Diagnostic accuracy and treatment management of depression in elderly primary care patients.

Background: The negative impact of major depression on the risk of somatic diseases, mortality and social functioning is prominent in elderly patients. Aim: We investigated how accurately general practitioners (GPs) diagnose depression in old age and if diagnostic accuracy is related to patient and clinical characteristics (study 1). Additionally, we evaluated the management of depression with antidepressants in this age group (study 2). Methods: Data were derived from a Dutch national survey of general practice (2001). In study 1, 55 patients (>55 year) with major depression according to a standardised psychiatric interview (CIDI) were compared with diagnoses by GPs in a one-year contact registration. In study 2, 3270 primary care patients (>55 year) participated who were diagnosed by their GP as having depressive feelings/depression in the last year. Patient characteristics included age, gender, education and ethnicity and clinical characteristics comprised depression severity, comorbidity of anxiety and somatic disorder, prescription of antidepressants and other drugs acting on the nervous system. Results: Study 1: From the 55 patients with a CIDI diagnosis depression 21% was diagnosed with depressive feelings/depression by their GP, 32% with other psychological problems, and 13% with social problems. An additional 11% was prescribed antidepressants without the GP diagnosis depressive feeling/depression. Accurately diagnosed patients were older and had a higher prescription rate of antidepressants than not diagnosed patients. Study 2: Antidepressants were prescribed in 78% of the patients who received a GP diagnosis of depressive feelings/depression. The modern SSRIs (Selective Serotonin Reuptake inhibiters) were most frequently prescribed (52%), followed by TCAs (Tricyclic Antidepressants) (19%). Sociodemographic and clinical characteristics differed between patients with and without an antidepressant prescription, but were not related to type of antidepressant treatment (SSRI or TCA). Conclusions: GPs are aware of the psychological problems in elderly depressed patients, but make no distinction between depression and other psychosocial problems. Regarding antidepressant treatment, GPs are not reluctant with prescribing antidepressants suggesting no undertreatment in this respect. (aut. ref.