Publication

Depression in older age: challenges for general practitioners

Holvast, F., 2019, [Groningen]: Rijksuniversiteit Groningen. 201 p.

Research output: ThesisThesis fully internal (DIV)Academic

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Documents

  • Title and contents

    Final publisher's version, 906 KB, PDF-document

  • Chapter 1

    Final publisher's version, 7 MB, PDF-document

  • Chapter 2

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  • Chapter 3

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  • Chapter 4

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  • Chapter 5

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    Embargo ends: 05/11/2019

  • Chapter 6

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  • Chapter 7

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    Embargo ends: 01/09/2019

  • Chapter 8

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  • Appendices

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  • Complete thesis

    Final publisher's version, 65 MB, PDF-document

    Embargo ends: 01/02/2020

  • Propositions

    Final publisher's version, 27 KB, PDF-document

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.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
Supervisors/Advisors
Award date17-Apr-2019
Place of Publication[Groningen]
Publisher
Print ISBNs978-94-034-1497-3
Electronic ISBNs978-94-034-1496-6
Publication statusPublished - 2019

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