Gender disparities in the treatment of late-life depression: qualitative and quantitative findings from the IMPACT trial.
OBJECTIVE
The objectives of this study were to examine gender differences in recruitment, depression presentation, and depression treatment history in a large effectiveness trial; and to use qualitative data to generate hypotheses about reasons for observed gender differences.


METHODS
Data from IMPACT, a multisite trial of a disease management program for late-life depression in primary care were used to examine gender differences quantitatively. Qualitative interviews were conducted with 30 key informants from IMPACT (referring physicians, depression care managers, and study recruiters) to learn more about challenges in recruiting and treating depressed older men and then analyzed thematically.


RESULTS
Compared with older women, older men were significantly less likely to be referred to IMPACT, to endorse core depressive symptoms, and to have received prior depression treatment. Gender differences in prior depression treatment persisted after adjustment for covariates. Qualitative themes identified as important contributors to gender disparities included 1) how men experience and express their depression, 2) traditional masculine values, and 3) the stigma of chronic mental illness.


CONCLUSIONS
This study provides further evidence of the gender gap in depression care, identifies possible contributing factors, and suggests avenues for future research.
Hinton
Ladson
L
Department of Psychiatry and Behavioral Sciences, University of California-Davis School of Medicine, Sacramento, California 95817, USA. ladson.hinton@ucdmc.ucdavis.edu
Zweifach
Mark
M
Oishi
Sabine
S
Tang
Lingqi
L
Unützer
Jürgen
J
D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D003710:Demography; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019260:Expressed Emotion; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012737:Sex Factors; D012803:Sick Role; D013240:Stereotyping