Graham,

Have you given up on us in UKPROF on CIS? I'm sorry that you couldn't have
access to our doctors only section

<< I would be delighted to read a study confirming your claim to gross
underdiagnosis. >>

Try these - a small selection of recent studies confirming this - but it is
fairly well documented


Rothschild AJ
The diagnosis and treatment of late-life depression.
In: J Clin Psychiatry (1996) 57 Suppl 5:5-11

  Depression in the elderly occurs commonly and is a major public
  health problem. Unfortunately, despite the availability of safe and
  effective treatments, late-life depression is often underdiagnosed
  because the symptoms are unrecognised by the patient and the health
  care provider. Late-life depression is described in this review, with
  a focus on symptoms, prevalence, diagnosis, and available treatment
  modalities.



Strauss PR  Gagiano CA  van Rensburg PH  de Wet KJ  Strauss HJ
Identification of depression in a rural general practice.
In: S Afr Med J (1995 Aug) 85(8):755-9

  Major depression is underdiagnosed by general practitioners, but the
  reasons for this are not clear. This study aimed to establish the
  prevalence of major depression and coexisting generalised anxiety
  disorder in a rural general practice in the Orange Free State. It
  also assessed the predictive value of a screening questionnaire for
  use by general practitioners. The two practitioners evaluated 858
  patients over a 4-week period. Those who met the screening criteria,
  together with a random sample of 60 patients who did not, were re-
  evaluated by a registrar in psychiatry who was unaware of the
  findings of his colleagues. Of the patients studied, 134 (15.6%) had
  major depression; 59 of these (44.0%) also had coexisting generalised
  anxiety disorder. The general practitioners had correctly diagnosed
  major depression in 32 patients (3.7%) before the study started. The
  screening questionnaire had a 42% chance of correctly identifying a
  patient with depression and a 97% chance of correctly identifying a
  patient who did not have major depression. Both practitioners were
  equally capable at identifying major depression. The study confirmed
  both the high prevalence of depression in a rural general practice
  and its low identification rate. It also showed the advantage of
  using a screening questionnaire to alert practitioners to the
  possibility of depression in their patients.

Fernandez F  Levy JK  Lachar BL  Small GW
The management of depression and anxiety in the elderly.
In: J Clin Psychiatry (1995) 56 Suppl 2:20-9

  The most common psychiatric disorders in later life, with the
  exception of dementia, are depression and anxiety. Often
  underdiagnosed or simply accepted with resignation as an inevitable
  part of aging or as an unavoidable complication of other
  constitutional illnesses, these disorders contribute to excess
  disability in older patients and further compromise their quality of
  life. This report discusses depression and anxiety in the growing
  elderly population--its prevalence, detection methods, diagnostic
  considerations, and present interventions.

Hall RC  Wise MG
The clinical and financial burden of mood disorders. Cost and
     outcome.
In: Psychosomatics (1995 Mar-Apr) 36(2):S11-8

  Depressive disorders are a chronic, recurrent, and severe burden to
  both patients and their families. Depressive disorders represent a
  major national public health problem, ranking within the top 10 most
  costly diseases in the United States. In 1990, depressive disorders
  afflicted at least 11 million Americans and cost the U.S. economy an
  estimated $44 billion. In addition, affective disorders are
  associated with increased accident rates, increased rates of
  substance abuse (especially alcoholism), increased medical
  hospitalisation, and an increase in somatic illnesses and outpatient
  medical utilisation. Despite their ranking as a major health problem,
  depressive disorders are often undersign and undertreated. Brief
  treatment strategies that focus only on acute episodes are often
  ineffective and result in chronic impairment, impairing performance
  at work and socially. Inadequate treatment increases costs,
  suffering, and lost productivity. Recent data suggest that effective
  treatment of depression requires long-term, skillful follow-up and
  active pharmacotherapy.



Capriotti T
Unrecognized depression in the elderly: a nursing assessment
     challenge.
In: Medsurg Nurs (1995 Feb) 4(1):47-54

  Depression in the elderly has been widely underdiagnosed and
  undertreated. Geriatric depression has a unique presentation that
  differs from the hallmarks of depressive illness documented in the
  Diagnostic and Statistical Manual of Mental Disorders (DSM IV)
  (American Psychiatric Association, 1994). The "masked" presentation
  of depression in the elderly contributes to problems with accurate
  assessment, prompt diagnosis, and treatment. Without treatment, there
  are serious negative consequences for elderly clients such as
  cognitive impairment, physical disability, social isolation, and
  suicide. Enhancing professional nurses' awareness of this
  underscoring mental health problem among elderly patients is a
  significant priority.


These are just some for the past 18 months

Best wishes

Iain




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