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Title: Depression in older medical inpatients : descriptive epidemiology and a pragmatic randomised controlled trial of liaison psychiatric nursing
Author: Cullum, S. J.
Awarding Body: University of Cambridge
Current Institution: University of Cambridge
Date of Award: 2004
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Depression is common in older people with long-term physical illness and disability. Studies suggest that people with depression make greater use of healthcare services, even after adjustment for the severity of their physical comorbidity. Although the prevalence of depression is high in older people the detection and treatment of the disorder is known to be poor. The National Service Framework of Older People recommended screening for depression in order to improve healthcare delivery and health outcomes of older people. Large-scale screening programmes are unlikely to be commenced without adequate evidence that they will be effective and cost-effective. The aim of this thesis is to contribute to that evidence base by investigating, in a sample of older people, in a hospital setting: a) the descriptive epidemiology of depression b) the effectiveness of screening for depression c) the effectiveness and cost-effectiveness of treatment of depression. The study encompassed a randomised controlled trial and cost-effectiveness analysis of liaison psychiatric nursing for older medical inpatients who screen positive for depression within a prevalence study of depression. The weighted prevalence estimate of ICD-10 depressive disorder in older medical inpatients was 17.7% (95% CI: 12.9 - 22.5). Depressive disorder was independently associated with being widowed (OR=6.6, 95% CI: 2.4-18.5), more severe physical comorbidity (OR=4.5, 95% CI: 1.3-15.2), more severe disability (OR=2.5, 95% CI: 1.2-5.6) and a past history of depression (OR=2.3, 95% CI: 1.0-5.3). The optimal cutpoint of the 15-item Geriatric Depression Scale for screening for depressive disorder was £7 (sensitivity 0.74, specificity 0.81). Liaison psychiatric nursing reduced the odds of having depressive disorder at follow-up (OR=0.5, 95% CI: 0.2-1.3) and increased the odds of being satisfied with service delivery (OR=6.1, 95% CI: 1.6-23.6). Healthcare utilisation was not reduced. These findings indicate that screening and treatment of depression in older medical patients would improve mental health outcomes but would not reduce overall costs.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available