Recognition of depression in older medical inpatients discharged to ambulatory care settings: a longitudinal study

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Objective This study aimed to examine the recognition of depression in older medical inpatients by nonpsychiatric physicians over a 2-year period. Methods A cohort of medical inpatients aged 65 and above was recruited at two university-affiliated hospitals, with oversampling of depressed patients. Participants were assessed with research diagnoses of major or minor depression ( DSM-IV) at admission and at 3, 6 and 12 months. Indicators of recognition during the 12 months before and the 12 months after admission, derived from administrative databases, included the following: depression diagnosis, antidepressant prescription and psychiatric referral. Multiple logistic regression analyses were used to identify factors associated with recognition. Results Among 185 patients with at least one research diagnosis of depression during the study, recognition rates ranged up to 56% during the 12 months before admission among patients with major depression lasting at least 6 months and up to 61% during the 12 months after admission among patients with persistent major depression. In both study periods, a greater number of physician visits and prescription of a psychotropic medication (non-antidepressant) were independently associated with recognition. Conclusions A longitudinal approach to measuring recognition of late-life depression in ambulatory care settings indicates that persistent major depression is more likely to be recognized than previously reported.