Major depressive disorder in late life: a multifocus perspective on care needs.
BACKGROUND
The effectiveness of late-life depression treatment can be improved by tailoring interventions to patients' needs. Unmet needs perceived by patients suffering from a severe mental illness, e.g. depression, may have a negative impact on their recovery.


OBJECTIVE
The aim of this study is to gain insight into the needs of outpatients with late-life depression.


METHODS
Ninety-nine outpatients (aged 58-92) receiving treatment for major depressive disorder were recruited from six specialized mental health care facilities in the Netherlands. They were interviewed using the Dutch version of the Camberwell Assessment of Needs for the Elderly (CANE-NL) to identify met and unmet needs. The Montgomery-Asberg Depression Rating Scale was administered to measure depression severity.


RESULTS
Depression severity levels varied from remission (23%), mild (31%), moderate (31%) to severe depression (15%). The average number of needs reported was 8.86, comprising 6.5 met needs and 2.3 unmet needs. Most of the unique variance in depression severity was explained by psychological unmet needs, more in particular by needs representing psychological distress. The environmental, social or physical unmet needs, respectively, showed less or no meaningful predictive value for variance in depression severity.


CONCLUSIONS
The psychological needs category of the CANE appeared to be the strongest predictor of depression severity. Systematic needs assessment may be considered as a necessary complement to medical examination and a prerequisite for the development of tailored treatment plans for older people with depression.
Houtjes
W
W
EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. w.houtjes@vumc.nl
van Meijel
B
B
Deeg
D J H
DJ
Beekman
A T F
AT
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D040561:Assisted Living Facilities / Q000458:organization & administration; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000523:psychology; D015577:Geriatric Assessment; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index