Effect of Patient Gender on Late-Life Depression Management

Center for Health Care Evaluation, VA Palo Alto Healthcare System, and Stanford University, Palo Alto, California 94025, USA.
Journal of Women's Health (Impact Factor: 2.05). 11/2004; 13(8):919-25. DOI: 10.1089/jwh.2004.13.919
Source: PubMed


To determine whether patient gender influences physicians' management of late-life major depression in older and younger elderly patients.
In 1996-2001, physician subjects viewed a professionally produced videotape vignette portraying an elderly patient meeting diagnostic criteria for major depression, then answered interviewer-administered questions about differential diagnosis and treatment. Patient gender and other characteristics were systematically varied in different versions of the videotape, but clinical content was held constant. This was a stratified random sample of 243 internists and family physicians with Veterans Health Administration (VA) or non-VA ambulatory care practices in the Northeastern United States. Outcomes were whether physicians followed a guideline-recommended management approach: treating with antidepressants or mental health referral or both and seeing the patient for follow-up within 2 weeks.
Only 19% of physicians recommended treating depression (12% recommended antidepressants and 7% mental health referral), and 43% recommended follow-up within 2 weeks. Patient gender did not influence management recommendations in either younger old (67 year old) or older old (79 year old) patients (p > 0.12 for all comparisons).
Gender disparities previously documented in the management of major conditions are not seen for the management of depression, a potentially stigmatized condition that does not require resource-intense interventions.

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    • "Standard clinical guidelines recommend follow-up within 2 weeks for patients with depression to assess for side effects, drug interactions , and worsening of depressive symptoms (Frayne, Skinner, Lin, Ash, & Freund, 2004; Unutzer, 2007). A study conducted by Frayne et al., (2004) discovered that even when PCP's identified depression in the elder patient (which was 50% of the time), only 19% recommended treatment. In addition, the study found that of those 19% who received treatment, only 12% were actually treated with an antidepressant, and only half of those patients were provided appropriate follow-up (Strothers et al., 2005). "
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