Descriptive epidemiology of undetected depression in institutionalized older people.
OBJECTIVE
To measure the prevalence and associated factors of undetected depression in institutionalized older people.


METHODS
Epidemiologic cross-sectional study in nursing homes and residential facilities.


METHODS
A stratified cluster sample of residents 65 years of age and older living in institutions of Madrid (Spain).


METHODS
Residents were considered to be depressed if they met at least 1 of the following 3 criteria: 10-item Geriatric Depression Scale score of 4 or higher, physician's diagnosis, or antidepressant use. Prevalence of undetected depression was defined as the proportion of depressed residents without documented diagnosis or treatment.


RESULTS
A total of 255 of 579 residents had depression (weighted prevalence 46.1%, 95% confidence interval [CI] 41.0%-51.3%) and 108 depressed residents were undetected (undetection prevalence 41.5%, 95% CI 33.2%-50.2%). Undetection was lower in younger residents, private versus public facilities (sex-, age-, and size-adjusted prevalence ratio [PR] 0.59, 95% CI 0.37-0.94), and larger facilities (sex-, age-, and ownership-adjusted PR 0.94 per 50-bed increase, 95% CI 0.88-1.00). Undetected depression was higher in residents with poor self-rated health (sex- and age-adjusted PR 1.83, 95% CI 1.24-2.73), whereas the opposite came about for physician-rated health (PR 0.65, 95% CI 0.44-0.95). Undetection decreased 11% (95% CI 4%-17%) per 1-medication increase, and it was lower in patients with Alzheimer disease, anxiety, and arrhythmia.


CONCLUSIONS
Number of medications and self-rated health were the main determinants of undetected depression. Physician-rated health, facility characteristics (size and ownership), and some diseases could also be considered.
National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain. jdamian@isciii.es
Javier
J
Damián
Roberto
R
Pastor-Barriuso
Emiliana
E
Valderrama-Gama
D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D013030:Spain / Q000453:epidemiology