title: Depressive symptoms and reduced preventive care use in older adults: the mediating role of perceived access.
abstract: BACKGROUND
  Depressive symptomatology is common in older adults and is associated with reduced adherence to recommended preventive care, but little is known as to why. Understanding how depressive symptoms may interfere with adherence can help to identify leverage points for interventions to increase preventive service use.
  
  
  OBJECTIVE
  This study examined perceived access to medical care as a possible mediator linking depressive symptomatology to reduced preventive service use in older adults.
  
  
  METHODS
  We analyzed data from 5465 respondents completing the 1993 and 2003/2004 waves of the Wisconsin Longitudinal Study. Depressive symptomatology was assessed using the Center for Epidemiologic Studies Depression Scale. Perceived access survey items were organized through factor analysis to represent key dimensions of access: availability/accessibility, affordability, acceptability, and accommodation. The primary outcome was the total number of 7 recommended preventive services that respondents received. Multivariate path analysis was used to estimate direct and indirect effects between depressive symptomatology, perceived access, and preventive service use.
  
  
  RESULTS
  Older adults with depressive symptomatology received fewer recommended services. Depressive symptomatology reduced preventive service use by adversely affecting 2 dimensions of perceived access: (1) acceptability, pertaining to poor patient-provider trust and communication, and (2) accommodation, pertaining to inconveniently organized services.
  
  
  CONCLUSIONS
  Depressive symptomatology may negatively alter older adults' perceptions of access and, in turn, negatively impact their preventive service use. In addition to treating depression, interventions designed to mitigate the impact of depression on the patient-provider relationship, and organizational changes to practice that better accommodate the needs of depressed patients, may increase adherence to preventive care guidelines in depressed older adults.
authors.affiliation: Division of Social and Administrative Sciences, University of Wisconsin, Madison School of Pharmacy, USA. thorpe2@wisc.edu
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Thorpe
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
authors.forename: Korey A
authors.initials: KA
authors.lastname: Kennelty
authors.forename: Betty A
authors.initials: BA
authors.lastname: Chewning
mesh_terms: D003863:Depression / Q000523:psychology*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014922:Wisconsin