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THE IMPACT OF SOCIAL SUPPORT AMONG DEPRESSED GERIATRIC OUTPATIENTS
AAGP 12th Annual Meeting time activity data to derive CBF measurements. There was a significant difference between mean cortical CBF in individuals under age 45 (mean age 28.5Ⳳ6.6 sd, N⳱18) (57Ⳳ10 ml/100ml/min) and those over age 60 (mean age 69.8Ⳳ5.4 sd, N⳱9) (50Ⳳ3.0 ml/100ml/ min) in the uncorrected PET data (P⳱0.03). This group difference resolved after partial volume correction (young: 62Ⳳ10, elderly: 61Ⳳ5.0 ml/100ml/min) (P⳱0.37). The magnitude of inverse correlations between age and regional CBF measurements also diminished after correction. The authors conclude that CBF does not decline with age in normal, healthy individuals. This study further suggests that failure to correct for the dilutional effect of age-related cerebral atrophy may confound interpretation of previous PET studies that have reported aging reductions in metabolic measurements. This work has implications for the study of neuropsychiatric disease of aging, such as late-life depression and Alzheimer’s disease, in which cerebral physiology may be altered. Meltzer CC, et al. J Comput Assist Tomogr 14:561–70, 1990. Woods RP, et al. J Comput Assist Tomogr 17:536–46, 1993.
Paper Abstracts—Session 2: Health Services THE IMPACT OF SOCIAL SUPPORT AMONG DEPRESSED GERIATRIC OUTPATIENTS. Patrick J. Raue, Ph.D.; Deborah A. Perlick, Ph.D.; Martha Livingston Bruce, Ph.D.; Jo Anne Sirey, Ph.D.; George S. Alexopoulos, M.D.; Barnett S. Meyers, M.D.
F
ailure to demonstrate an effect of social support on outcome among geriatric patients may be due to use of measures that do not reflect the multidimensional nature of support. The authors examined the impact of different types of social support as well as different sources of support on the symptomatic improvement of 25 depressed geriatric outpatients at 3-month follow up. Controlling for initial depression severity, intensity of antidepressant treatment, perceived health, and presence of a personality disorder, the following types of social support predicted symptomatic improvement in separate regression models: instrumental support (partial r⳱ⳮ0.70; P⳱0.002) and subjective support (partial r⳱ⳮ0.58; P⳱0.015). In contrast, social interaction frequency and size of the social network failed to predict outcome. Further analyses examined source of support: correlations controlling for initial depression severity suggested that patient perception of the family environment was associated with outcome
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(partial r of perceived support from family⳱ⳮ0.54; P⳱0.007; partial r of perceived stress from family⳱0.44; P⳱0.030), whereas perception of the social environment of their friends and acquaintances was not. Results indicate that, contrary to studies using aggregate measures of social support, certain aspects of support strongly predict symptomatic recovery among geriatric outpatients with major depression.
STIGMA, INITIAL SATISFACTION AND TREATMENT ADEQUACY AMONG YOUNG AND OLDER ADULT OUTPATIENTS WITH DEPRESSION. Jo Anne Sirey, Ph.D.; Martha L. Bruce, Ph.D.; Barnett S. Meyers, M.D.
A
im: This study was designed to compare young and older outpatients with major depression on perceived stigma and attitudes towards care as predictors of medication adequacy and treatment adherence. Method: A twostage sampling design was used to identify and follow 68 outpatients age 25–64 and 31 patients age ⬎65 with SCIDdiagnosed major depression seeking outpatient mental health treatment. Instruments were administered to assess perceived stigma, need for treatment and satisfaction with clinic upon admission. At 3 months, patients were reinterviewed about their treatment, service use, and depressive symptoms. Adequate antidepressant treatment was operationalized as 4 weeks at a therapeutic dose as defined by a standardized measure of antidepressant intensity (CAD). Results: Although older patients reported lower levels of stigma (t⳱2.34, df⳱95, P⳱ 0.02), higher stigma predicted discontinuing treatment among older and not younger outpatients even after controlling for depression severity (OR⳱ 0.77, P⳱ 0.05). Despite lower stigma, older adults reported less need for treatment (t⳱2.52, df⳱97, P⳱ 0.01) and less concern about the impact of the depression (t⳱3.72, df⳱97, P⬍ 0.001). Satisfaction with the clinic at admission was predictive of “adequate” antidepressant treatment in both age groups at the 3-month follow-up (OR⳱1.33, P⳱ 0.007). Conclusions: Patients’ perceptions of care at the initiation of treatment impact on both treatment adherence and medication adequacy. Early detection of age-related patient barriers to care (stigma, dissatisfaction, and not acknowledging the need for treatment) and active interventions to overcome them may maximize the likelihood of adequate antidepressant treatment.
PATTERNS OF CARE FOR LATE LIFE DEPRESSION. Jurgen Unutzer, M.D., M.P.H.; Gregory Simon, M.D., M.P.H.; Wayne J. Katon, M.D.
T
he authors reviewed automated visit and pharmacy data from a large staff model HMO to describe patterns of care for depression in 2,558 older adults followed pro-
Am J Geriatr Psychiatry Supplement, Fall 1999
Paper Abstracts—Session 2: Health Services THE IMPACT OF SOCIAL SUPPORT AMONG DEPRESSED GERIATRIC OUTPATIENTS. Patrick J. Raue, Ph.D.; Deborah A. Perlick, Ph.D.; Martha Livingston Bruce, Ph.D.; Jo Anne Sirey, Ph.D.; George S. Alexopoulos, M.D.; Barnett S. Meyers, M.D.
F
ailure to demonstrate an effect of social support on outcome among geriatric patients may be due to use of measures that do not reflect the multidimensional nature of support. The authors examined the impact of different types of social support as well as different sources of support on the symptomatic improvement of 25 depressed geriatric outpatients at 3-month follow up. Controlling for initial depression severity, intensity of antidepressant treatment, perceived health, and presence of a personality disorder, the following types of social support predicted symptomatic improvement in separate regression models: instrumental support (partial r⳱ⳮ0.70; P⳱0.002) and subjective support (partial r⳱ⳮ0.58; P⳱0.015). In contrast, social interaction frequency and size of the social network failed to predict outcome. Further analyses examined source of support: correlations controlling for initial depression severity suggested that patient perception of the family environment was associated with outcome
30
(partial r of perceived support from family⳱ⳮ0.54; P⳱0.007; partial r of perceived stress from family⳱0.44; P⳱0.030), whereas perception of the social environment of their friends and acquaintances was not. Results indicate that, contrary to studies using aggregate measures of social support, certain aspects of support strongly predict symptomatic recovery among geriatric outpatients with major depression.
STIGMA, INITIAL SATISFACTION AND TREATMENT ADEQUACY AMONG YOUNG AND OLDER ADULT OUTPATIENTS WITH DEPRESSION. Jo Anne Sirey, Ph.D.; Martha L. Bruce, Ph.D.; Barnett S. Meyers, M.D.
A
im: This study was designed to compare young and older outpatients with major depression on perceived stigma and attitudes towards care as predictors of medication adequacy and treatment adherence. Method: A twostage sampling design was used to identify and follow 68 outpatients age 25–64 and 31 patients age ⬎65 with SCIDdiagnosed major depression seeking outpatient mental health treatment. Instruments were administered to assess perceived stigma, need for treatment and satisfaction with clinic upon admission. At 3 months, patients were reinterviewed about their treatment, service use, and depressive symptoms. Adequate antidepressant treatment was operationalized as 4 weeks at a therapeutic dose as defined by a standardized measure of antidepressant intensity (CAD). Results: Although older patients reported lower levels of stigma (t⳱2.34, df⳱95, P⳱ 0.02), higher stigma predicted discontinuing treatment among older and not younger outpatients even after controlling for depression severity (OR⳱ 0.77, P⳱ 0.05). Despite lower stigma, older adults reported less need for treatment (t⳱2.52, df⳱97, P⳱ 0.01) and less concern about the impact of the depression (t⳱3.72, df⳱97, P⬍ 0.001). Satisfaction with the clinic at admission was predictive of “adequate” antidepressant treatment in both age groups at the 3-month follow-up (OR⳱1.33, P⳱ 0.007). Conclusions: Patients’ perceptions of care at the initiation of treatment impact on both treatment adherence and medication adequacy. Early detection of age-related patient barriers to care (stigma, dissatisfaction, and not acknowledging the need for treatment) and active interventions to overcome them may maximize the likelihood of adequate antidepressant treatment.
PATTERNS OF CARE FOR LATE LIFE DEPRESSION. Jurgen Unutzer, M.D., M.P.H.; Gregory Simon, M.D., M.P.H.; Wayne J. Katon, M.D.
T
he authors reviewed automated visit and pharmacy data from a large staff model HMO to describe patterns of care for depression in 2,558 older adults followed pro-
Am J Geriatr Psychiatry Supplement, Fall 1999