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Title: Identification and management of late life depression : working across primary care and community service boundaries
Author: Arthur, Antony John
Awarding Body: University of Leicester
Current Institution: University of Leicester
Date of Award: 2000
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In 1990, annual health checks for people aged 75 years and over were introduced into general practice. This was seen as a potential vehicle for systematic screening, with subsequent referral to specialist community services, for older people with depression. Previous research had identified a number of obstacles to the recognition and treatment of late life depression. This thesis consists of two studies to evaluate the effectiveness of a structured approach by primary care and community services to the identification and management of depression among older people. Phase One was a validation study of the short Geriatric Depression Scale (GDS15) as part of an annual over-75 health check by the practice nurse. A stratified random sample of patients who completed the GDS15 was followed up with a diagnostic interview. At a cut-point of <3/3+ the GDS15 was 100% sensitive and 72% specific in detecting cases of depression. Phase Two was a randomised controlled trial of follow-up assessment by the local Community Mental Health Team (CMHT) for older people identified as depressed at the practice nurse health check. A total of 93 older people with GDS15 scores of 5 or more were randomised to either CMHT assessment (N=47) or routine GHP care (N=46). Uptake of the intervention was 72% (N=34). At the follow-up health check, 18 months after the initial health check, a greater proportion of the control group had improved GDS15 scores (p=0.08). Requests by the CMHT to continue to be involved with some of the patients in the intervention group were often rejected by patients' general practitioners. Although the GDS15 appears to be a useful instrument in the context of an over-75 health check, further mental health assessment should only be considered where there is a commitment by all service provides to implement recommendations.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available