for depression in HMO patients aged 65 and older. J Am Geriatr Soc2000; 48: 871–878.
18.
18. US Substance Abuse Mental Health Administration. Fewer US healthcare dollars spent on mental health. July 18, 2000. http://samhsa.gov/news/newsrelease/000718NR.HTM.
19.
19. Rost K, Nutting P, Smith J, et al., The role of competing demands in the treatment provided primary care patients with major depression. Arch Fam Med2000; 9: 150–154
20.
20. Raue PJ., Social support and presentation to outpatient treatment: pilot data. Poster presented at the Institute on Psychiatric Services, Washington, DC, October 25, 1997.
21.
21. Bowers J, Jorm AF, Henderson S, Harris P., General practitioners' detection of depression and dementia in elderly patients. Med J Aust1990; 153: 192–196.
22.
22. Robinson JW, Roter DL., Psychosocial problem disclosure by primary care patients. Soc Sci Med1999; 48: 1353–1362.
23.
23. Tiemens BG, Ormel J, Jenner JA, et al., Training primary-care physicians to recognize, diagnose and manage depression: does it improve patient outcomes?Psychol Med1999; 29: 833–845.
24.
24. Leaf PJ., Factors affecting the utilization of specialty and general medical mental health services. Med Care1988; 26: 9–26.
25.
25. Lemelin J, Hotz S, Swensen R, Elmslie T., Depression in primary care. Why do we miss the diagnosis?Can Fam Physician1994; 40: 104–108.
26.
26. Marino S, Gallo JJ, Ford D, Anthony JC., Filters on the pathway to mental health care, I. Incident mental disorders. Psychol Med1995; 25: 1135–1148.
27.
27. Chochinov HM, Wilson KG, Enns M., “Are you depressed?” Screening for depression in the terminally ill. Am J Psychiatry1997; 154: 674–676.
28.
28. Yesaveage JA, Brink TL, Rose TL., Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res1982–83; 17: 37–49.
29.
29. Radloff LS., The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas1977; 1: 381–401.
30.
30. Mulrow CD, Williams JW, Gerety MG, et al., Case-finding instruments for depression in primary care settings. Ann Intern Med1995; 122: 913–921.
31.
31. Okimoto JT, Barnes RF, Veith RC., Screening for depression in geriatric medical patients. Am J Psychiatry1982; 139: 799–802.
32.
32. Jack MA, Stobo SA, Scott LA., Prevalence of depression in general practice patients over 75 years of age. J R Coll Gen Pract1988; 38: 20–21.
33.
33. NIH Consensus Development Panel on Depression in Later Life. Diagnosis and treatment of depression in late life. JAMA1997; 278: 1186–1190.
34.
34. McCusker J, Cole M, Keller E, et al., Effectiveness of treatments of depression in older ambulatory patients. Arch Intern Med1998; 158: 705–712.
35.
35. Gill D, Hatcher S., Do antidepressants work in physical illness? Presented at the 44th Annual Meeting of the Academy of Psychosomatic Medicine, Coronado, CA, November 22, 1989.
36.
36. Reynolds CF, Frank E, Perel JM., Outcomes of maintenance therapies for recurrent major depression in patients older than 59 years: randomized controlled trial of nortriptyline and interpersonal psychotherapy. JAMA1999; 281: 39045.
37.
37. Colenda CC, Schneider LS, Katz IR, et al., Late-life depression. In: Levenson JL, ed., Philadelphia: American College of Physicians, 2000: 169–200.
38.
38. Katon W, Von Korff M, Lin E, et al., Collaborative management to achieve depression treatment guidelines. J Clin Psychiatry1997; 58(Suppl 1), 20–23.
39.
39. Roose SP, Laghrissi-Thode F, Kennedy JS., Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease. JAMA1998; 279: 287–291.
40.
40. Glassman AH, Rodriquez AI, Shapiro PA., The use of antidepressant drugs in patients with heart disease. J Clin Psychiatry1998; 59(Suppl 10), 4–8.
41.
41. Stoudernire A, Hilld CD, Marquardt M., Recovery and relapse in geriatric depression after treatment with antidepressants and ECT in a medical-psychiatry population. Gen Hosp Psychiatry1998; 20: 170–174.
42.
42. Ashton CM, Duykendall DH, Johnson ML., A method for developing and weighing explicit process of care criteria for quality assessment. Med Care1994; 32: 755–770.
43.
43. Cohen LJ, Gutherie SK., Depression in primary care: review of AHCPR guidelines. Ann Pharmacother1997; 31: 782–785.
44.
44. Niedereche G., Psychosocial treatments with depressed older adults: a research update. Am J Geriatr Psychiatry1996; 4(Suppl 4): S66–S78.
45.
45. Katon W, von Korff M, Lin E, et al., Adequacy and duration of antidepressant treatment in primary care. Med Care1992; 30: 67–76.
46.
46. Pelonero AL., Practice guidelines. In: Levenson JL, ed., Depression. Philadelphia: American College of Physicians. 2000: 310–346.
47.
47. Ellison JM, Harney PA., Treatment-resistant depression and the collaborative treatment relationship. J Psychother Pract Res2000; 9(1), 7–17.
48.
48. Coleman EA, Grothaus LC, Sandhu N, Wagner EH., Chronic care clinics: a randomized controlled trial of a new model of primary care for frail older adults. J Am Geriatr Soc1999; 47: 775–783.
49.
49. Feinman JA, Cardillo D, Palmer J, Mitchel M., Development of a model for the detection and treatment of depression in primary care. Psychiatr Q2000; 71(1), 59–78.
50.
50. Colenda CC, Banazak D, Mickus M., Mental health services in managed care: quality questions remain. Geriatrics1998; 53(8), 49–63.
