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J Am Geriatr Soc. 2011 Jun;59(6):1042-51. doi: 10.1111/j.1532-5415.2011.03447.x. Epub 2011 Jun 7.

Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005.

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1
School of Social Work, Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers, State University of New Jersey, New Brunswick, New Jersey 08901, USA. aakinci@rci.rutgers.edu

Abstract

OBJECTIVE:

To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer-generation antidepressants.

DESIGN:

Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005.

SETTING:

Community, usual care.

PARTICIPANTS:

Older Medicare fee-for-service beneficiaries.

MEASUREMENTS:

Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers.

RESULTS:

The proportion of older adults who received a depression diagnosis doubled, from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups. Of those diagnosed, the proportion receiving antidepressants increased from 53.7% to 67.1%, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8%. Adjusting for other characteristics, odds of antidepressant treatment in older adults diagnosed with depression were 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for metropolitan-area residents, and 55% greater for nonmetropolitan-area residents. Odds of antidepressant treatment were 54% greater for those diagnosed with major depressive disorder (MDD) and 83% greater for those with other depression diagnoses, whereas the odds of receiving psychotherapy was 29% lower in those with MDD diagnoses and 74% lower in those with other depression diagnoses.

CONCLUSION:

Overall diagnosis and treatment rates increased over time. Antidepressants are assuming a more-prominent and psychotherapy a less-prominent role. These shifts are most pronounced in groups with less-severe depression, in whom evidence of efficacy of treatment with antidepressants alone is less clear.

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