Diagnosis and Treatment of Depression in Older Community-Dwelling Adults: 1992-2005

School of Social Work, Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers, State University of New Jersey, New Brunswick, New Jersey 08901, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 06/2011; 59(6):1042-51. DOI: 10.1111/j.1532-5415.2011.03447.x
Source: PubMed


To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer-generation antidepressants.
Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005.
Community, usual care.
Older Medicare fee-for-service beneficiaries.
Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers.
The proportion of older adults who received a depression diagnosis doubled, from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups. Of those diagnosed, the proportion receiving antidepressants increased from 53.7% to 67.1%, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8%. Adjusting for other characteristics, odds of antidepressant treatment in older adults diagnosed with depression were 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for metropolitan-area residents, and 55% greater for nonmetropolitan-area residents. Odds of antidepressant treatment were 54% greater for those diagnosed with major depressive disorder (MDD) and 83% greater for those with other depression diagnoses, whereas the odds of receiving psychotherapy was 29% lower in those with MDD diagnoses and 74% lower in those with other depression diagnoses.
Overall diagnosis and treatment rates increased over time. Antidepressants are assuming a more-prominent and psychotherapy a less-prominent role. These shifts are most pronounced in groups with less-severe depression, in whom evidence of efficacy of treatment with antidepressants alone is less clear.

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Available from: Ayse Akincigil, Feb 13, 2015
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    • "The prevalence and treatment of mental health (MH) problems among older adults are significantly lower than for younger adults, but there has also been an overall upward trend in diagnosis and treatment among older adults. Medicare claims data from 1992 to 2005 showed that the proportion of older adults who received a depression diagnosis doubled from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups (Akincigil et al., 2011). Of those diagnosed with depression, the proportion receiving any treatment (pharmacotherapy and/or psychotherapy) steadily increased from 64.6% to 71.4% during the study period. "
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    ABSTRACT: This study examined age group differences in and correlates of treatment use and perceived treatment need for substance use disorders (SUD) and mental health (MH) problems as well as self-reported barriers to treatment among people 65+ years old vs. 26-34, 35-49, and 50-64 years old. Data are from the 2008 to 2012 National Survey on Drug Use and Health (NSDUH) (N=96,966). Age group differences were examined using descriptive bivariate analyses and binary logistic regression analyses. The 65+ age group was least likely to use treatment and perceive treatment need, but the 50-64 age group was more similar to the younger age groups than the 65+ age group. Controlling for age, other predisposing, and enabling factors, alcohol and illicit drug dependence and comorbid SUD and MH problems increased the odds of SUD treatment use. Of MH problems, anxiety disorder had the largest odds for MH treatment use. Bivariate analyses showed that lack of readiness to stop using and cost/limited insurance were the most frequent barriers to SUD and MH treatment, respectively, among older adults, and they were less likely than younger age groups to report stigma/confidentiality concerns for MH treatment. Older adults will become a larger portion of the total U.S. population with SUD and/or MH problems. Healthcare providers should be alert to the need to help older adults with SUD and/or MH problems obtain treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Oct 2014 · Drug and Alcohol Dependence
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    • "This study found greater likelihood of antidepressants use and lower likelihood of psychotherapy among elderly compared to younger adults. These findings are consistent with evidence from published literature that suggests an association between increasing age and decreasing odds of receiving psychotherapy [35,36]. As mentioned in the introduction combination therapy has been found to be effective in reducing pain and improving depressive symptoms among older adults [4]. "
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    ABSTRACT: Background Arthritis and depression often co-occur; however, studies that describe patterns of depression treatment among individuals with arthritis are scant. The purpose of the study was to examine depression treatment patterns among individuals with osteoarthritis (OA) by predisposing, enabling, need factors, personal health practices and external health environment. Methods Retrospective cross-sectional design was used. Data were obtained from 2008 and 2010 Medical Expenditure Panel Survey (MEPS). The sample consisted of 647adults aged over 21 years with depression and OA. Depression treatment was categorized as: 1) No treatment;2) antidepressant use only and 3) both antidepressants and psychotherapy (combination therapy). Chi- square tests and multinomial logistic regressions were used to describe patterns of depression treatment. All analysis was performed using Statistical Analysis Software (SAS) version 9.3. Results Overall, 13.0% of the study sample reported no depression treatment, 67.8% used antidepressants only and 19.2% used combination therapy. Among individuals with OA significant subgroup differences in depression treatment were observed. For example, African Americans were less likely to report depression treatment compared to whites [antidepressants: AOR=0.33, 95% CI=0.21,0.51; combination therapy: AOR=0.39, 95% CI=0.23, 0.65]. Elderly adults were more likely to receive antidepressants and less likely to receive psychotherapy as compared to younger adults [AOR=0.53, 95% CI= 0.28,0.98]. Adults with anxiety were more likely to report depression treatment compared to those without anxiety [antidepressants: AOR=1.53, 95% CI=1.06, 2.22; combination therapy: AOR=3.52, 95% CI=2.40, 5.15]. Conclusion Future research needs to examine the reason for low rates of combination therapy as well as subgroup differences in combination therapy among individuals with OA.
    Full-text · Article · Apr 2013 · BMC Psychiatry
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    • "These studies also showed that for the majority of older adults who used any mental health service, their treatment consisted of pharmacotherapy from primary care physicians (PCPs), while only a small minority received psychotherapy from specialty mental health care providers. Among Medicare beneficiaries with a depression diagnosis, the proportion receiving antidepressants increased from 53.7% to 67.1% between 1992 and 2005, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8% during the same period (Akincigil et al., 2011). "
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    ABSTRACT: Objective: This study examined previous mental health service use among low-income homebound middle-aged and older adults who participated in a study testing the feasibility and efficacy of telehealth problem-solving therapy for depression. Method: The sample consisted of 188 homebound adults aged 50 years or older. Data on mental health service use were collected at baseline. We used multivariable logistic regression analysis to examine correlates of different types of outpatient service use within the preceding 12 months. Results: Of the subjects, 56% reported mental health service use. Of the users, 80% had made at least one primary care mental health visit, 21% had visited a psychiatrist, and 25% had received counseling. Higher depressive symptom severity scores were positively associated with a psychiatrist visit only. Discussion: The need to improve low-income homebound older adults' access to psychotherapy was clearly evident.
    Full-text · Article · Apr 2013 · Journal of Aging and Health
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