Among the elderly, few conditions are more consequential than depression. Rapid evolution in health care systems, new treatment technologies, changing prescription patterns and wider social acceptance of the biomedical basis of depression have created a new context for diagnosis and treatment of depression among the elderly. Such changes make it essential to examine national patterns and trends in the diagnosis and treatment of geriatric depression. In this study, nationally representative data from the Medicare Current Beneficiary Survey, including detailed longitudinal information on use of pharmaceuticals and mental health services, will be used to examine patterns of diagnosis of geriatric depression; analyze trends in and predictors of antidepressant treatment among the elderly; analyze use of specialty mental health services among elderly diagnosed with depression; investigate the extent and predictors of early discontinuation of antidepressant use; model amounts received and duration of mental health services use; and compare observed treatment patterns to those recommended by treatment guidelines. Variations in these patterns by care sector (mental health specialty versus general medical care), payer system (managed care versus fee-for-service), sociodemographic subgroup, insurance coverage, medical comorbidities, and other factors will be evaluated. We will also use data from the National Ambulatory Medical Care Survey, which link physician specialty, assigned diagnoses and medications prescribed during physician visits, to explore the evolving roles of the specialty and general medical care sectors in treatment of geriatric depression, and analyze the relationship between diagnoses assigned and psychotropic treatments prescribed at medical visits. Data from both sources will also be used to study the diffusion of selective serotonin reuptake inhibitors (SSRIs) among the elderly. These analyses will contribute to a better understanding of the process of diagnosis and treatment of depression in the elderly population, so that barriers to optimal care can be identified and addressed. They will also provide important information on trends in treatment patterns and shed light on the impact of health care system changes on the treatment of depression.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
1R01MH060831-01
Application #
6033679
Study Section
Special Emphasis Panel (ZMH1-SRV-C (04))
Program Officer
Oliver, Karen Anderson
Project Start
2000-01-01
Project End
2002-12-31
Budget Start
2000-01-01
Budget End
2000-12-31
Support Year
1
Fiscal Year
2000
Total Cost
$196,437
Indirect Cost
Name
Rutgers University
Department
Type
Organized Research Units
DUNS #
038633251
City
New Brunswick
State
NJ
Country
United States
Zip Code
08901
Akincigil, Ayse; Olfson, Mark; Siegel, Michele et al. (2012) Racial and ethnic disparities in depression care in community-dwelling elderly in the United States. Am J Public Health 102:319-28
Akincigil, Ayse; Olfson, Mark; Walkup, James T et al. (2011) Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005. J Am Geriatr Soc 59:1042-51
Crystal, Stephen; Gaboda, Dorothy; Lucas, Judith et al. (2010) Assessing medication exposures and outcomes in the frail elderly: assessing research challenges in nursing home pharmacotherapy. Med Care 48:S23-31
West, Joyce C; Wilk, Joshua E; Rae, Donald S et al. (2010) First-year Medicare Part D prescription drug benefits: medication access and continuity among dual eligible psychiatric patients. J Clin Psychiatry 71:400-10
Prince, Jonathan D; Akincigil, Ayse; Hoover, Donald R et al. (2009) Substance abuse and hospitalization for mood disorder among Medicaid beneficiaries. Am J Public Health 99:160-7
Himelhoch, Seth; Brown, Clayton H; Walkup, James et al. (2009) HIV patients with psychiatric disorders are less likely to discontinue HAART. AIDS 23:1735-42
Walkup, James; Wei, Wenhui; Sambamoorthi, Usha et al. (2008) Antidepressant treatment and adherence to combination antiretroviral therapy among patients with AIDS and diagnosed depression. Psychiatr Q 79:43-53
Hoover, Donald R; Akincigil, Ayse; Prince, Jonathan D et al. (2008) Medicare inpatient treatment for elderly non-dementia psychiatric illnesses 1992--2002;length of stay and expenditures by facility type. Adm Policy Ment Health 35:231-40
Akincigil, Ayse; Hoover, Donald R; Walkup, James T et al. (2008) Hospitalization for psychiatric illness among community-dwelling elderly persons in 1992 and 2002. Psychiatr Serv 59:1046-8
Prince, Jonathan D; Akincigil, Ayse; Kalay, Ece et al. (2008) Psychiatric rehospitalization among elderly persons in the United States. Psychiatr Serv 59:1038-45

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