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Wicke FS, Dinh TS, Riedel-Heller S, Weyerer S, König HH, Gensichen J, Schön G, Wegscheider K, Bickel H, Fuchs A, Schäfer I, van den Bussche H, Scherer M, Mergenthal K. Predictors of change in depressive symptoms in older and multimorbid patients: a longitudinal analysis of the multicare cohort. Aging Ment Health 2022; 26:818-827. [PMID: 33764211 DOI: 10.1080/13607863.2021.1902470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Depression in older adults is becoming an increasing concern. As depressive symptoms change over time, it is important to understand the determinants of change in depressive symptoms. The aim of our study is to use a longitudinal study design to explore the predictors of change, remission and incident depression in older patients with multimorbidity. METHODS Data from the MultiCare cohort study were used. The cohort studied 3,189 multimorbid general practice patients aged 65-85. Data were collected during personal interviews. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS-15). Predictors of change in depressive symptoms were determined using multivariate linear regression, while multivariate logistic regression was used to analyze predictors of remission and incident depression. Models included depressive symptoms at baseline and follow-up, socio-demographics and data on health status and social support. RESULTS Overall, 2,746 participants with complete follow-up data were analyzed. Mean age was 74.2 years, 59.2% were female, and 11.3% were classified as depressed at baseline. Burden of multimorbidity and social support were statistically significant predictors in all regression analyses. Further predictors of change in depressive symptoms were: income, pain, nursing grade, self-rated health and self-efficacy. LIMITATIONS The sample size for prediction of remission limited statistical certainty. Assessment of depressive symptoms using GDS-15 differs from routine clinical diagnoses of depression. CONCLUSIONS Predictors of change in depressive symptoms in older multimorbid patients are similar to those predicting remission and incident depression, and do not seem to differ significantly from other older patient populations with depressive symptoms.
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Affiliation(s)
- Felix Sebastian Wicke
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Truc Sophia Dinh
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Steffi Riedel-Heller
- Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Ingmar Schäfer
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik van den Bussche
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
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Agüera-Ortiz L, Claver-Martín MD, Franco-Fernández MD, López-Álvarez J, Martín-Carrasco M, Ramos-García MI, Sánchez-Pérez M. Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association. Front Psychiatry 2020; 11:380. [PMID: 32508684 PMCID: PMC7251154 DOI: 10.3389/fpsyt.2020.00380] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Present knowledge about depression in the elderly is still scarce and often controversial, despite its high frequency and impact. This article reports the results and most relevant conclusions of a Delphi-based consensus on geriatric depression promoted by the Spanish Psychogeriatric Association. METHODS A 78-item questionnaire was developed by 7 highly specialized geriatric psychiatrists and was evaluated using the Modified Delphi technique in two rounds answered by 35 psychiatrists with an extensive expertise in geriatric depression. The topics and number of questions (in brackets) covered were: concepts, clinical aspects, and risk factors (12); screening and diagnosis (7); psychotic depression (17); depression and dementia (5); antidepressant drug treatment (18); non-pharmacological biological treatments (5); psychotherapeutic treatments (4); comorbidity and preventive aspects (6); professional training needed (4). In addition, the expert panel's opinion on the antidepressants of choice in 21 common comorbid conditions and on different strategies to approach treatment-resistant cases in terms of both efficacy and safety was assessed. RESULTS After the two rounds of the Delphi process, consensus was reached for 59 (75.6%) of the 78 items. Detailed recommendations are included in the text. Considering pharmacological treatments, agomelatine was the most widely mentioned drug to be recommended in terms of safety in comorbid conditions. Desvenlafaxine, sertraline, and vortioxetine, were the most frequently recommended antidepressants in comorbid conditions in general. Combining parameters of efficacy and safety, experts recommended the following steps to address cases of treatment resistance: 1. Escalation to the maximum tolerated dose; 2. Change of antidepressant; 3. Combination with another antidepressant; 4. Potentiation with an antipsychotic or with lamotrigine; 5. Potentiation with lithium; 6. Potentiation with dopamine agonists or methylphenidate. DISCUSSION AND CONCLUSIONS Consensus was reached for a high number of items as well as for the management of depression in the context of comorbid conditions and in resistant cases. In the current absence of sufficient evidence-based information, our results can be used to inform medical doctors about clinical recommendations that might reduce uncertainty in the diagnosis and treatment of elderly patients with depressive disorders.
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Affiliation(s)
- Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | | | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - María Isabel Ramos-García
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Sánchez-Pérez
- Unidad de Psiquiatría Geriátrica, Hospital Sagrat Cor. Martorell, Barcelona, Spain
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Zülke A, Luck T, Pabst A, Hoffmann W, Thyrian JR, Gensichen J, Kaduszkiewicz H, König HH, Haefeli WE, Czock D, Wiese B, Frese T, Röhr S, Riedel-Heller SG. AgeWell.de - study protocol of a pragmatic multi-center cluster-randomized controlled prevention trial against cognitive decline in older primary care patients. BMC Geriatr 2019; 19:203. [PMID: 31370792 PMCID: PMC6670136 DOI: 10.1186/s12877-019-1212-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the absence of treatment options, the WHO emphasizes the identification of effective prevention strategies as a key element to counteract the dementia epidemic. Regarding the complex nature of dementia, trials simultaneously targeting multiple risk factors should be particularly effective for prevention. So far, however, only few such multi-component trials have been launched, but yielding promising results. In Germany, comparable initiatives are lacking, and translation of these complex interventions into routine care was not yet done. Therefore, AgeWell.de will be conducted as the first multi-component prevention trial in Germany which is closely linked to the primary care setting. METHODS AgeWell.de will be designed as a multi-centric, cluster-randomized controlled multi-component prevention trial. Participants will be older community-dwelling general practitioner (GP) patients (60-77 years; n = 1,152) with increased dementia risk according to CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) Dementia Risk Score. Recruitment will take place at 5 study sites across Germany. GP practices will be randomized to either intervention A (advanced) or B (basic). GPs will be blinded to their respective group assignment, as will be the statistician conducting the randomization. The multi-component intervention (A) includes nutritional counseling, physical activity, cognitive training, optimization of medication, management of vascular risk factors, social activity, and, if necessary, further specific interventions targeting grief and depression. Intervention B includes general health advice on the intervention components and GP treatment as usual. We hypothesize that over the 2-year follow-up period the intervention group A will benefit significantly from the intervention program in terms of preserved cognitive function/delayed cognitive decline (primary outcome), and other relevant (secondary) outcomes (e.g. quality of life, social activities, depressive symptomatology, cost-effectiveness). DISCUSSION AgeWell.de will be the first multi-component trial targeting risk of cognitive decline in older adults in Germany. Compared to previous trials, AgeWell.de covers an even broader set of interventions suggested to be beneficial for the intended outcomes. The findings will add substantial knowledge on modifiable lifestyle factors to prevent or delay cognitive decline. TRIAL REGISTRATION German Clinical Trials Register (reference number: DRKS00013555 ).
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Affiliation(s)
- Andrea Zülke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
| | - Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
- Department of Economic & Social Sciences & Institute of Social Medicine, Rehabilitation Sciences and Healthcare Research (ISRV), University of Applied Sciences Nordhausen, Nordhausen, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald (UMG), Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/ Greifswald, Greifswald, Germany
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Service Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - David Czock
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Birgitt Wiese
- Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Saale Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, 04103 Leipzig, Germany
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Beesdo-Baum K, Knappe S, Einsle F, Knothe L, Wieder G, Venz J, Rummel-Kluge C, Heinz I, Koburger N, Schouler-Ocak M, Wilbertz T, Unger HP, Walter U, Hein J, Hegerl U, Lieb R, Pfennig A, Schmitt J, Hoyer J, Wittchen HU, Bergmann A. [How frequently are depressive disorders recognized in primary care patients? : A cross-sectional epidemiological study in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:52-64. [PMID: 29189872 DOI: 10.1007/s00103-017-2662-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary care physicians (PCPs) play a crucial role for guideline-oriented intervention in patients with depression. OBJECTIVES Based on a diagnostic screening questionnaire, this study investigates the sensitivity of PCPs to recognize patients with depression as well as the factors facilitating recognition and concordant diagnostic decisions. METHOD In a cross-sectional epidemiological study in six regions of Germany, 3563 unselected patients filled in questionnaires on mental and physical complaints and were diagnostically evaluated by their PCP (N = 253). The patient reports on an established Depression-Screening-Questionnaire (DSQ), which allows the approximate derivation of an ICD-10 depression diagnosis, were compared with the physician diagnosis (N = 3211). In a subsample of discordant cases a comprehensive standardized clinical-diagnostic interview (DIA-X/CIDI) was applied. RESULTS On the study day, the prevalence of ICD-10 depression was 14.3% according to the DSQ and 10.7% according to the physician diagnosis. Half of the patients identified by DSQ were diagnosed with depression by their physician and two thirds were recognized as mental disorder cases. More severe depression symptomatology and the persistent presence of main depression symptoms were related to better recognition and concordant diagnostic decisions. Diagnostic validation interviews confirmed the DSQ diagnosis in the majority of the false-negative cases. Indications for at least a previous history of depression were found in up to 70% of false-positive cases. CONCLUSION Given the high prevalence of depression in primary care patients, there is continued need to improve the recognition and diagnosis of these patients to assure guideline-oriented treatment.
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Affiliation(s)
- Katja Beesdo-Baum
- Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland.
- Behaviorale Epidemiologie, Technische Universität Dresden, Dresden, Deutschland.
- Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Deutschland.
| | - Susanne Knappe
- Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland
| | - Franziska Einsle
- Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland
| | - Lisa Knothe
- Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland
- Behaviorale Epidemiologie, Technische Universität Dresden, Dresden, Deutschland
| | - Gesine Wieder
- Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland
- Behaviorale Epidemiologie, Technische Universität Dresden, Dresden, Deutschland
| | - John Venz
- Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland
- Behaviorale Epidemiologie, Technische Universität Dresden, Dresden, Deutschland
- Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Deutschland
| | - Christine Rummel-Kluge
- Stiftung Deutsche Depressionshilfe, Leipzig, Deutschland
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Ines Heinz
- Deutsches Bündnis gegen Depression e.V., Leipzig, Deutschland
| | - Nicole Koburger
- Leipziger Bündnis gegen Depression e.V., Leipzig, Deutschland
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Meryam Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Deutschland
| | - Theresia Wilbertz
- Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Deutschland
| | - Hans-Peter Unger
- Harburger Bündnis gegen Depression e.V., Asklepios Klinik Harburg, Hamburg, Deutschland
| | - Ulrich Walter
- Akademie für Suizidprävention des Gesundheitsnetz Osthessen e.V., Fulda, Deutschland
| | - Joachim Hein
- Münchner Bündnis gegen Depression e.V., München, Deutschland
| | - Ulrich Hegerl
- Stiftung Deutsche Depressionshilfe, Leipzig, Deutschland
- Deutsches Bündnis gegen Depression e.V., Leipzig, Deutschland
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Roselind Lieb
- Klinische Psychologie und Epidemiologie, Fakultät für Psychologie, Universität Basel, Basel, Schweiz
| | - Andrea Pfennig
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Carl-Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Carl-Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Jürgen Hoyer
- Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland
| | - Hans-Ulrich Wittchen
- Institut für Klinische Psychologie und Psychotherapie, Behaviorale Epidemiologie & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Deutschland
- Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Antje Bergmann
- Allgemeinmedizin, Medizinische Fakultät Carl-Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
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Dorow M, Stein J, Pabst A, Weyerer S, Werle J, Maier W, Miebach L, Scherer M, Stark A, Wiese B, Moor L, Bock JO, König HH, Riedel-Heller SG. Categorical and dimensional perspectives on depression in elderly primary care patients - Results of the AgeMooDe study. Int J Methods Psychiatr Res 2018; 27:e1577. [PMID: 28948667 PMCID: PMC6877261 DOI: 10.1002/mpr.1577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 02/04/2023] Open
Abstract
An accurate diagnosis is essential for the management of late-life depression in primary care. This study aims to (1) provide information on the agreement on depression diagnoses between general practitioners (GPs), dimensional tools (Geriatric Depression Scale [GDS], Hospital Anxiety and Depression Scale [HADS]) and a categorical tool (Structured Clinical Interview for DSM-IV criteria [SCID]) and (2) identify factors associated with different diagnoses. As part of the multicenter study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)" a sample of 1113 primary care patients aged 75 years and older was assessed. The proportion of depression was 24.3% according to GPs, 21.8% for the GDS, 18.9% for the HADS and 8.2% for the SCID. Taking GDS, HADS and SCID as reference standards, recognition of GPs was 47%, 48% and 63%. Cohen's Kappa values indicate slight to moderate agreement between diagnoses. Multinomial logistic regression models showed that patient related factors of depression were anxiety, intake of antidepressants, female gender, a low state of health, intake of medication for chronic diseases and functional impairment. GPs performed better at ruling out depression than ruling in depression. High levels of disagreement between different perspectives on depression indicate that they may be sensitive to different aspects of depression.
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Affiliation(s)
- Marie Dorow
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Lisa Miebach
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Lilia Moor
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
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Subthreshold Depression and Clinically Significant Depression in an Italian Population of 70-74-Year-Olds: Prevalence and Association with Perceptions of Self. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3592359. [PMID: 28393076 PMCID: PMC5368375 DOI: 10.1155/2017/3592359] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/06/2017] [Indexed: 11/17/2022]
Abstract
Estimates of depressive disorders in the elderly vary depending on how cases are defined. We estimated the prevalence of subthreshold depression (SD) and clinically significant depression (D) in a population of 70–74-year-olds. We also looked for associations with sociodemographic factors and perceptions of self. Participants underwent a multidimensional assessment (social, medical, and neuropsychological). The estimated prevalence of SD was 15.71% (95% CI: 13.70–17.72), while that of D was 5.58% (95% CI: 4.31–6.85). Multinomial logistic regression analysis revealed that female gender and dissatisfaction with family relationships were related to SD and D. A self-perception of physical age as older than actual age (but not comorbidity) and greater self-perceived stress caused by negative life events both increased the probability of SD. The likelihood of D was decreased in those who perceived their own health as good, whereas a self-perception of mental age as older than actual age and dissatisfaction with relationships with friends were both significantly associated with D. Both SD and D emerged as key problems in our population. Female gender and self-perceptions of various characteristics, which can be explored through simple questions, are associated with late-life depression in elderly people independently of their actual physical condition and other characteristics.
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Abstract
BACKGROUND If patients are treated according to their personal preferences, depression treatment success is higher. It is not known which treatment options for late-life depression are preferred by patients aged 75 years and over and whether there are determinants of these preferences. METHODS The data were derived from the German "Late-life depression in primary care: needs, health care utilization, and costs (AgeMooDe)" study. Patients aged 75+ years (N = 1,230) were recruited from primary care practices. Depressive symptoms were determined using the Geriatric Depression Scale (GDS-15). Support for eight treatment options was determined. RESULTS Medication, psychotherapy, talking to friends and family, and exercise were the preferred treatment options. Having a GDS score ≥ 6 significantly lowered the endorsement of some treatment options. For each treatment option, the probability of choosing the indecisive category "I do not know" was significantly increased in participants with moderate depressive symptoms. CONCLUSIONS Depressive symptoms influence the preference for certain treatment options and also increase indecision in patients. The high preference for psychotherapy suggests a much higher demand for late-life psychotherapy in the future. Healthcare systems should begin to prepare to meet this anticipated need. Future studies should include previous experience with treatment methods as a confounding variable.
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Bock JO, Brettschneider C, Weyerer S, Werle J, Wagner M, Maier W, Scherer M, Kaduszkiewicz H, Wiese B, Moor L, Stein J, Riedel-Heller SG, König HH. Excess health care costs of late-life depression - Results of the AgeMooDe study. J Affect Disord 2016; 199:139-47. [PMID: 27104802 DOI: 10.1016/j.jad.2016.04.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/10/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The study aimed at determining excess costs of late-life depression from a societal perspective. Moreover, the impact of recognition of depression by GPs on costs was investigated. METHODS Cross-sectional data were obtained from a large multicenter observational cohort study (AgeMooDe). Participants (n=1197) aged 75 years or older and were recruited via their GPs in Leipzig, Bonn, Hamburg, and Mannheim in Germany from May 2012 until December 2013. In the base case analysis, depression was assessed using the Geriatric Depression Scale (GDS; cutoff GDS≥6). Data on health care utilization and costs were based on participants' self-reports for inpatient treatment, outpatient treatment, pharmaceuticals, and formal and informal nursing care. RESULTS Unadjusted mean costs in a six-month period for depressed individuals (€5031) exceeded those of non-depressed (€2700) by the factor 1.86 and were higher in all health care sectors considered. Statistically significant positive excess costs persisted in all formal health care sectors after adjusting for comorbidity and socio-demographics. Recognition of depression by the GP did not moderate the relationship of depression and health care costs. LIMITATIONS Analyses were restricted to a cross-sectional design, not permitting any conclusions on causal interference of the variables considered. CONCLUSION The findings stress the enormous burden of depression in old age for all sectors of the health care system. The fact that GPs' recognition of depression does not moderate the relationship between depression and costs adds further insights into the economics of this frequent psychiatric disorder.
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Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty, University of Kiel, Kiel, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Lilia Moor
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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