OBJECTIVE: Most older people with psychiatric disorders are never treated b
y mental health specialists, although they visit their primary care physici
ans regularly. There are no published studies describing the broad array of
psychiatric disorders in such patients using validated diagnostic instrume
nts. We therefore characterized Axis I psychiatric diagnoses among older pa
tients seen in primary care.
DESIGN: Survey of psychopathology using standardized diagnostic methods.
SETTING: The private practices of three board-certified general internists,
and a free-standing family medicine clinic.
PARTICIPANTS: All patients aged 60 years or older who gave informed consent
were eligible.
MEASUREMENTS AND MAIN RESULTS: For the 224 subjects completing the study, p
sychiatric diagnoses were based on the Structured Clinical Interview for DS
M-III-R. Point prevalence estimates used weighted averages based on the str
atified sampling method. For the combined sites, 31.7% of the patients had
at least one active psychiatric diagnosis. Prevalent current disorders incl
uded major depression (6.5%), minor depression (5.2%), dementia (5.0%), alc
ohol abuse or dependence (2.3%), and psychotic disorders (2.0%). Dysthymic
disorder and primary anxiety and somatoform disorders were less common and
frequently comorbid with major depression.
CONCLUSIONS: Mental disorders, particularly depression, are common among ol
der persons seen in these primary care settings. Clinicians should be parti
cularly vigilant about depression when evaluating older patients with anxie
ty or putative somatoform symptoms, given the relatively low prevalences of
primary anxiety and somatoform disorders.