title: Unmet needs of outpatients with late-life depression; a comparison of patient, staff and carer perceptions.
abstract: BACKGROUND
  There is evidence that late life depression is associated with high levels of unmet needs. Only a minority of the depressed patients appears to be adequately treated.
  
  
  METHODS
  Ninety-nine older patients (58-92 years), 96 informal carers and 85 health-care professionals were recruited from six outpatient facilities for old age psychiatry in the Netherlands and interviewed to identify met and unmet needs, using the Camberwell Assessment of Needs for the Elderly (CANE). The severity of depression was measured with the Montgomery Åsberg Depression Rating Scale (MADRS).
  
  
  RESULTS
  On average patients scored more unmet needs than staff and carers. On item level, patients and staff showed the highest agreement in the psychological needs category. Patient and carers showed the highest agreement on physical health needs. Logistic regression showed that severe depression is a significant predictor of low concordance between stakeholders on a substantial number of CANE items.
  
  
  CONCLUSIONS
  Kappa coefficients were computed to determine agreement between parties involved. However, Kappa coefficients should be interpreted with caution, especially when obvious disparity in unmet needs scores between groups of interest can be observed.
  
  
  CONCLUSIONS
  Home dwelling older patients with major depressive disorder, their practitioners and their informal carers have different perceptions of the older patients unmet needs.Practitioners should be aware of the negative impact of depression severity on reaching agreement regarding unmet needs and its possible consequences for mutual goal setting and compliance.
authors.affiliation: EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. w.houtjes@vumc.nl
authors.forename: W
authors.initials: W
authors.lastname: Houtjes
authors.forename: B
authors.initials: B
authors.lastname: van Meijel
authors.forename: D J H
authors.initials: DJ
authors.lastname: Deeg
authors.forename: A T F
authors.initials: AT
authors.lastname: Beekman
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D003863:Depression; D003866:Depressive Disorder; D003865:Major Depressive Disorder / Q000451:nursing / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006282:Health Personnel; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009426:Netherlands; D010045:Outpatients; D012720:Severity of Illness Index