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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