Perceptions about competing psychosocial problems and treatment priorities among older adults with depression.
OBJECTIVE
Depression often co-occurs with other conditions that may pose competing demands to depression care, particularly in later life. This study examined older adults' perceptions of depression among co-occurring social, medical, and functional problems and compared the priority of depression with that of other problems.


METHODS
The study's purposeful sample comprised 49 adults age 60 or older with a history of depression and in publicly funded community long-term care. Four-part, mixed-methods interviews sought to capture participants' perceptions of life problems as well as the priority they placed on depression. Methods included standardized depression screening, semistructured qualitative interviews, listing of problems, and qualitative and quantitative analysis of problem rankings.


RESULTS
Most participants identified health, functional, and psychosocial problems co-occurring with depressive symptoms. Depression was ranked low among the co-occurring conditions; 6% ranked depression as the most important of their problems, whereas 45% ranked it last. Relative rank scores for problems were remarkably similar, with the notable exception of depression, which was ranked lowest of all problems. Participants did not see depression as a high priority compared with co-occurring problems, particularly psychosocial ones.


CONCLUSIONS
Effective and durable improvements to mental health care must be shaped by an understanding of client perceptions and priorities. Motivational interviewing, health education, and assessment of treatment priorities may be necessary in helping older adults value and accept depression care. Nonspecialty settings of care may effectively link depression treatment to other services, thereby increasing receptivity to mental health services.
Brown School of Social Work, Washington University, 1 Brookings Dr., Campus Box 1093, St. Louis, MO 63130, USA. ekp@wustl.edu
Enola K
EK
Proctor
Leslie
L
Hasche
Nancy
N
Morrow-Howell
Martha
M
Shumway
Grace
G
Snell
D000368:Aged; D015897:Comorbidity; D003657:Decision Making; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010465:Perception