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Clinical Decisionmaking

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Elderly patients with serious depression may not accurately describe their physical health

Elderly people who have minor depression or are not depressed generally rate their physical health better as their level of illness declines. On the other hand, elderly patients who are suffering from serious depression often provide assessments of their health that are inconsistent with clinical evidence, finds a multidisciplinary study supported by the Agency for Health Care Policy and Research (HS07772). Thus, very depressed elderly patients probably provide doctors with a less accurate picture of their health than others, concludes Cynthia L. Leibson, Ph.D., a member of the research team based at the Mayo Foundation.

Dr. Leibson and principal investigator Judith M. Garrard, Ph.D., of the University of Minnesota, and their colleagues analyzed depression scales and health status scales of 549 elderly patients as part of a larger study of outcomes associated with antidepressant treatment among members of a large health maintenance organization. The sample was stratified by depressive status based on the Geriatric Depression Scale. The researchers confirmed depression with the telephone version of the Diagnostic Interview Schedule (DIS) and asked respondents to rate themselves as unhealthy, somewhat healthy, in average health, or very healthy. The researchers used the chronic disease score (CDS)—which identifies patterns of medication use across 17 chronic disease categories—to measure clinically defined illness and a health status questionnaire to measure physical functioning and pain.

Of those studied, 47 percent had no depressive symptoms, 41 percent had minor depression, and 12 percent had serious depression. For patients with no depression or minor depression, self-rated health improved significantly as clinically defined illness decreased, leading the researchers to conclude that when a patient's report is inconsistent with clinical condition, evidence of minor depression should not preclude further investigation of inconsistencies between a patient's report and clinical evidence. However, there was no such inverse association for those with serious depression; these individuals rated their health worse or better than clinical evidence suggested.

More details are in "The role of depression in the association between self-rated physical health and clinically defined illness," by Drs. Leibson and Garrard, Nicole Nitz, M.S., and others, in The Gerontologist 39(3), pp. 291-298, 1999.

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