Thursday, 21 August 2003
This presentation is part of : Approaches to Depression

S095-001 Diagnosing Major Depression in Elderly Primary Care Patients: Nuances and Determinants

Anita C. Volkers, Jasper Nuijen, Peter F.M. Verhaak, and Francois G. Schellevis. Mental Health Care, NIVEL (Netherlands Institute for Health Services Research), Utrecht, Netherlands

Objective: We studied how general practitioners (GPs) diagnosed elderly patients with depressive symptoms. Sociodemographic factors such as younger age, female sex and more education, clinical characteristics such as severe depression and comorbidity of anxiety disorders are suggested to improve the diagnostic rate of depression. It may be decreased by comorbidity of somatic diseases. The role of these determinants was investigated in old age.

Design: A random sample of patients >55 year was screened for psychopathology. This was followed by the assessment of psychiatric disorders by a standardized psychiatric interview. Finally, 55 patients turned out to suffer from a major depressive disorder. GPs registered during one year all contact diagnoses and prescriptions for medication.

Materials and Methods: The General Health Questionnaire (GHQ-12) was used as screening instrument for psychopathology, and the Composite International Diagnostic Interview (12-month version) to assess (severity of) major depression and anxiety disorders in the last year. Contact diagnoses were defined according to the International Classification of Primary Care (ICPC). The ICPC codes P03 and P76 refer to a down/depressive feeling and depression respectively. Somatic comorbidity was determined based on contact diagnoses, and antidepressant use was assessed based on prescription data. T-tests, M-W U-tests and Chi-square tests were applied to study differences in sociodemographic and clinical factors between patients with and without a diagnosis coded as P03 or P76 by the GP.

Results: 20.8% were classified by their GP as having a depressive feeling and/or depression, 32.1% as having psychological problems other than depression and 13.2% has having no psychological problems, but social problems (closely related to psychological problems). In 11.3% of the depressed patients, antidepressants were prescribed without the diagnostic classification depressive feeling/depression. Patients who were accurately diagnosed by their GP were significantly older than patients who were not. We found no substantial differences in severity of depression and comorbidity of somatic diseases or anxiety disorders between the patient groups. However, the prescription rate of antidepressants was significantly higher in the accurately diagnosed patients.

Conclusion: In 77.4 % of elderly depressed patients GPs seem to be aware of psychological problems, but in only 20.8% of the patients the problems were specified as depressive feeling or depression. The one year registration period offered GPs the possibility to follow depressive episodes in their entire course from onset of symptoms, full manifestation of symptoms, till recovering state. Nevertheless, the diagnostic rate remained low. Training programs for improving the diagnostic rate in elderly patients should focus on a broad spectrum of psychological and social problems, while at the same time GPs should practice how to distinct these problems from each other.

Back to S095 Approaches to Depression
Back to The Eleventh International Congress