Discussion of depression in follow-up medical visits with older patients

OBJECTIVES: To determine the frequency of discussion about depression in follow-up medical visits of older patients, who initiates these discussions, the quality of responsiveness of physicians and patients in these discussions, and patient and physician characteristics that influence these discussions. DESIGN: Convenience sample of 482 audiotaped follow-up visits. SETTING: Three community-based practice sites. PARTICIPANTS: Three hundred seventy-six community-dwelling older patients without dementia and 43 primary care physicians. MEASUREMENTS: Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis system to determine the content and process of medical conversations; patients completed Medical Outcomes Study 36-item Short Form Survey questionnaires immediately after the visit. RESULTS: Depression was discussed in 7.3% of medical visits; physicians raised this topic in 41% of visits, patients raised it in 48% of visits, and accompanying persons raised it in 10% of visits. Visits were longer when the topic of depression was discussed. Depression was raised almost exclusively in the first 2.5 years of the patient-physician relationship. Physicians with some geriatric training were more likely to discuss depression, and these visits were shorter than visits to physicians without geriatric training. CONCLUSION: Depression was raised infrequently in follow-up visits. The high prevalence of depression in older people and the associated mortality merit discussion of depression early and later in the patient-physician relationship. Although visits were longer when depression was discussed, physicians with some geriatric training were more likely to raise depression, and more time-efficient when they did so, than physicians without geriatric training.