The underdiagnosis of depression in the elderly and its effect on this population

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The underdiagnosis of depression in the elderly and its effect on this population

Introduction

Postnatal depression is a common and potentially serious health problem, with adverse consequences not only for the mother's mental health and functioning, but also for the psychological health of the partner and, significantly, for the cognitive and social development of the infant (Murray & Cooper, 1997). The prevalence of major depressive disorder in the weeks following delivery approximates to one in ten mothers, with symptoms typically enduring for 2-6 months (Cooper et al, 1988; O'Hara, 1997). As is the case for all depressive disorders, the combination of a high prevalence rate, extended duration of symptoms and a marked adverse effect on health status means that postnatal depression imposes a considerable clinical, social and economic burden at the population level, which is further exacerbated by low levels of case recognition, treatment and public awareness. Research into treatments that might reduce the burden of postnatal depression remains modest, although controlled studies suggest that both pharmacological and psychological interventions can have a discernible impact on clinical outcome (Appleby et al, 1997; Cooper & Murray, 1997; O'Hara et al, 2000).

Depression in the Elderly

It was within this context that a health services research component was incorporated into a cross-cultural study of postnatal depression. The main intent of the health services research was to complement the work on diagnosis and the assessment of motherhood experience by developing and applying qualitative and quantitative research tools for assessing the availability of and access to appropriate care, as well as the actual uptake of services by mothers with postnatal depression. In the absence of comparable international data on service provision or use for women with postnatal depression, our working hypothesis- informed by other international epidemiological studies of depression, such as the World Health Organization studies on pathways to care (Gater et al, 1991) and psychological problems in general health care (Üstün & Sartorius, 1995) - was that the provision of services for depressed mothers and recognition of their needs would vary across study sites, but take-up of such services would be universally low.

The primary aim of the Transcultural Study of Postnatal Depression (TCS-PND) was to develop (or modify), translate and validate research instruments that could be used for future studies in the field of perinatal psychiatry in different countries and cultures. The instruments were chosen to assess key aspects of the maternity experience, namely clinical diagnosis, the psychosocial context of pregnancy and motherhood, mother-infant interaction, the child's environment, and health service structure, use and its associated costs. The modified and translated research tools were then piloted in order to assess their validity in a range of diverse perinatal population settings. This paper specifically reports on the adaptation and piloting of a health service utilisation measure, the Client Service Receipt Inventory (CSRI; Beecham & Knapp, 2000), for use in studies of postnatal depression.

Postnatal depression (PND) is a condition which is clinically similar to depression occurring within ...