Depression Screening and Rates of Mood Disorder Diagnosis and Suicide in Younger and Older Adults

Abstract

Rates of suicide are elevated among older adults in the U.S. and around the world, with the highest rates in older men (CDC, 2019; WHO, 2014). More than half of older adults who die by suicide were in contact with a primary care physician within the month prior to death, and almost one-third within the prior week (Luoma et al., 2002; Stene-Larsen & Reneflot, 2019), demonstrating the importance of better identification and treatment of mental health issues among older adults across healthcare systems. Depression, a well-established risk factor for suicide, goes under-diagnosed and under-treated, especially among older adults (Bryant, 2010). The University of Rochester Medical Center has led integration of patient-reported outcomes assessment via large-scale implementation of PROMIS measures across multiple departments. We compared results of PROMIS depression screening from 1/1/2015 to 8/31/2019 with mood disorder diagnoses within the year prior and year following screening. Twenty-six percent (39491/154669) of adults under age 65 and 23% (11694/51702) of those age 65 and older screened positive for mild, moderate, or severe depression. Whereas 29.0% of younger adults who screened positive received mood disorder diagnoses, 22.1% of older adults received a diagnosis (χ2(1)=214.69, p<.001). Suicide outcomes using National Death Index data will also be reported. Results confirm depression is underdiagnosed (and, by extension, likely undertreated) at all ages, but show a distinct disparity for older adults, which may put them at greater risk for negative outcomes such as suicide.