title: A prospective study of mental health care for comorbid depressed mood in older adults with painful osteoarthritis.
abstract: BACKGROUND
  Comorbid depression is common among adults with painful osteoarthritis (OA). We evaluated the relationship between depressed mood and receipt of mental health (MH) care services.
  
  
  METHODS
  In a cohort with OA, annual interviews assessed comorbidity, arthritis severity, and MH (SF-36 mental health score). Surveys were linked to administrative health databases to identify mental health-related visits to physicians in the two years following the baseline interview (1996-98). Prescriptions for anti-depressants were ascertained for participants aged 65+ years (eligible for drug benefits). The relationship between MH scores and MH-related physician visits was assessed using zero-inflated negative binomial regression, adjusting for confounders. For those aged 65+ years, logistic regression examined the probability of receiving any MH-related care (physician visit or anti-depressant prescription).
  
  
  RESULTS
  Analyses were based on 2,005 (90.1%) individuals (mean age 70.8 years). Of 576 (28.7%) with probable depression (MH score < 60/100), 42.5% experienced one or more MH-related physician visits during follow-up. The likelihood of a physician visit was associated with sex (adjusted OR women vs. men = 5.87, p = 0.005) and MH score (adjusted OR per 10-point decrease in MH score = 1.63, p = 0.003). Among those aged 65+, 56.7% with probable depression received any MH care. The likelihood of receiving any MH care exhibited a significant interaction between MH score and self-reported health status (p = 0.0009); with good general health, worsening MH was associated with increased likelihood of MH care; as general health declined, this effect was attenuated.
  
  
  CONCLUSIONS
  Among older adults with painful OA, more than one-quarter had depressed mood, but almost half received no mental health care, suggesting a care gap.
authors.affiliation: University of Toronto, Toronto, ON M5S 1A8, Canada.
authors.forename: Yehoshua
authors.initials: Y
authors.lastname: Gleicher
authors.forename: Ruth
authors.initials: R
authors.lastname: Croxford
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hochman
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010003:Osteoarthritis / Q000150:complications / Q000523:psychology*; D010146:Pain / Q000150:complications / Q000523:psychology*; D055656:Prescriptions / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012727:Sex Characteristics
chemical_list: D000928:Antidepressive Agents