Effect of patient gender on late-life depression management.
OBJECTIVE
To determine whether patient gender influences physicians' management of late-life major depression in older and younger elderly patients.


METHODS
In 1996-2001, physician subjects viewed a professionally produced videotape vignette portraying an elderly patient meeting diagnostic criteria for major depression, then answered interviewer-administered questions about differential diagnosis and treatment. Patient gender and other characteristics were systematically varied in different versions of the videotape, but clinical content was held constant. This was a stratified random sample of 243 internists and family physicians with Veterans Health Administration (VA) or non-VA ambulatory care practices in the Northeastern United States. Outcomes were whether physicians followed a guideline-recommended management approach: treating with antidepressants or mental health referral or both and seeing the patient for follow-up within 2 weeks.


RESULTS
Only 19% of physicians recommended treating depression (12% recommended antidepressants and 7% mental health referral), and 43% recommended follow-up within 2 weeks. Patient gender did not influence management recommendations in either younger old (67 year old) or older old (79 year old) patients (p > 0.12 for all comparisons).


CONCLUSIONS
Gender disparities previously documented in the management of major conditions are not seen for the management of depression, a potentially stigmatized condition that does not require resource-intense interventions.
Frayne
Susan M
SM
Center for Health Care Evaluation, VA Palo Alto Healthcare System, and Stanford University, Palo Alto, California 94025, USA. sfrayne@stanford.edu
Skinner
Katherine M
KM
Lin
Hai
H
Ash
Arlene S
AS
Freund
Karen M
KM
D000328:Adult; D001291:Attitude of Health Personnel; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009511:New England; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014743:Videotape Recording; D016387:Women's Health