دانلود رایگان مقاله انگلیسی افسردگی عمده و افسردگی زیر آستانه ای بین دریافت مراقبت در خانه بزرگسالان سالمند - الزویر 2018

Abstract

Objective: This study aims to estimate the prevalence and correlates of major and subthreshold depression and the extent of treatment utilization in older adults receiving home care. Methods: The study sample included 811 community-dwelling adults ages 60 and over who received paid home care during the 2008-2014 waves of the Health and Retirement Study. Depression was assessed using short forms of the Composite International Diagnostic Interview and the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to examine correlates of depression type and treatment utilization. Results: One in two older home care recipients suffered from probable depression; 13.4% of the sample suffered from major depression and an additional 38.7% met study criteria for subthreshold depression. The majority (72.7%) of participants with major depression and almost half (44.5%) of participants with subthreshold depression reported taking medication for anxiety or depression. One-third (33.2%) of older home care recipients with major depression and 14.2% of those with subthreshold depression reported receiving formal psychiatric or psychological treatment. Males as compared with females and persons with pain problems as compared with no pain complaints had a higher risk of subthreshold and major depression. The receipt of medication or psychiatric treatment declined with age. African Americans were less likely to receive medication for anxiety or depression compared with non-Hispanic Whites. Conclusion: Depression affects a substantial proportion of older adults receiving home care and may be inappropriately treated. Future research is needed to develop optimal strategies for integrating depression assessment and treatment into home care.

Discussion

This study provides national estimates of depression prevalence and associated treatment among older adults receiving home care. One in two older home care recipients suffered from probable depression; 13.4% of the study participants suffered from major depression and 38.7% met study criteria for subthreshold depression. Our estimate of major depression was almost identical to the 13.5% reported in a previous study of a local sample of Medicare home health care patients.3 Compared to other studies of HCBS recipients,8–15 our study reported a slightly higher combined prevalence rate of depression (52.1%, including major and subthreshold depression). Home care tends to serve individuals with a high level of functional impairment whereas HCBS includes a wide range of services targeting individuals with varying functioning levels. In addition, home care recipients have restricted outdoor mobility whereas not all HCBS recipients are homebound. This burden of disability and social isolation may explain the higher prevalence of depression found in our sample of home care recipients compared with previous studies of HCBS users.

No-treatment rates reported in the present study are similar to recent studies,11 but are lower compared with earlier studies. A recent study using 2010-2012 waves of the HRS found that 51% HCBS recipients with subthreshold depression were not using psychiatric medication,11 and that is comparable to the 56% found in this study. Earlier studies reported much higher rates of no-treatment. A 2002 study by Bruce et al.3 found that 78% of home health patients with major depression were not receiving antidepressants. Weissman et al.27 reported that 66% of home health patients with depression from the National Home Health and Hospice Care survey did not use antidepressants. Several reasons can explain this discrepancy. Our estimate of notreatment rate is probably an underestimate because the treatment utilization question included medications for anxiety and depression. As such, the actual no-treatment rate for depression medication alone is likely to be closer to those reported in previous studies. On the other hand, antidepressants use has dramatically increased in the US in the last decade.28 Antidepressants are frequently prescribed for anxiety disorders, insomnia, pain, and other conditions.29 The overall increasing trends in antidepressant use and off-label prescriptions could explain why a quarter of the study sample without depression also reported taking psychiatric medication.