Prof Osvaldo P Almeida, Jon J Pfaff, Brian M Draper, Jane E Pirkis, Nigel P Stocks, John A Snowdon, Moira G Simi, Gerard J Byrne, Nicola T Lautenschlager, Leon A Flicker, Ngaire M Kerse, Robert O Goldney
University of Western Australia
Beyond Blue Strategic Research
Project completion year
In Australia and other Western countries, older adults are the fastest-growing segment of the population. While this dramatic demographic change is a desirable and welcome phenomenon, the social, financial and health consequences of an ageing society cannot be ignored. Most people over the age of 65 years have at least one long-term medical illness, and about 25 per cent have five or more chronic diseases.
Depression is one of the most disabling mental disorders of later life, and current evidence suggests that those who experience a chronic medical condition are twice as likely as their healthy counterparts to develop major depression. Among older adults, depressive symptoms can complicate the clinical course of medical conditions, lead to a decline in self-rated health, and increase mortality.
Considering that about 80 percent of older adults will visit their general practitioner at least once a year in Australia, GPs are strategically placed to detect and treat cases of depression in people of this age group. GPs remain the first, and in many cases the only, health professionals involved in the management of a whole range of conditions, from common anxiety and depressive disorders to severe and enduring mental illnesses.
The project research objectives were to estimate the prevalence of depression among older Australians with common medical morbidities, and to determine the association between poor physical health and depression in this demographic.
The study undertook a cross-sectional survey of community-dwelling older primary care patients aged 60 years or over who attended GPs participating in the Depression and Early Prevention of Suicide in General Practice (DEPS-GP) project. The DEPS-GP study was conducted between 2005 and 2008.
The main outcome measures were depressive symptoms, health status, social support and demographic and lifestyle information.
Survey Results: 18,190 participants (90.1 per cent) reported having at least one chronic physical health condition, while 1,493 (7.1 per cent) experienced clinically significant depression (3.1 per cent major depressive syndrome; 4.0 per cent other depressive syndrome). Most chronic physical illnesses were associated with increased odds of depression, and participants with numerous medical morbidities and a high level of functional impairment were three to four times more likely to have a depressive illness.
The researchers found that depression is more the exception than the rule in later life, and among those who are medically unwell, the level of associated impairment may determine their risk of depression more than their acquired physical illness. Many of the factors associated with depression in medically ill patients are amenable to treatment, and GPs are in a unique position to address this important public health issue.
Osvaldo P. Almeida, et al. A Randomized Trial to Reduce the Prevalence of Depression and Self-Harm Behaviour in Older Primary Care Patients. Annals of Family Medicine - www.annfammed.org ; Vol. 10, No. 4, July/August 2012
Osvaldo P. Almeida, Ian Draper, John Snowdon, Nicola T Lautenschlager, Jane Pirkis, Gerard Byrne, Moira Sim, Nigel Stocks, Leon Flicker and Jon J. Pfaff, Factors associated with suicidal thoughts in a large community study of older adults, British Journal of Psychiatry (2012) 201: 466-472 doi: 10.1192/bjp.bp.112.110130