Recognition of depression in older medical inpatients discharged to ambulatory care settings: a longitudinal study Jane McCusker, M.D., Dr.P.H. a,b, ⁎ , Martin Cole, M.D., F.R.C.P.(C) b,c , Eric Latimer, Ph.D. b,d , Maida Sewitch, Ph.D. a,b , Antonio Ciampi, Ph.D. a,b , Monica Cepoiu, M.D., M.Sc. a , Eric Belzile, M.Sc. a a Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal, Quebec, Canada H3T 1M5 b McGill University, Montreal, Quebec, Canada H3A 2T5 c St. Mary's Hospital, Montreal, Quebec, Canada H3T 1M5 d Douglas Hospital, Montreal, Quebec, Canada H3T 1M5 Received 28 November 2007; accepted 23 January 2008 Abstract Objective: This study aimed to examine the recognition of depression in older medical inpatients by nonpsychiatric physicians over a 2-year period. Methods: A cohort of medical inpatients aged 65 and above was recruited at two university-affiliated hospitals, with oversampling of depressed patients. Participants were assessed with research diagnoses of major or minor depression (DSM-IV) at admission and at 3, 6 and 12 months. Indicators of recognition during the 12 months before and the 12 months after admission, derived from administrative databases, included the following: depression diagnosis, antidepressant prescription and psychiatric referral. Multiple logistic regression analyses were used to identify factors associated with recognition. Results: Among 185 patients with at least one research diagnosis of depression during the study, recognition rates ranged up to 56% during the 12 months before admission among patients with major depression lasting at least 6 months and up to 61% during the 12 months after admission among patients with persistent major depression. In both study periods, a greater number of physician visits and prescription of a psychotropic medication (non-antidepressant) were independently associated with recognition. Conclusions: A longitudinal approach to measuring recognition of late-life depression in ambulatory care settings indicates that persistent major depression is more likely to be recognized than previously reported. © 2008 Elsevier Inc. All rights reserved. Keywords: Aged; Depression; Primary care; Recognition 1. Introduction Late-life depression is a common problem in ambulatory care settings, associated with increased disability and use of services [1–3]. Despite the apparent effectiveness of antidepressant and psychosocial treatments in this popula- tion [4], a recent meta-analysis found that, at all ages, depression is recognized by nonpsychiatric physicians in a minority of cases [summary sensitivity of 36.4%, 95% confidence interval (CI)=27.9, 44.8] [5]. Prior research on recognition has two major limitations. First, most prior studies have been cross-sectional even though a longitudinal approach may be more relevant when the chronic, often fluctuating course of depression and the longitudinal relationship between patients and their primary physicians are considered. Second, prior research has tended to focus on patient factors associated with recognition (e.g., greater severity of depressive symptoms [6], self-reported use of sleeping tablets) [6] and not on characteristics of ambulatory care. Although primary care physicians bear primary responsibility for the recognition and treatment of Available online at www.sciencedirect.com General Hospital Psychiatry 30 (2008) 245 – 251 ⁎ Corresponding author. Tel.: +1 514 345 3511x5060; fax: +1 514 734 2652. E-mail address: jane.mccusker@mcgill.ca (J. McCusker). 0163-8343/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.genhosppsych.2008.01.006