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Depression in older age

Challenges for general practitioners
PhD ceremony:Ms F. (Floor) Holvast
When:April 17, 2019
Supervisors:prof. dr. P.F.M. Verhaak, prof. dr. F.G. Schellevis, prof. dr. R.C. (Richard) Oude Voshaar
Co-supervisor:dr. H. (Huibert) Burger
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Depression in older age

The aim of this thesis was to clarify the care delivered by general practitioners (GPs) to older adults with depression. Older adults represent a large cohort in general practice, and will eventually face (health) problems. If these problems interact with others, they are referred to as complex problems. Older patients with depression may be prone to face these complex problems because their mental health interacts with other problems. In this thesis, we report that feelings of loneliness were frequently present among older adults with depression, and that these contributed to a worse prognosis of their depression. Loneliness was also adversely related to having contact for a mental health problem with a care provider. Other factors associated with contact with a care provider were age, ethnicity, and household income. The presence of a psychiatric disorder was not associated with having contact. A meta-analysis demonstrated that cognitive behavioural therapy is an effective treatment for depression, while other non-pharmacological treatments were not sufficiently studied. Furthermore, adherence to antidepressant therapy was at stake: more than one third discontinued antidepressant use prematurely and about a quarter discontinued within the first four weeks of treatment. Finally, older adults with depression have more chronic somatic diseases, use more drugs chronically (independent of the use of antidepressants), and were more often nonadherent to cardiovascular drugs as compared to mentally healthy controls. These findings confirm that older adults with depression often have complex problems. The findings contribute to our knowledge of care requirements for older adults with depression by identifying key difficulties in the provision of care by GPs.