• Jürgen Unützer, Wayne Katon, Christopher M Callahan, John W Williams, Enid Hunkeler, Linda Harpole, Marc Hoffing, Richard D Della Penna, Polly Hitchcock Noel, Elizabeth H B Lin, Lingqi Tang, and Sabine Oishi.
• Center for Health Services Research, UCLA Neuropsychiatric Institute, Los Angeles, California 90024, USA. unutzer@ucla.edu
• J Am Geriatr Soc. 2003 Apr 1;51(4):505-14.

ObjectivesTo examine rates and predictors of lifetime and recent depression treatment in a sample of 1,801 depressed older primary care patientsDesignCross sectional survey data collected from 1999 to 2001 as part of a treatment effectiveness trial.SettingEighteen primary care clinics belonging to eight organizations in five states.ParticipantsOne thousand eight hundred one clinic users aged 60 and older who met diagnostic criteria for major depression or dysthymia.MeasurementsLifetime depression treatment was defined as ever having received a prescription medication, counseling, or psychotherapy for depression. Potentially effective recent depression treatment was defined as 2 or more months of antidepressant medications or four or more sessions of counseling or psychotherapy for depression in the past 3 months.ResultsThe mean age +/- standard deviation was 71.2 +/- 7.5; 65% of subjects were women. Twenty-three percent of the sample came from ethnic minority groups (12% were African American, 8% were Latino, and 3% belonged to other ethnic minorities). The median household income was $23,000. Most study participants (83%) reported depressive symptoms for 2 or more years, and most (71%) reported two or more prior depressive episodes. About 65% reported any lifetime depression treatment, and 46% reported some depression treatment in the past 3 months, although only 29% reported potentially effective recent depression treatment. Most of the treatment provided consisted of antidepressant medications, with newer antidepressants such as selective serotonin reuptake inhibitors constituting the majority (78%) of antidepressants used. Most participants indicated a preference for counseling or psychotherapy over antidepressant medications, but only 8% had received such treatment in the past 3 months, and only 1% reported four or more sessions of counseling. Men, African Americans, Latinos, those without two or more prior episodes of depression, and those who preferred counseling to antidepressant medications reported significantly lower rates of depression care.ConclusionThe findings suggest that there is considerable opportunity to improve care for older adults with depression. Particular efforts should be focused on improving access to depression care for older men, African Americans, Latinos, and patients who prefer treatments other than antidepressants.

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