THE RECOGNITION AND TREATMENT OF DEPRESSION IN OLDER-PEOPLE IN PRIMARY-CARE

Objectives. To examine general practitioners' (GP) awareness of depres sion in their elderly patients (aged over 65) and to identify characte ristics of those patients least likely to be recognized and treated. D esign. A cross-sectional study comparing the clinical opinion of the G P with assessment of mental state using a validated interview schedule (the Short Comprehensive Assessment and Referral Evaluation). Setting and subjects. 510 elderly residents in the Gospel Oak area of Camden in North London registered with 28 GPs at 13 practices. Main outcome m easures. Agreement between GP view and patient interview. Evidence of active management measured by examining GP records for appointments, r eferrals and prescription of psychotropic mediation. Results. GPs were aware of depression in 36 (51%) of 70 depressed patients. Those least likely to be recognized were men, the married, those with high levels of physical handicap, those suffering from visual impairment and thos e who were least well educated. Of the 32 patients believed to be depr essed, 12 (38%) were prescribed antidepressant medication and/or refer red to mental health/social services. Conclusions. Levels of recogniti on of depression were lower than other recent reports. These findings may reflect the continued debate about the most suitable management of the elderly depressed in primary care and stress the need for further evaluation of appropriate treatment strategies for this group. (C) 19 98 John Wiley & Sons, Ltd.