Clinical detection of depression among community-based elderly people with self-reported symptoms of depression.
BACKGROUND
Depression is under-diagnosed and under-treated in the primary care sector. The purpose of this study was to determine the association between self-reported indications of depression by community-dwelling elderly enrollees in a managed care organization and clinical detection of depression by primary care clinicians.


METHODS
This was a 2-year cohort study of elderly people (n = 3410) who responded to the Geriatric Depression Scale (GDS) at the midpoint of the study period. A broad measure of clinical detection was used consisting of one or more of three indicators: diagnosis of depression, visit to a mental health specialist, or antidepressant medication treatment.


RESULTS
Approximately half of the community-based elderly people with self-reported indications of depression (GDS > or = 11) did not have documentation of clinical detection of depression by health providers. Physician recognition of depression tended to increase with the severity of enrollees' self-reported feelings of depression. Men 65-74 years old and those > or = 85 years old were at highest risk for under-detection of depression by primary care providers.


CONCLUSIONS
Clinical detection of depression of elderly people living in the community continues to be a problem. The implications of failure to recognize the possibility of depression among elderly White men suggest a serious public health problem.
Garrard
J
J
Institute of Health Services Research, School of Public Health, University of Minnesota, Minneapolis, USA. jgarrard@maroon.tc.umn.edu
Rolnick
S J
SJ
Nitz
N M
NM
Luepke
L
L
Jackson
J
J
Fischer
L R
LR
Leibson
C
C
Bland
P C
PC
Heinrich
R
R
Waller
L A
LA
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D015331:Cohort Studies; D003154:Community Medicine / Q000379:methods*; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D010820:Physicians; D012647:Self-Assessment