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Journal ArticleDOI

Healthcare and preventive services utilization of elderly Europeans with depressive symptoms.

01 Jan 2008-Journal of Affective Disorders (Elsevier)-Vol. 105, Iss: 1, pp 247-252

TL;DR: Share data suggest that patients with depressive symptoms are frequent users of healthcare but not preventive services, and low screening rates may reflect missed screening opportunities rather than a lack of screening opportunities.

AbstractBackground Depressive symptoms are associated with increased healthcare utilization. However, it is unclear whether depressed individuals experience more or less frequent access to preventive services. Our goal was to investigate the association between depressive symptoms and both utilization of healthcare and preventive services. Methods Baseline self-reported data (2004) from non-institutionalized individuals aged ≥ 50 years participating in the Survey of Health, Ageing, and Retirement in Europe (SHARE) were used. Of the 18,560 respondents to the baseline questionnaire, 13,580 answered the supplementary questionnaire, which included measures of preventive services. Healthcare utilization during the previous 12 months, including outpatient visits, medication, hospitalization, surgery, and home healthcare were assessed. Preventive service measures assessed the participation in influenza immunization and colorectal and breast cancer screening. Depression status was assessed with the EURO-D, a validated instrument for which a score > 3 defines clinically significant depressive symptoms. Logistic regressions were performed adjusting for age, gender, socioeconomic status, behavioral risk, chronic disease, disability, and country of residence. Results The estimated prevalence of depressive symptoms was 28.2%. Depressive symptoms were associated with significantly greater use of all healthcare domains but not preventive services, with the exception of colorectal cancer screening. Similar trends were found for each country of residence and for both genders. Limitations It was not known whether medical tests were used for screening or diagnostic purposes. Conclusions SHARE data suggest that patients with depressive symptoms are frequent users of healthcare but not preventive services. Low screening rates may reflect missed screening opportunities rather than a lack of screening opportunities.

Topics: Breast cancer screening (56%)

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Citations
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Journal ArticleDOI
TL;DR: There is strong evidence to suggest that the quality of preventive and screening services received by patients with mental illness is often lower, but occasionally superior to that received by individuals who have no comparable mental disorder.
Abstract: Background There has been long-standing concern about the delivery of preventive and screening services to patients with mental illness. Objective We aimed to examine whether the quality of preventive care received by patients with mental health conditions differs from that received by individuals who have no comparable mental disorder. Our hypothesis was that patients with mental illness would be in receipt of lower quality or lower frequency of preventive care. Method Studies that examined the quality of care in those with and without comorbid mental illness were reviewed and comparative data extracted. By using only comparative studies we hope to ascertain whether inequalities in care existed by virtue of psychiatric diagnoses (or closely affiliated factors). Results We identified 26 studies that examined preventive care in individuals with vs. without psychiatric illness. From these eligible studies, 61 comparisons were documented across 13 health care domains. These included mammography, cervical smears, vaccinations, cholesterol screening, lifestyle counseling, colonoscopy. Twenty-seven comparisons revealed inferior preventive health care in those with mental illness, but 10 suggested superior preventive health care and 24 reached inconclusive findings. Inferior preventive care was most apparent in those with schizophrenia and in relation to osteoporosis screening, blood pressure monitoring, vaccinations, mammography and cholesterol monitoring. Conclusions We conclude there is strong evidence to suggest that the quality of preventive and screening services received by patients with mental illness is often lower, but occasionally superior to that received by individuals who have no comparable mental disorder. More work must be done to improve the quality of medical and preventive care for individuals with mental illness.

94 citations


Cites background from "Healthcare and preventive services ..."

  • ...Eight studies showed no effect of mental illness on mammography [33,35,36,38,45–47,50]....

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  • ...This trend was despite a significantly higher use of services in the depressed group [33]....

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  • ...In the large European interview and survey study [33], the group screening positive for a depressive disorder had higher rates of colonoscopy or sigmoidoscopy (16....

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  • ...Neutral association In a large European interview and survey study, the group with high Euro-D scores, suggesting the presence of a depressive disorder, had a trend towards higher flu vaccination, but this was not significant [33]....

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  • ...[33] conducted an interview and questionnaire survey of over 50 years old in 10 European countries (n=15,380); those who scored N3 on the Euro-D were less likely to have a mammogram in the last 2 years, but the adjusted odds ratio was no longer significant (OR 1....

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Journal ArticleDOI
02 Feb 2009-BMJ
TL;DR: Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.
Abstract: Objectives To study the duration of depression, recovery over time, and predictors of prognosis in an older cohort (≥55 years) in primary care. Design Longitudinal cohort study, with three years’ follow-up. Setting 32 general practices in West Friesland, the Netherlands. Participants 234 patients aged 55 years or more with a prevalent major depressive disorder. Main outcome measures Depression at baseline and every six months using structured diagnostic interviews (primary care evaluation of mental disorders according to diagnoses in Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and a measure of severity of symptoms (Montgomery Asberg depression rating scale). The main outcome measures were time to recovery and the likelihood of recovery at different time points. Multivariable analyses were used to identify variables predicting prognosis. Results The median duration of a major depressive episode was 18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressed patients recovered within one year, 60% within two years, and 68% within three years. A poor outcome was associated with severity of depression at baseline, a family history of depression, and poorer physical functioning. During follow-up functional status remained limited in patients with chronic depression but not in those who had recovered. Conclusion Depression among patients aged 55 years or more in primary care has a poor prognosis. Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.

86 citations


Journal ArticleDOI
TL;DR: Rates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress, clearly extend into preventive population screening.
Abstract: Background There is a higher mortality rate due to cancer in people with mental illness and previous work suggests suboptimal medical care in this population. It remains unclear if this extends to breast cancer population screening. Aims To conduct a systematic review and meta-analysis to establish if women with a mental health condition are less likely to receive mammography screening compared with those without mental ill health. Method Major electronic databases were searched from inception until February 2014. We calculated odds ratios (OR) with a random effects meta-analysis comparing mammography screening rates among women with and without a mental illness. Results were stratified according to primary diagnosis including any mental illness, mood disorders, depression, severe mental illness (SMI), distress and anxiety. Results We identified 24 publications reporting breast cancer screening practices in women with mental illness ( n = 715 705). An additional 5 studies investigating screening for those with distress ( n = 21 491) but no diagnosis of mental disorder were identified. The pooled meta-analysis showed significantly reduced rates of mammography screening in women with mental illness (OR = 0.71, 95% CI 0.66-0.77), mood disorders (OR = 0.83, 95% CI 0.76-0.90) and particularly SMI (OR = 0.54, 95% CI 0.45-0.65). No disparity was evident among women with distress alone. Conclusions Rates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress. Disparities in medical care due to mental illness clearly extend into preventive population screening.

79 citations


Cites background from "Healthcare and preventive services ..."

  • ...…et al (2008) 58 (Canada) Green & Pope (2000) 49 Druss et al (2008) 48 (primary care) Masterton et al (2010) 54 (moderate) Pirraglia et al (2004) 52 Peytremann-Bridevaux et al (2008) 51 Carney & Jones (2006) 42 (any low severity) Carney & Jones (2006) 42 (mood disorder low severity) Werneke et al…...

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Journal ArticleDOI
TL;DR: Forgone care should be reduced even if it is not justified by an 'objective' need for health care, as it could be an independent stressor in its own right, and as patient satisfaction is a strong predictor of compliance.
Abstract: Studies on the association between access to health care and household income have rarely included an assessment of 'forgone care', but this indicator could add to our understanding of the inverse care law. We hypothesize that reporting forgone care is more prevalent in low income groups. The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the non-institutionalized population aged 50 years or older. Data are included from France, Germany, Greece, Italy and Sweden. The dependent variable is assessed by the following question: During the last twelve months, did you forgo any types of care because of the costs you would have to pay, or because this care was not available or not easily accessible? The main independent variable is household income, adjusted for household size and split into quintiles, calculating the quintile limits for each country separately. Information on age, sex, self assessed health and chronic disease is included as well. Logistic regression models were used for the multivariate analyses. The overall level of forgone care differs considerably between the five countries (e.g. about 10 percent in Greece and 6 percent in Sweden). Low income groups report forgone care more often than high income groups. This association can also be found in analyses restricted to the subsample of persons with chronic disease. Associations between forgone care and income are particularly strong in Germany and Greece. Taking the example of Germany, forgone care in the lowest income quintile is 1.98 times (95% CI: 1.08–3.63) as high as in the highest income quintile. Forgone care should be reduced even if it is not justified by an 'objective' need for health care, as it could be an independent stressor in its own right, and as patient satisfaction is a strong predictor of compliance. These efforts should focus on population groups with particularly high prevalence of forgone care, for example on patients with poor self assessed health, on women, and on low income groups. The inter-country differences point to the need to specify different policy recommendations for different countries.

77 citations


Cites background or methods from "Healthcare and preventive services ..."

  • ...Methods The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the noninstitutionalized population aged 50 years or older from 11 European countries plus Israel [16-23]....

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  • ...Shmueli A, Achdut L, Sabag-Endeweld M: Financing the package of services during the first decade of the national health insurance law in Israel: trends and issues....

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  • ...Methods The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the non- institutionalized population aged 50 years or older from 11 European countries plus Israel [16-23]....

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  • ...2004), and they are well accepted in the public health community [18-23]....

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Journal ArticleDOI
TL;DR: The KORA-Age consortium was able to collect data in a large population-based sample and is contributing to the understanding of multimorbidity and successful aging.
Abstract: Background The objective of the KORA-Age research consortium is to assess the determinants and consequences of multimorbidity in the elderly and to look into reasons for successful aging in the general public. Patients and methods In the KORA-Age cohort study 9,197 persons were included who where born in the year 1943 or before and participants of previous KORA cohort studies conducted between 1984 and 2001 (KORA: Cooperative Health Research in the Region of Augsburg). The randomized intervention study KORINNA (Coronary infarct follow-up treatment in the elderly) tested a nurse-based case management program with 338 patients with myocardial infarct and included an evaluation in health economics. Results A total of 2,734 deaths were registered, 4,565 participants submitted a postal health status questionnaire and 4,127 participants were interviewed by telephone (response 76.2% and 68.9% respectively). A gender and age-stratified random sample of the cohort consisting of 1,079 persons took part in a physical examination (response 53.8%). Conclusion The KORA-Age consortium was able to collect data in a large population-based sample and is contributing to the understanding of multimorbidity and successful aging.

74 citations


References
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Journal ArticleDOI
TL;DR: A systematic review of community-based studies of the prevalence of depression in later life (55+) found consistent evidence for higher prevalence rates for women and among older people living under adverse socio-economic circumstances.
Abstract: BACKGROUND Despite considerable interest, there is no consensus regarding the prevalence of depression in later life. AIMS To assess the prevalence of late-life depression in the community. METHOD A systematic review of community-based studies of the prevalence of depression in later life (55+). Literature was analysed by level of caseness at which depression was defined and measured. RESULTS Thirty-four studies eligible for inclusion were found. The reported prevalence rates vary enormously (0.4-35%). Arranged according to level of caseness, major depression is relatively rare among the elderly (weighted average prevalence 1.8%), minor depression is more common (weighted average prevalence 9.8%), while all depressive syndromes deemed clinically relevant yield an average prevalence of 13.5%. There is consistent evidence for higher prevalence rates for women and among older people living under adverse socio-economic circumstances. CONCLUSIONS Depression is common in later life. Methodological differences between studies preclude firm conclusions about cross-cultural and geographical variation. Improving the comparability of epidemiological research constitutes an important step forward.

1,037 citations


"Healthcare and preventive services ..." refers background in this paper

  • ...In the elderly, the average prevalence of clinically relevant depressive syndromes (major and minor depression) is 13.5% (Beekman et al., 1999)....

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Journal ArticleDOI
TL;DR: The authors conclude that physical disabilities among the elderly do not appear to be a major threat to the validity of the CES-D scale and that the strong associations between physical and mental health should be rigorously investigated.
Abstract: The associations between depressive symptoms and functional disability and chronic conditions are examined in an elderly cohort of 2,806 noninstitutionalized men and women living in New Haven, Connecticut who were interviewed in 1982 as a part of the Yale Health and Aging Project. The aim is to explore several potential sources of invalidity in using the Center for Epidemiologic Studies-Depression scale (CES-D) to measure depressive symptoms in elderly populations. In particular, the authors are concerned with the possibility that prevalent physical illnesses and disabilities may cause the older person to report many somatic complaints, a major component of most measures of depressive symptomatology, and thereby inflate his or her CES-D score. Mean CES-D scores are 4.86 for those without any disabilities and range to 13.51 for those with major functional disabilities. However, physical disability is significantly associated with virtually every item on the CES-D scale not just those somatically-oriented items. The addition of functional disability to a multivariate model including age subfactor analysis of responses from this elderly sample produces results almost identical to those reported by earlier investigators who studied younger and middle-aged adults. The authors conclude that physical disabilities among the elderly do not appear to be a major threat to the validity of the CES-D scale and that the strong associations between physical and mental health should be rigorously investigated.

793 citations


Journal ArticleDOI
TL;DR: A two-factor solution seemed appropriate: depression, tearfulness and wishing to die loaded on the first factor (affective suffering), and loss of interest, poor concentration and lack of enjoyment on the second (motivation).
Abstract: BACKGROUND In an 11-country European collaboration, 14 population-based surveys included 21,724 subjects aged > or = 65 years. Most participating centres used the Geriatric Mental State (GMS), but other measures were also used. AIMS To derive from these instruments a common depression symptoms scale, the EURO-D, to allow comparison of risk factor profiles between centres. METHOD Common items were identified from the instruments. Algorithms for fitting items to GMS were derived by observation of item correspondence or expert opinion. The resulting 12-item scale was checked for internal consistency, criterion validity and uniformity of factor-analytic profile. RESULTS The EURO-D is internally consistent, capturing the essence of its parent instrument. A two-factor solution seemed appropriate: depression, tearfulness and wishing to die loaded on the first factor (affective suffering), and loss of interest, poor concentration and lack of enjoyment on the second (motivation). CONCLUSIONS The EURO-D scale should permit valid comparison of risk-factor associations between centres, even if between-centre variation remains difficult to attribute.

541 citations


"Healthcare and preventive services ..." refers methods in this paper

  • ...The Survey of Health, Ageing, and Retirement in Europe (SHARE) [Börsch-Supan et al., 2005) included 10 countries in 2004 (Austria, Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, and Switzerland)....

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  • ...This was defined by a score N3 on the EURO-D, a validated instrument developed in Europe (Prince et al., 1999)....

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  • ...Methods: Baseline self-reported data (2004) from non-institutionalized individuals aged ≥50 years participating in the Survey of Health, Ageing, and Retirement in Europe (SHARE) were used....

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  • ...Twenty-eight percent of European men and women presented clinically significant depressive symptoms....

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  • ...The SHARE data collection has been primarily funded by the European Commission through the 5th framework programme (project QLK6-CT-2001-00360 in the thematic programme Quality of Life)....

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Journal ArticleDOI
TL;DR: The role of general medical practitioners in treating persons with psychiatric disorders is more limited than was anticipated and patients in categories associated with extensive use of professional care are more likely to have unmet care needs.
Abstract: OBJECTIVES: This study examined the use of primary health care, mental health care, and informal care services, as well as unmet care needs, by individuals with different psychiatric diagnoses. METHODS: Data were derived from the Netherlands Mental Health Survey and Incidence Study and were based on a representative sample (n = 7147) of the general population (aged 18-64 years). RESULTS: In a 12-month period, 33.9% of those with a psychiatric disorder used some form of care; 27.2% used primary care, and 15.3% used mental health care. Patients with mood disorders were the most likely to enlist professional care; those with alcohol- and drug-related disorders were the least likely to do so. Higher educated persons who live alone, single parents, unemployed persons, and disabled persons were more likely to use mental health care. Unmet need for professional help was reported by 16.8% (men 9.9%, women 23.9%) of those with a disorder. CONCLUSIONS: Care use varies widely by diagnostic category. The role of general medical practitioners in treating persons with psychiatric disorders is more limited than was anticipated. Patients in categories associated with extensive use of professional care are more likely to have unmet care needs.

362 citations


"Healthcare and preventive services ..." refers background in this paper

  • ...Depressive symptoms are a major public health problem because of their high prevalence, their detrimental effect on health (Braam et al., 2005) and their association with relatively frequent use of medical services (Bijl and Ravelli, 2000; Huang et al., 2000)....

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  • ..., 2005) and their association with relatively frequent use of medical services (Bijl and Ravelli, 2000; Huang et al., 2000)....

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Journal ArticleDOI
TL;DR: Both major and minor depression are consequential for well-being and disability, supporting efforts to improve the recognition and treatment in primary care and underscoring the importance of recognition.
Abstract: Background. The consequences of major depression for disability, impaired well-being and service utilization have been studied primarily in younger adults. In all age groups the consequences of minor depression are virtually unknown. In later life, the increased co-morbidity with physical illness may modify the consequences of depression, warranting special study of the elderly. With rising numbers of elderly people, excess service utilization by depressed elderly represents an increasingly important issue. Methods. Based on a large, random community-based sample of older inhabitants of the Netherlands (55-85 years), the associations of major and minor depression with various indicators of disability, well-being and service utilization were assessed, controlling for potential confounding factors. Depression was diagnosed using a two-stage screening design. Diagnosis took place in all subjects with high depressive symptom levels and a random sample of those with low depressive symptom levels. The study sample consists of all participants to diagnostic interviews (N = 646). Results. As in younger adults, associations of both major and minor depression with disability and well-being remained significant after controlling for chronic disease and functional limitations. Adequate treatment is often not administered, even in subjects with major depression. As the vast majority of those depressed were recently seen by their general practitioners, treatment could have been provided in most cases. Bivariate analyses show that major and minor depression are associated with an excess use of non-mental health services, underscoring the importance of recognition. In multivariate analyses the evidence of excess service utilization was less compelling. Conclusions. Both major and minor depression are consequential for well-being and disability, supporting efforts to improve the recognition and treatment in primary care. However, controlled trials are necessary to assess the impact this may have on service utilization.

354 citations


"Healthcare and preventive services ..." refers result in this paper

  • ...Concordant with previous population-based studies from several countries (Beekman et al., 1997; Fischer et al., 2002; Himelhoch et al., 2004; McCracken et al., 2006; Rowan et al., 2002), our results reveal an association between depressive symptoms and general healthcare use, which was not fully…...

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  • ...Concordant with previous population-based studies from several countries (Beekman et al., 1997; Fischer et al., 2002; Himelhoch et al., 2004; McCracken et al., 2006; Rowan et al., 2002), our results reveal an association between depressive symptoms and general healthcare use, which was not fully explained by chronic diseases and/or disability....

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