Depression treatment in a sample of 1,801 depressed older adults in primary care.
OBJECTIVE
To examine rates and predictors of lifetime and recent depression treatment in a sample of 1,801 depressed older primary care patients


METHODS
Cross sectional survey data collected from 1999 to 2001 as part of a treatment effectiveness trial.


METHODS
Eighteen primary care clinics belonging to eight organizations in five states.


METHODS
One thousand eight hundred one clinic users aged 60 and older who met diagnostic criteria for major depression or dysthymia.


METHODS
Lifetime depression treatment was defined as ever having received a prescription medication, counseling, or psychotherapy for depression. Potentially effective recent depression treatment was defined as 2 or more months of antidepressant medications or four or more sessions of counseling or psychotherapy for depression in the past 3 months.


RESULTS
The mean age +/- standard deviation was 71.2 +/- 7.5; 65% of subjects were women. Twenty-three percent of the sample came from ethnic minority groups (12% were African American, 8% were Latino, and 3% belonged to other ethnic minorities). The median household income was $23,000. Most study participants (83%) reported depressive symptoms for 2 or more years, and most (71%) reported two or more prior depressive episodes. About 65% reported any lifetime depression treatment, and 46% reported some depression treatment in the past 3 months, although only 29% reported potentially effective recent depression treatment. Most of the treatment provided consisted of antidepressant medications, with newer antidepressants such as selective serotonin reuptake inhibitors constituting the majority (78%) of antidepressants used. Most participants indicated a preference for counseling or psychotherapy over antidepressant medications, but only 8% had received such treatment in the past 3 months, and only 1% reported four or more sessions of counseling. Men, African Americans, Latinos, those without two or more prior episodes of depression, and those who preferred counseling to antidepressant medications reported significantly lower rates of depression care.


CONCLUSIONS
The findings suggest that there is considerable opportunity to improve care for older adults with depression. Particular efforts should be focused on improving access to depression care for older men, African Americans, Latinos, and patients who prefer treatments other than antidepressants.
Unützer
Jürgen
J
Center for Health Services Research, UCLA Neuropsychiatric Institute, Los Angeles, California 90024, USA. unutzer@ucla.edu
Katon
Wayne
W
Callahan
Christopher M
CM
Williams
John W
JW
Hunkeler
Enid
E
Harpole
Linda
L
Hoffing
Marc
M
Della Penna
Richard D
RD
Noel
Polly Hitchcock
PH
Lin
Elizabeth H B
EH
Tang
Lingqi
L
Oishi
Sabine
S
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy*; D005006:Ethnicity; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012923:Social Class
D000928:Antidepressive Agents