Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger Depression prevalence and treatment among older home health services users in the United States Xiaoling Xiang a, ⁎ , Margaret K. Danilovich b , Kathryn Noth Tomasino c , Neil Jordan d a School of Social Work, University of Michigan, 1080 S University Ave, 48109, MI, United States b Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, United States c Preventive Medicine, Northwestern University u Feinberg School of Medicine, United States d Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States ARTICLE INFO Keywords: Depression Older adults Home health services ABSTRACT Objective: The purpose of this study is to provide a nationally representative estimate of the rates of depression and depression treatment, and to explore factors associated with receipt of depression treatment, among older home health services users. Methods: Older home health services users (n = 1666) were selected from 2008 to 2013 Medical Expenditure Panel Survey. Depression was measured by the Patient Health Questionnaire-2. Depression treatment included antidepressants use and receipt of mental health counseling or psychotherapy. Logistic regression was used to examine the association of individual characteristics and receipt of depression treatment. Results: Current depression affected 23% of older home health services users. Less than 40% of those who screened positive for depression reported receiving depression treatment. Among those who received treatment, virtually all (99.8%) reported receiving antidepressants and only 9.5% reported receiving psychotherapy. Among older home health services users with current depression, older age and non-Hispanic black race were associated with lower odds of receiving depression treatment whereas having cognitive impairment was posi- tively associated with receiving depression treatment. Conclusion: Depression affects a substantial proportion of older home health services users and is undertreated. Home health services settings may be important platforms to improve depression care among older adults. Future research is needed to develop optimal strategies for integrating depression assessment and treatment in home health services settings. 1. Introduction As many as 15% of adults 65 years or older living in the community have clinically significant depression and this rate is much higher among medical outpatients, medical inpatients, and residents of long- term care facilities (Blazer, 2003; Fiske, Wetherell, & Gatz, 2009). De- pression in late life poses a serious threat to the health and survival of older adults. Research has consistently linked depression to a series of adverse outcomes, including elevated risk for chronic diseases, non- adherence to medication and treatment regimens, greater health ser- vices utilization and expenditures, functional impairment and dis- ability, and shortened life expectancy (Barth, Schumacher, & Herrmann-Lingen, 2004; Schulz et al., 2000; Xiang & An, 2015a, 2015b). Even mild yet clinically relevant depressive symptoms can cause functional impairment comparable to or poorer than that of chronic physical diseases such as heart disease and diabetes (Sriwattanakomen et al., 2008). Depression is also a significant risk factor for suicide. Suicide rates have historically been the highest among people 85 years and older relative to other age groups (Centers for Disease Control, 2015). However, due to multi-level factors such as ageism, stigma associated with mental illness and shortage of geriatric mental health providers, depressive symptoms are frequently missed, improperly diagnosed, and inadequately treated in older adults (Charney et al., 2003). To improve identification and treatment of depression in late life, there has been a growing interest in coordination and integration of mental health services in the home health setting (Bruce et al., 2015; Choi et al., 2014; Ciechanowski et al., 2004; Gellis, Kenaley, & Have, 2014; Shao, Peng, Bruce, & Bao, 2011). Home health agencies provide a wide range of medical and social services that aim to promote health https://doi.org/10.1016/j.archger.2017.12.005 Received 26 September 2016; Received in revised form 19 February 2017; Accepted 10 December 2017 ⁎ Corresponding author. E-mail addresses: xiaoling.xiang@northwestern.edu (X. Xiang), margaret-wente@northwestern.edu (M.K. Danilovich), kathryn.noth@northwestern.edu (K.N. Tomasino), neil-jordan@northwestern.edu (N. Jordan). Archives of Gerontology and Geriatrics 75 (2018) 151–157 Available online 21 December 2017 0167-4943/ © 2017 Published by Elsevier Ireland Ltd. T