Volume 53, Issue 12 p. 2178-2183

The Influence of Comorbid Chronic Medical Conditions on the Adequacy of Depression Care for Older Americans

Jeffrey S. Harman PhD

Jeffrey S. Harman PhD

From the * Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, and Department of Medicine, Division of Internal Medicine, University of Florida, Gainesville, Florida Central Arkansas Veterans Healthcare System, Little Rock, Arkansas § Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

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Mark J. Edlund MD, PhD

Mark J. Edlund MD, PhD

From the * Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, and Department of Medicine, Division of Internal Medicine, University of Florida, Gainesville, Florida Central Arkansas Veterans Healthcare System, Little Rock, Arkansas § Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

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John C. Fortney PhD

John C. Fortney PhD

From the * Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, and Department of Medicine, Division of Internal Medicine, University of Florida, Gainesville, Florida Central Arkansas Veterans Healthcare System, Little Rock, Arkansas § Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

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Henrique Kallas MD

Henrique Kallas MD

From the * Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, and Department of Medicine, Division of Internal Medicine, University of Florida, Gainesville, Florida Central Arkansas Veterans Healthcare System, Little Rock, Arkansas § Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

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First published: 20 October 2005
Citations: 56
Address correspondence to Jeffrey S. Harman, PhD, Assistant Professor, Department of Health Services Research, Management and Policy, University of Florida, PO Box 100195, Gainesville, FL 32611. E-mail: [email protected]

This research was funded by National Institutes of Health (NIH) Grant K01 MH63780 and a Department of Veterans Affairs, Health Services Research and Development Service career development award to Dr. Edlund. Preliminary findings were presented at the NIH Complexities of Co-occurring Conditions Conference, Washington, DC, June 2004.

Abstract

Objectives: To assess the effect of the co-occurrence of four common chronic medical conditions (hypertension, diabetes mellitus, arthritis, heart disease) on the probability of receiving adequate depression treatment.

Design: Retrospective analysis of the 2000 and 2001 Medical Expenditure Panel Surveys (MEPS).

Setting: Households in the United States.

Participants: MEPS respondents aged 65 and older with self-reported depression (N=498).

Measurements: Adequate depression treatment is defined as receiving eight psychotherapy sessions or filling at least four antidepressant prescriptions at a minimally adequate dosage. Comorbid diabetes mellitus, hypertension, heart disease, and arthritis in older persons with depression were identified from patient self-report.

Results: An estimated 34% (95% confidence interval=28–39%) of older persons with self-reported depression received an adequate course of depression treatment during a calendar year. Having hypertension or diabetes mellitus was associated with significantly greater odds of receiving adequate depression care (hypertension odds ratio (OR)=1.81, P=.02; diabetes mellitus OR=1.77, P=.03). Having heart disease or arthritis was not significantly associated with the odds of receiving adequate depression care.

Conclusion: Some chronic medical conditions are associated with a greater likelihood of receiving adequate depression care; comorbid medical conditions do not result in lower quality of depression treatment in older persons. The high prevalence rates of comorbid depression and low rates of adequate depression care in elderly persons with chronic illnesses point to the importance of improving primary care depression treatment or enhancing specialty mental health referral.