The prevalence of undiagnosed depression among the elderly in an internal medicine practice

Depression in the elderly is a serious problem that is underdiagnosed and undertreated in primary care settings. Underrecognition of depression is not a new problem, but several factors make it an urgent concern. These factors include: a growing elderly population; continuing pressure on primary care clinicians to diagnose and manage psychiatric disorders despite time restrictions on office visits; and the availability antidepressant medications that are underutilized because of missed or overlooked opportunities for diagnosis and treatment. One hallmark of depression in older adults is its comorbidity with medical illness that, in turn, can contribute to depression and compromise quality of life. The purpose of the study was twofold: (1) to determine the prevalence of undiagnosed depression among older patients in an internal medicine practice in the Southeastern United States; and (2) to determine if there is an association between the number and type of comorbid illnesses and depression. A clinical series of older adults (N = 300) completed the Geriatric Depression Scale (GDS). Older adults (n = 22) with GDS scores ≥11 were identified as depressed. The prevalence of undiagnosed depression was 7% at a 95% confidence interval. Results of chi-square analysis identified a statistically significant proportion of depressed older adults with 4 comorbid illnesses: hyperlipidemia (p = .04), myocardial infarctions (p = .02), stroke (p = .01) and transient ischemic attacks (p = .03). Two medications, hydrocodone (p = .02) and xanax (p = .01), were more common among the depressed. One drug, premarin (p = .01), seemed to be protective against depression in older women. Depressed patients in the study were older, had more divorces and separations, and had a family history of alcohol use or abuse.