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.
