Attitudes, knowledge, and behavior of family physicians regarding depression in late life

Objectives: To assess self-reported knowledge, attitudes, and behaviors of practicing community family physicians regarding identification and management of depression in late life. Design: We sent a 3-page "fax-back" survey to 768 active physician members of the Maryland Academy of Family Physicians, Baltimore. Measurements: We asked physicians to rate how confident they felt in evaluating several common medical conditions of late life, including depression. The questionnaire included items related to knowledge and treatment practices for depression in older adults. Results: Two hundred fifteen usable surveys were returned. In general, physicians took responsibility for diagnosing and treating depression. Few physicians reported that they routinely referred the older patient to a psychiatrist to treat depression, and only half thought that consultation was helpful. Physicians responding to the survey were generally aware of alternative presentations of depression in elderly persons, and were well informed about the duration of treatment with medications for depression. Most were using selective serotonin reuptake inhibitors as first-line agents to treat depression. Physicians thought that medications for depression were as effective for older patients as for younger patients, but were less optimistic about the effectiveness of psychotherapy. The barriers to identifying and treating depression in older patients most often mentioned by physicians were related to the atypical presentation of depression in older adults. More than half of the physicians rated themselves as "very confident" in evaluating depression. There were few differences in the responses of physicians with and those without a Certificate of Added Qualifications in geriatrics. Conclusions: Depression in late life remains a difficult clinical challenge for primary care physicians. These findings are particularly relevant in the face of recent efforts to increase collaboration between primary care physicians and mental health professionals.