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

• Autores: Ayse Akincigil, Mark Olfson, James T. Walkup, Michele Siegel, Ece Kalay, Shahla Amin, Karen A. Zurlo, Stephen Crystal
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 59, Nº. 6, 2011, págs. 1042-1051
• Idioma: inglés
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• Dialnet Métricas: 1 Cita
• Resumen

  • OBJECTIVE: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer-generation antidepressants.

    DESIGN: Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005.

    SETTING: Community, usual care.

    PARTICIPANTS: Older Medicare fee-for-service beneficiaries.

    MEASUREMENTS: Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers.

    RESULTS: 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.

    CONCLUSION: 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.