Psychiatric disorders in older primary care patients

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.