title: Depression in public community long-term care: implications for intervention development.
abstract: The objective of this paper is to increase understanding of geriatric depression in the public community long-term care system to guide intervention development. Protocols included screening 1,170 new clients of a public community long-term care agency and interviewing all clients with major, dysthymia, or subthreshold depression (n = 299) and a randomly selected subset of nondepressed older adults (n = 315) at baseline, 6-month, and 1 year. Six percent had major depression, one-half of a percent had dysthymia only, and another 19% had subthreshold depression. Over the year observation period, 40% were persistently depressed; 32% were assessed as depressed only at the first observation; and the remainder was intermittently depressed. There were high levels of comorbid medical, functional, and psychosocial conditions. Mental health service use was low, and clients reported attitudinal and other barriers to depression treatment. Findings suggest the need for universal screening for depression with some strategies for triaging the most severely and persistently depressed for treatment. Although there will be challenges to the development of depression interventions, the public community long-term care system has high potential to assist vulnerable older adults receive help with depression.
authors.affiliation: Center for Mental Health Services Research, Washington University, St. Louis, MO 63130, USA. morrow-howell@wustl.edu
authors.forename: Nancy
authors.initials: N
authors.lastname: Morrow-Howell
authors.forename: Enola
authors.initials: E
authors.lastname: Proctor
authors.forename: Sunha
authors.initials: S
authors.lastname: Choi
authors.forename: Lisa
authors.initials: L
authors.lastname: Lawrence
authors.forename: Ashley
authors.initials: A
authors.lastname: Brooks
authors.forename: Leslie
authors.initials: L
authors.lastname: Hasche
authors.forename: Peter
authors.initials: P
authors.lastname: Dore
authors.forename: Wayne
authors.initials: W
authors.lastname: Blinne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D017150:Public Sector