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Nursing home residents likely to receive diagnosis and pills for depression but not psychotherapy

Diagnosis and treatment of depression in nursing homes occurs much more frequently than past studies have suggested, according to a new study. Using government datasets commonly kept by nursing homes, researchers looked at both diagnosis and treatment of depression in 76,735 residents of 921 Ohio nursing homes in 2000.

In the diagnosis arena, researchers found several disparities. Educated females in nursing homes who had ever been married were more likely than other residents to be diagnosed with depression. On the other hand, black residents were half as likely as white residents to be diagnosed with depression. Residents older than 75 were a third less likely than those aged 65 to 75 to be diagnosed.

Residents with severe cognitive impairment were a third less likely to be diagnosed than residents with normal cognitive functioning. Finally, government-owned nursing homes and facilities with a high number of deficiencies (more than eight) also tended to not diagnose depression as readily. The authors did not speculate on why these disparities exist but suggested they deserve exploration.

Disparities were also found in the treatment realm. Residents who were aged 75 and older, black, had severe mental illness, were entirely dependent on assistance with activities of daily living, and had severe cognitive impairment were all less likely to receive treatment for their depression than patients with higher education levels, who were or had been married, and had one or more physical ailments.

When patients were diagnosed with depression, 77 percent received either an antidepressant or psychotherapy. Most often, antidepressants were the treatment of choice, perhaps because they are cheaper than psychotherapy, the authors suggest. However, in some cases clinicians might avoid prescribing antidepressants to preclude drug interactions with other medications.

This study was funded in part by the Agency for Healthcare Research and Quality (HS11825).

See "Prevalence and treatment of diagnosed depression among elderly nursing home residents in Ohio," by Carrie A. Levin, Ph.D., Wenhui Wei, Ph.D., Ayse Akincigil, Ph.D., and others in the November 2007 Journal of the American Medical Directors Association 8(9), pp. 585-594.

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