title: Physician willingness to refer older depressed patients for psychotherapy.
abstract: OBJECTIVE
  Psychotherapy for late-life depression is an efficacious treatment option for older primary care patients who do not wish to take or do not respond to antidepressant medication. However, rates of physician referral to psychotherapy to treat late-life depression tend to be low. The purpose of this study was to assess attitudes toward psychotherapy for late-life depression and to identify predictors of physician willingness to refer older patients to psychotherapy.
  
  
  METHODS
  Two hundred and five physicians identified from PPO directories of general internists in California and North Carolina completed a brief mailed survey about how they would treat a hypothetical older depressed patient and specific attitudes and practices regarding their own treatment of late-life depression.
  
  
  RESULTS
  Only 27 percent of physicians said they would refer a depressed older patient to psychotherapy. In a regression analysis, female gender, the belief that psychotherapy is effective for older adults, and physician use of psychosocial techniques were associated with increased willingness to refer to psychotherapy. Practicing in North Carolina, awareness of depression treatment guidelines, and the perception of patient willingness to attend psychoeducational classes on depression and medication management were associated with decreased willingness to refer.
  
  
  CONCLUSIONS
  More efforts are needed to increase the use of referral to psychotherapy as a treatment option for older medical patients. Education about guideline-level treatment alone may not be sufficient. More specific education, including information about the efficacy of psychotherapy for older adults, as well as direct training in psychosocial techniques, may be helpful in promoting referral to psychotherapy.
authors.affiliation: Department of Psychiatry, University of California, San Francisco 94115, USA. alvid@itsa.ucsf.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Alvidrez
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Areán
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards; D008875:Middle Aged; D010817:Physician-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires