Revealing hidden depression in older people: a qualitative study within a randomised controlled trial

Deborah Foster,Helen Lewis,Karen Overend,Simon Gilbody,Rebecca Woodhouse,Sarah Nutbrown,Carolyn Chew-Graham,Katharine Bosanquet,Della Bailey,Samantha Gascoyne

doi:10.1186/s12875-015-0362-2

Abstract

BackgroundThe prevalence of depressive symptoms in older people may be as high as 20 %. Depression in older people is associated with loss, loneliness and physical co-morbidities; it is known to be under-diagnosed and under-treated. Older people may find it difficult to speak to their GPs about low mood, and GPs may avoid identifying depression due to limited consultation time and referral options for older patients.MethodsA nested qualitative study in a randomised controlled trial for older people with moderate to severe depression: the CASPER Plus Trial (Collaborative Care for Screen Positive Elders). We interviewed GPs, case managers (CM) and patient participants to explore perspectives and experiences of delivering and receiving a psychosocial intervention, developed specifically for older adults in primary care, within a collaborative care framework. Transcripts were analysed thematically using principles of constant comparison.ResultsThirty three interviews were conducted and, across the three data-sets, four main themes were identified: revealing hidden depression, reducing the ‘blind spots’, opportunity to talk outside the primary care consultation and ‘moving on’ from depression.ConclusionsDepression in older people is commonly hidden, and may coexist with physical conditions that are prioritised by both patients and GPs. Being invited to participate in a trial about depression may allow older people to disclose their feelings, name the problem, and seek help. Offering older people an opportunity to talk outside the primary care consultation is valued by patients and GPs. A psychosocial intervention delivered by a case manager in the primary care setting may fill the gap in the care of older people with depression.Trial registrationCurrent Controlled Trials ISRCTN45842879.

Highlights

The prevalence of depressive symptoms in older people may be as high as 20 %
Estimates of the prevalence of depression in older people vary but may be as high as 20 % [1, 2] Poor mental health is often co-morbid with long term, chronic physical illness [3] such as diabetes, coronary heart disease, stroke and Parkinson’s disease, all of which are more common in later life
We report the main themes identified in the data: Revealing hidden depression, reducing the ‘blind spots’, opportunity to talk outside the primary care consultation and ‘moving on’ from depression

Summary

Introduction

The prevalence of depressive symptoms in older people may be as high as 20 %. Introduction Estimates of the prevalence of depression in older people vary but may be as high as 20 % [1, 2] Poor mental health is often co-morbid with long term, chronic physical illness [3] such as diabetes, coronary heart disease, stroke and Parkinson’s disease, all of which are more common in later life. Barriers to identifying and managing depression in an older population are complex [9,10,11] Older people with long term conditions (LTCs) may view their chronic illness as a justifiable cause of low mood, and may hold negative views about available treatment options [10, 11]. A one-year follow-up study by Licht-Strunk et al [13] showed, compared to depressed older patients identified by their GPs, prognosis of those with undetected depression is poor

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