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The Nature of Depression Among Older People in Inner London, and the Contact with Primary Care

Published online by Cambridge University Press:  02 January 2018

M. R. Blanchard*
Affiliation:
The Maudsley Hospital, London SE5
A. Waterreus
Affiliation:
Section of Epidemiology and General Practice, Institute of Psychiatry, and Hampstead Health Authority
A. H. Mann
Affiliation:
Section of Epidemiology and General Practice, Institute of Psychiatry, and Royal Free Hospital Medical School, London
*
Correspondence

Abstract

Ninety-six people of pensionable age from an inner-London electoral ward who had been identified by short-CARE screening as having ‘probable pervasive depression’ were interviewed further to ascertain their GMS-AGECAT and self-CARE status, comorbid features, and current primary-care psychiatric management. Estimated incidence rates of 30.8 per 1000 per year for ‘probable pervasive depression’ and 15.4 per 1000 per year for GMS diagnostic depression were calculated using results from a short-CARE screen in 1988. Among GMS diagnostic depression cases, anxiety was the major psychiatric comorbid feature (95%) and organic features were uncommon (8.4%). Of 66 self-CARE cases, 48 (73%) were also GMS–AGECAT cases; of 24 self-CARE non-cases, 15 (62.5%) were not GMS–AGECAT cases. Among subjects who had ‘probable pervasive depression’, 38% said that they had declared their symptoms to their general practitioner. Only 14% of subjects were prescribed antidepressants; 24% were prescribed hypnotics. Half the GMS–AGECAT-case subjects who stated that they had declared to their general practitioner were on specific therapy. Screening for depression and health education aimed at increasing psychological declaration are seen as ways forward in the management of this depression.

Type
Peer Review
Copyright
Copyright © 1994 The Royal College of Psychiatrists 

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References

Bird, A., Macdonald, A., Mann, A., et al (1987) Preliminary experience with the SELFCARE (D): a self-rating depression questionnaire for use in elderly, non-institutionalized subjects. International Journal of Geriatric Psychiatry, 2, 3138.CrossRefGoogle Scholar
Bridges, K. & Goldberg, D. (1985) Somatic presentation of DSM–III psychiatric disorders in primary care. Journal of Psychosomatic Research, 29, 563569.Google Scholar
Bridges, K. & Goldberg, D. Evans, B., et al (1991) Determinants of somatization in primary care. Psychological Medicine, 21, 473483.CrossRefGoogle ScholarPubMed
Copeland, J., Dewey, M. & Griffiths-Jones, H. (1986) A computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT. Psychological Medicine, 16, 8999.CrossRefGoogle ScholarPubMed
Copeland, J., Dewey, M. Wood, N., et al (1987) Range of mental illness amongst the elderly in the community: prevalence in Liverpool using the GMS-AGECAT package. British Journal of Psychiatry, 150, 815823.CrossRefGoogle Scholar
Copeland, J., Davidson, I., Dewey, M., et al (1992) Alzheimer's disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool. British Journal of Psychiatry, 161, 230239.Google Scholar
Gask, L. (1992) Training general practitioners to detect and manage emotional disorders. International Review of Psychiatry, 4, 293300.Google Scholar
Good, M. D., Good, B. J. & Cleary, P. D. (1987) Do patient attitudes influence physician recognition of psychosocial problems in primary care? Journal of Family Practice, 25, 5359.Google ScholarPubMed
Gurland, B., Copeland, J. R. M., Kelleher, M. J., et al (1983) The Mind and Mood of Ageing: The Mental Health Problems of the Community Elderly in New York and London. New York and London: Haworth Press and Croom Helm.Google Scholar
Gurland, B., Golden, R., Teresi, J., et al (1984) The SHORT-CARE: an efficient instrument for the assessment of depression, dementia and disability. Journal of Gerontology, 39, 166169.Google Scholar
International Journal of Geriatric Psychiatry (1990) The prevalence of depression in old age (editorial). International Journal of Geriatric Psychiatry, 5, 141144.CrossRefGoogle Scholar
Johnstone, A. & Goldberg, D. (1976) Psychiatric screening in general practice: a controlled trial. Lancet, i, 605608.Google Scholar
Kay, D., Henderson, A., Scott, R., et al (1985) Dementia and depression amongst the elderly living in the Hobart community: the effect of the diagnostic criteria on the prevalence rates. Psychological Medicine, 15, 771778.CrossRefGoogle Scholar
Kinzie, J. D., Lewinsohn, P., Maricle, R., et al (1986) The relationship of depression to medical illness in an older community population. Comprehensive Psychiatry, 27, 241246.Google Scholar
Lewis, G. & Williams, P. (1989) Clinical judgement and the standardised interview in psychiatry. Psychological Medicine, 19, 971979.Google Scholar
Livingston, G., Hawkins, A., Graham, N., et al (1990) The Gospel Oak Study: prevalence rates of dementia, depression and activity limitation among elderly residents in Inner London. Psychological Medicine, 20, 137146.CrossRefGoogle ScholarPubMed
Macdonald, A. (1986) Do general practitioners ‘miss’ depression in elderly patients? British Medical Journal, 292, 13651367.Google Scholar
Morgan, K., Dallosso, H. M., Arie, T., et al (1987) Mental health and psychological well-being among the old and very old living at home. British Journal of Psychiatry, 150, 801807.CrossRefGoogle ScholarPubMed
Murphy, E. (1986) Preface. Affective Disorders in the Elderly. Edinburgh: Churchill Livingstone.Google Scholar
O'Hara, W., Kohout, F. & Wallace, R. (1985) Depression among the rural elderly: a study of prevalence and correlates. Journal of Nervous and Mental Disease, 173, 582589.CrossRefGoogle ScholarPubMed
Romaniuk, M., McAuley, W. & Arling, G. (1983) An examination of the prevalence of mental disorders in the community. Journal of Abnormal Psychology, 92, 458467.CrossRefGoogle ScholarPubMed
Waxman, H., Carner, E. & Blum, A. (1983) Depressive symptoms and health service utilization among the community elderly. Journal of the American Geriatric Society, 31, 417420.Google Scholar
Weissman, M., Myers, J., Tischler, G., et al (1985) Psychiatric disorders (DSM–III) and cognitive impairment among the elderly in a US urban community. Acta Psychiatrica Scandinavica, 71, 366379.Google Scholar
Williamson, J., Stokoe, I. H., Gray, S., et al (1964) Old people at home: their unreported needs. Lancet, i, 11171120.Google Scholar
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