title: Assessment and treatment of geriatric depression in primary care settings.
abstract: OBJECTIVE
  To examine primary care physicians' practices relating to the diagnosis and management of geriatric depression, attitudes regarding responsibilities for and barriers to management, self-assessments of their needs in providing this care, and physician characteristics that correlate with attitudes and practices.
  
  
  METHODS
  Descriptive and analytic needs assessment.
  
  
  METHODS
  A midwestern city and surrounding county and the suburb of another midwestern city.
  
  
  METHODS
  A self-administered survey consisting mainly of close-ended, Likert scale questions.
  
  
  METHODS
  One hundred forty-one family physicians and general internists (53.2%) responded. Respondents were 75.4% male and 50.8% general internists and ranged in age from 29 to 75 years (mean, 43 years; SD, 11 years).
  
  
  RESULTS
  No standard test to screen for depression was used by 66.7% of respondents. The 2 most common laboratory studies ordered were thyroid studies (41.1%) and chemistry panels (37.6%). Selective serotonin reuptake inhibitors were most commonly prescribed for depression (53.2%). Although 98.6% of respondents agreed that treatment of depression in elderly patients was important, 29.0% reported that depressed elderly patients frustrated them, and 24.2% were too pressured for time to routinely investigate depression in the elderly. The most frequently identified needs in caring for these patients were increased time with patients (97.1%); increased reimbursement for counseling (87.8%); greater emphasis in medical training on the link between physical and mental health (85.6%); improved patient compliance with treatment (84.3%); and more training and attention to depression in residency (82.1%). In general, family physicians were more active and positive in their approach toward geriatric depression.
  
  
  CONCLUSIONS
  Potential interventions to improve the diagnosis and management of geriatric depression include the following: use of screening instruments in a more efficient and timely manner; increased reimbursement for counseling of patients; more educational programs at the undergraduate, graduate, and continuing medical education levels; and clinical practice guidelines specific to geriatric depression.
authors.affiliation: Department of Family and Community Medicine, University of Illinois College of Medicine at Rockford, 61107, USA.
authors.forename: M
authors.initials: M
authors.lastname: Glasser
authors.forename: J A
authors.initials: JA
authors.lastname: Gravdal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003863:Depression / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care