Late-life depression in primary care. How well are we doing?

To discover primary care physicians' attitudes toward their abilities to detect and treat depression in the elderly.

A self-administered questionnaire sent to 1,000 primary care physicians in the state of Michigan.

The survey was sent to physicians who practice general internal medicine or family medicine.

The questionnaire was sent to 500 MD and 500 DO physicians; equal representation was given to general internal medicine and family medicine. Of all 1,000 physicians, 60% (n = 604) responded, 51% (n = 309) were MD's, 48% (n = 295) were DO's, 41% (n = 245) were general internists, and 59% (n = 359) were family medicine physicians.

Despite positive attitudes about their skills for detecting and treating depression in the elderly, only one quarter of the respondents routinely used a screening tool in practice. Forty-one percent of all physicians were not aware of depression practice guidelines. Family physicians were more confident about their treatment skills than were general internists (85% vs 50%; chi 2 = 11.42, p < or = .003). Male physicians more often endorsed pharmacologic treatment, while female physicians more frequently used counseling and exercise techniques to treat depressed older patients. Half of all physicians felt knowledgeable about community resources to treat older depressed patients.

This survey identified several perceived needs for future targeted interventions: (1) additional Agency for Health Care Policy and Research guideline exposure for all primary care physicians, (2) targeted counseling skill intervention for male physicians and medication management for female physicians, and (3) additional continuing medical education intervention for practicing general internists. Further research is needed to correlate physician attitudes with ensuing behaviors to fully appreciate the nature of late-life depression treatment within the primary care arena.