Objective
To measure the prevalence and associated factors of undetected depression in institutionalized
older people.
Design and Setting
Epidemiologic cross-sectional study in nursing homes and residential facilities.
Participants
A stratified cluster sample of residents 65 years of age and older living in institutions
of Madrid (Spain).
Measurements
Residents were considered to be depressed if they met at least 1 of the following
3 criteria: 10-item Geriatric Depression Scale score of 4 or higher, physician's diagnosis,
or antidepressant use. Prevalence of undetected depression was defined as the proportion
of depressed residents without documented diagnosis or treatment.
Results
A total of 255 of 579 residents had depression (weighted prevalence 46.1%, 95% confidence
interval [CI] 41.0%–51.3%) and 108 depressed residents were undetected (undetection
prevalence 41.5%, 95% CI 33.2%–50.2%). Undetection was lower in younger residents,
private versus public facilities (sex-, age-, and size-adjusted prevalence ratio [PR]
0.59, 95% CI 0.37–0.94), and larger facilities (sex-, age-, and ownership-adjusted
PR 0.94 per 50-bed increase, 95% CI 0.88–1.00). Undetected depression was higher in
residents with poor self-rated health (sex- and age-adjusted PR 1.83, 95% CI 1.24–2.73),
whereas the opposite came about for physician-rated health (PR 0.65, 95% CI 0.44–0.95).
Undetection decreased 11% (95% CI 4%–17%) per 1-medication increase, and it was lower
in patients with Alzheimer disease, anxiety, and arrhythmia.
Conclusions
Number of medications and self-rated health were the main determinants of undetected
depression. Physician-rated health, facility characteristics (size and ownership),
and some diseases could also be considered.
Keywords
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Article info
Publication history
Published online: May 14, 2010
Footnotes
This work was supported by the Spanish “Fondo de Investigación Sanitaria” (grant 96/0201).
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
