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Diagnosis and treatment of depression in the elderly increased in the 1990s, but racial and other disparities persist

The problem of depression among the elderly became more recognized during the 1990s. The proportion of elderly Medicare patients diagnosed with depression more than doubled from 2.8 percent in 1992 to 5.8 percent in 1998, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11825 and HS09566).

About two-thirds of those diagnosed with depression received treatment in each year, but those older than 75, those of "Hispanic or other" ethnicity, and those who did not have supplemental insurance coverage to augment Medicare were significantly less likely to receive treatment. For example, although blacks were as likely as whites to receive medication or psychotherapy, other racial/ethnic minorities were only half as likely as whites to receive any treatment, controlling for other characteristics.

Half of elderly patients who did not have additional coverage to supplement Medicare did not receive treatment, compared with about one-third of those who did have supplemental coverage. If treated, those with low income or less than a college education and those older than age 75 were less likely to receive psychotherapy, notes Stephen Crystal, Ph.D., of Rutgers University. During this period, Medicare did not cover most prescription drug use, and there were high copayments for mental health specialty services such as psychotherapy (50 vs. 20 percent for other outpatient services).

Of all elderly Medicare patients treated for depression, 60 percent received antidepressants only, 14 percent received psychotherapy, and 26 percent received both. Overall, accounting for those receiving no treatment, only 17 percent of patients diagnosed with depression received both antidepressants and psychotherapy during the course of a year. These findings were based on an analysis of merged interview and Medicare claims data from 1992 through 1998 for nearly 21,000 elderly individuals included in the nationally representative Medicare Current Beneficiary Survey.

See "Diagnosis and treatment of depression in the elderly Medicare population: Predictors, disparities, and trends," by Dr. Crystal, Usha Sambamoorthi, Ph.D., James T. Walkup, Ph.D., and Ayse Akincigil, M.A., in the December 2003 Journal of the American Geriatrics Society 51, pp. 1718-1728.

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