Revealing hidden depression in older people: a qualitative study within a randomised controlled trial.
BACKGROUND
The prevalence of depressive symptoms in older people may be as high as 20 %. Depression in older people is associated with loss, loneliness and physical co-morbidities; it is known to be under-diagnosed and under-treated. Older people may find it difficult to speak to their GPs about low mood, and GPs may avoid identifying depression due to limited consultation time and referral options for older patients.


METHODS
A nested qualitative study in a randomised controlled trial for older people with moderate to severe depression: the CASPER Plus Trial (Collaborative Care for Screen Positive Elders). We interviewed GPs, case managers (CM) and patient participants to explore perspectives and experiences of delivering and receiving a psychosocial intervention, developed specifically for older adults in primary care, within a collaborative care framework. Transcripts were analysed thematically using principles of constant comparison.


RESULTS
Thirty three interviews were conducted and, across the three data-sets, four main themes were identified: revealing hidden depression, reducing the 'blind spots', opportunity to talk outside the primary care consultation and 'moving on' from depression.


CONCLUSIONS
Depression in older people is commonly hidden, and may coexist with physical conditions that are prioritised by both patients and GPs. Being invited to participate in a trial about depression may allow older people to disclose their feelings, name the problem, and seek help. Offering older people an opportunity to talk outside the primary care consultation is valued by patients and GPs. A psychosocial intervention delivered by a case manager in the primary care setting may fill the gap in the care of older people with depression.


BACKGROUND
Current Controlled Trials ISRCTN45842879 .
University of York, Heslington, York, YO10 5DD, UK. Karen.overend@york.ac.uk.
Karen
K
Overend
University of York, Heslington, York, YO10 5DD, UK. Kate.bosanquet@york.ac.uk.
Katharine
K
Bosanquet
University of York, Heslington, York, YO10 5DD, UK. Della.bailey@york.ac.uk.
Della
D
Bailey
University of York, Heslington, York, YO10 5DD, UK. Deborahfoster1@nhs.net.
Deborah
D
Foster
University of York, Heslington, York, YO10 5DD, UK. Samantha.gascoyne@york.ac.uk.
Samantha
S
Gascoyne
University of York, Heslington, York, YO10 5DD, UK. Helen.lewis@york.ac.uk.
Helen
H
Lewis
University of York, Heslington, York, YO10 5DD, UK. Sarah.Nutbrown@hyms.ac.uk.
Sarah
S
Nutbrown
University of York, Heslington, York, YO10 5DD, UK. Rebecca.woodhouse@york.ac.uk.
Rebecca
R
Woodhouse
University of York, Heslington, York, YO10 5DD, UK. Simon.gilbody@york.ac.uk.
Simon
S
Gilbody
Research Institute, Primary Care and Health Sciences, NIHR CLAHRC West Midlands, Keele, Staffordshire, ST5 5BG, UK. carolyn.chew-graham@keele.ac.uk.
Carolyn
C
Chew-Graham
D000368:Aged / Q000523:psychology; D000369:Aged, 80 and over / Q000523:psychology; D019090:Case Management; D003142:Communication; D003299:Cooperative Behavior; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research