title: Management strategies in geriatric depression by primary care physicians and factors associated with the use of psychiatric services: a naturalistic study.
abstract: Approximately 10% of elderly patients in primary care have depression yet it is often under-diagnosed and under-treated. It is unclear exactly how patients are being managed in primary care or what factors are associated with referral to psychiatric services. This study aimed to establish in a naturalistic setting how older depressed patients are managed in primary care; to determine which patients are referred to psychiatric services and the differences between patients referred and those not; in terms of primary care consultation rate and degree of co-morbid illness. Computerised records and referral letters were read for 1089 elderly patients in a large practice in central Manchester, UK. Of the 9% identified as depressed, 90% were managed in primary care alone, a third without antidepressants. More than half of those prescribed antidepressants received tricyclic antidepressants. Suicidal ideation and treatment failure were the principle reasons for referral. Patients referred had a greater psychiatric co-morbidity and had consulted their GP more frequently in the past year. Management of depression in the elderly may be conservative and older antidepressants may be over-prescribed. Increased primary care consultation rate and a greater psychiatric co-morbidity may be associated with referral to psychiatric services.
authors.affiliation: Department of Psychiatry, Royal Preston Hospital, Preston, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Dearman
authors.forename: W
authors.initials: W
authors.lastname: Waheed
authors.forename: V
authors.initials: V
authors.lastname: Nathoo
authors.forename: R C
authors.initials: RC
authors.lastname: Baldwin
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy / Q000628:therapy*; D005163:Factor Analysis, Statistical; D005260:Female; D005852:Geriatric Psychiatry / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012931:Social Environment; D006113:United Kingdom
chemical_list: D000928:Antidepressive Agents