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Recognition of Depression in Older Medical Inpatients

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Background

Studies of recognition of depression in older (aged 65 or more) medical inpatients show low rates of recognition of depression by attending physicians. However, few studies have compared different measures of recognition of depression.

Objectives

(1) To compare the validity of four indicators of recognition of depression and a global measure of recognition against a diagnosis of depression and (2) to explore the effect of patient characteristics on recognition of depression.

Methods

In a cohort of 264 medical inpatients 65 years and older (115 with major or minor depression, 78 with no depression), sensitivities, specificities, and diagnostic odds ratios (DOR) of 4 indicators of recognition (symptoms, diagnosis, treatment, and referral) and a global measure of recognition (any of the 4 indicators) were calculated. The associations between patient characteristics (age, sex, history of depression, antidepressant use before admission, severity of depression, comorbidity, duration of hospitalization, disability, and hospital of admission) and recognition were explored using multiple logistic regression.

Results

Less than half of the depressed patients were recognized. The indicator with the highest sensitivity was treatment (27.8%, 95% confidence interval [CI] 20.0–37.0), whereas the indicator with the best specificity was diagnosis (96.6%, 95% CI 91.9–98.7). The unadjusted DOR of global recognition was 2.6 (95% CI 1.5, 4.4). Less comorbidity, more severe depression symptoms, a history of depression, longer hospital stay, and antidepressant use before admission were significantly associated with better global recognition.

Conclusion

Recognition of depression in elderly medical inpatients depends upon the indicator of recognition used.

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Acknowledgements

This study was supported by a grant from Fonds de la recherche en santé du Québec (grant no. 25004-2560) and 2 grants from Institutes for Health Research (grant nos. MOP-64462 and 11949).

Potential Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Clinical Epidemiology and Community Studies, St. Mary’s Hospital, 3830 Lacombe Avenue, Montreal, QC, H3T 1M5, Canada

    Monica Cepoiu MD, MSc, Jane McCusker MD, DrPH, Maida Sewitch PhD & Antonio Ciampi PhD

  2. Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada

    Jane McCusker MD, DrPH & Antonio Ciampi PhD

  3. Department of Psychiatry, St. Mary’s Hospital, Montreal, QC, Canada

    Martin G. Cole FRCP(C)

  4. Department of Psychiatry, McGill University, Montreal, QC, Canada

    Martin G. Cole FRCP(C)

  5. Department of Medicine, St. Mary’s Hospital, Montreal, QC, Canada

    Maida Sewitch PhD

Authors
  1. Monica Cepoiu MD, MSc
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  2. Jane McCusker MD, DrPH
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  3. Martin G. Cole FRCP(C)
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  5. Antonio Ciampi PhD
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Correspondence to Monica Cepoiu MD, MSc.

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Cepoiu, M., McCusker, J., Cole, M.G. et al. Recognition of Depression in Older Medical Inpatients. J GEN INTERN MED 22, 559–564 (2007). https://doi.org/10.1007/s11606-006-0085-0

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