The influence of comorbid chronic medical conditions on the adequacy of depression care for older Americans

OBJECTIVES: To assess the effect of the co-occurrence of four common chronic medical conditions (hypertension, diabetes mellitus, arthritis, heart disease) on the probability of receiving adequate depression treatment. DESIGN: Retrospective analysis of the 2000 and 2001 Medical Expenditure Panel Surveys (MEPS). SETTING: Households in the United States. PARTICIPANTS: MEPS respondents aged 65 and older with self-reported depression (N=498). MEASUREMENT: Adequate depression treatment is defined as receiving eight psychotherapy sessions or filling at least four antidepressant prescriptions at a minimally adequate dosage. Comorbid diabetes mellitus, hypertension, heart disease, and arthritis in older persons with depression were identified from patient self-report. RESULTS: An estimated 34% (95% confidence interval=28-39%) of older persons with self-reported depression received an adequate course of depression treatment during a calendar year. Having hypertension or diabetes mellitus was associated with significantly greater odds of receiving adequate depression care (hypertension odds ratio (OR)=1.81, P=.02; diabetes mellitus OR=1.77, P=.03). Having heart disease or arthritis was not significantly associated with the odds of receiving adequate depression care. CONCLUSION: Some chronic medical conditions are associated with a greater likelihood of receiving adequate depression care; comorbid medical conditions do not result in lower quality of depression treatment in older persons. The high prevalence rates of comorbid depression and low rates of adequate depression care in elderly persons with chronic illnesses point to the importance of improving primary care depression treatment or enhancing specialty mental health referral.