title: Identification and recognition of depression in community care assessments: impact of a national policy in England.
abstract: BACKGROUND
  Depression continues to be under-recognized in older people. Most policies addressing this issue focus on the primary health care team. However, recognition may be improved by use of assessment tools and collaboration between secondary health and social care, particularly at the assessment stage. This study aimed to evaluate whether the Single Assessment Process (SAP), introduced in England from April 2004, promoting such processes, improved the identification and correct recognition of depression by enhancing the content of statutory community care assessments by social services care managers.
  
  
  METHODS
  An observational study compared depression identification and its accuracy ("correct recognition") in samples of older people before and after SAP introduction. Participants were interviewed using standardized measures including the Geriatric Depression Scale (GDS). Depression elicited from the GDS was compared with that recorded in community care assessments with calculation of inter-rater reliabilities (kappa statistic) pre- and post-SAP. Logistic regression examined the associations between the policy's introduction, potential confounding factors (depression, cognitive impairment, function, behavior and characteristics) and the identification and correct recognition of depression.
  
  
  RESULTS
  Whilst the identification of depression was more likely after SAP, its correct recognition did not improve after the policy, with only slight agreement between GDS and community care assessments. The existence of depression and cognitive impairment made identification, but not correct recognition, more likely.
  
  
  CONCLUSIONS
  Correct recognition of depression was not improved in these statutory care assessments following the policy. Recognizing and thus responding to depression in a coordinated and appropriate way in the community requires further action.
authors.affiliation: Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK. paul.clarkson@manchester.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Clarkson
authors.forename: Michele
authors.initials: M
authors.lastname: Abendstern
authors.forename: Caroline
authors.initials: C
authors.lastname: Sutcliffe
authors.forename: Jane
authors.initials: J
authors.lastname: Hughes
authors.forename: David
authors.initials: D
authors.lastname: Challis
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D004739:England / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000592:standards