title: Discussion of depression in follow-up medical visits with older patients.
abstract: OBJECTIVE
  To determine the frequency of discussion about depression in follow-up medical visits of older patients, who initiates these discussions, the quality of responsiveness of physicians and patients in these discussions, and patient and physician characteristics that influence these discussions.
  
  
  METHODS
  Convenience sample of 482 audiotaped follow-up visits.
  
  
  METHODS
  Three community-based practice sites.
  
  
  METHODS
  Three hundred seventy-six community-dwelling older patients without dementia and 43 primary care physicians.
  
  
  METHODS
  Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis system to determine the content and process of medical conversations; patients completed Medical Outcomes Study 36-item Short Form Survey questionnaires immediately after the visit.
  
  
  RESULTS
  Depression was discussed in 7.3% of medical visits; physicians raised this topic in 41% of visits, patients raised it in 48% of visits, and accompanying persons raised it in 10% of visits. Visits were longer when the topic of depression was discussed. Depression was raised almost exclusively in the first 2.5 years of the patient-physician relationship. Physicians with some geriatric training were more likely to discuss depression, and these visits were shorter than visits to physicians without geriatric training.
  
  
  CONCLUSIONS
  Depression was raised infrequently in follow-up visits. The high prevalence of depression in older people and the associated mortality merit discussion of depression early and later in the patient-physician relationship. Although visits were longer when depression was discussed, physicians with some geriatric training were more likely to raise depression, and more time-efficient when they did so, than physicians without geriatric training.
authors.affiliation: Division of Geriatrics and Gerontology, Weill Medical College of Cornell University, New York, New York 10021, USA. rdadelma@med.cornell.edu
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Adelman
authors.forename: Michele G
authors.initials: MG
authors.lastname: Greene
authors.forename: Erika
authors.initials: E
authors.lastname: Friedmann
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Cook
mesh_terms: D000368:Aged; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D007407:Interviews as Topic / Q000379:methods*; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010821:Physicians, Family; D012189:Retrospective Studies; D013637:Tape Recording; D014481:United States / Q000453:epidemiology