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General practitioners’ assessment of, and treatment decisions regarding, common mental disorder in older adults: thematic analysis of interview data

  • JENNIFER STRACHAN (a1), GILL YELLOWLEES (a2) and APRIL QUIGLEY (a2)

Abstract

Primary and secondary care services are charged with failing to adequately detect and treat mental disorder in older adults due to the ‘understandability phenomenon’; the belief that mental disorder in old age is inevitable and therefore not worthy of intervention. Quantitative data appear to support this hypothesis but lack the explanatory power of detailed accounts. Nine general practitioners (GPs) participated in group interviews about their assessment and treatment of older patients, and their expectations and experience of referral to secondary care. Resulting transcripts were subject to Thematic Analysis. Respondents recognised the unique features of these clients, and their impact on the detailed, recursive processes of assessment, clinical decision-making and intervention. GPs described confidence in managing most cases of mental disorder, describing the role of secondary care as one of consultancy in extreme or unusual cases. GPs did view mental disorder as commonly originating in adverse circumstances, and queried the validity of pharmacological or psychological interventions in these cases. They did not, however, equate understandability with acceptability, and called for social interventions to be integrated with health-care interventions to tackle the cause of mental disorder in older adults. At a wider level, findings highlight the discrepancy between assumptions about GP attitudes and actions, and their own accounts. At a local level, findings will assist in focusing secondary care service development where need is perceived, into consultancy and training.

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Corresponding author

Address for correspondence: Jennifer Strachan, Clinical Psychologist, Psychological Services, 12–14 Roxburgh Street, Galashiels TD1 1PF, UK. E-mail: Jennifer.Strachan@nhs.net

References

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Age Concern 2007. Improving Services and Support for Older People with Mental Health Problems: The Second Report from the UK Inquiry into Mental Health and Wellbeing in Later Life. Age Concern England, London.
Age Concern 2008. Undiagnosed, Untreated, at Risk: The Experiences of Older People with Depression. Age Concern England, London.
Alvidrez, J. and Arean, P. A. 2002. Physician willingness to refer older depressed patients for psychotherapy. International Journal of Psychiatry in Medicine, 32, 1, 2135.
Arean, P. A., Alvidrez, J., Feldman, M., Tong, L. and Shermer, R. 2003. The role of provider attitudes in prescribing antidepressants to older adults: leverage points for effective provider education. International Journal of Psychiatry in Medicine, 33, 3, 241–56.
Braun, V. and Clarke, V. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 1, 77101.
Bruce, M. 2002. Psychosocial risk factors for depression in later life. Biological Psychiatry, 52, 3, 175–80.
Burroughs, H., Lovell, K., Morley, M., Baldwin, R., Burns, A. and Chew-Graham, C. 2006. ‘Justifiable depression’: how primary care professionals and patients view late-life depression. A qualitative study. Family Practice, 23, 3, 369–77.
Callahan, C. M., Dittus, R. S. and Tierney, W. M. 1996. Primary care physicians’ medical decision making for late-life depression. Journal of General Internal Medicine, 11, 4, 218–25.
Chew-Graham, C., Baldwin, R. and Burns, A. 2004. Treating depression in later life. British Medical Journal, 329, 7459, 182–3.
Dearman, S. P., Waheed, W., Nathoo, V. and Baldwin, R. C. 2006. Management strategies in geriatric depression by primary care physicians and factors associated with the use of psychiatric services: a naturalist study. Aging and Mental Health, 10, 5, 521–4.
Dew, K., Dowell, A., McLeod, D., Collings, S. and Bushnell, J. 2005. ‘This glorious twilight zone of uncertainty’: mental health consultations in general practice in New Zealand. Social Science & Medicine, 61, 6, 1189–200.
Drennan, V., Walters, K., Lenihan, P., Cohen, S., Myerson, S. and Iliffe, S.for the SPICE Research Group. 2007. Priorities in identifying unmet need in older people attending general practice: a nominal group technique study. Family Practice, 24, 5, 454–60.
Gallo, J. J., Ryan, S. D. and Ford, D. E. 1999. Attitudes, knowledge and behaviour of family physicians regarding depression in late life. Archives of Family Medicine, 8, 3, 249–56.
Healthcare Commission 2009. Equality in Later Life: A National Study of Older People's Mental Health Services. Commission for Healthcare Audit and Inspection, London.
Joffe, H. and Yardley, L. 2004. Content and Thematic Analysis. In Marks, D. F. and Yardley, L. (eds), Research Methods for Clinical and Health Psychology. Sage, London, 5668.
Kendrick, T., Dowrick, C., McBride, A., Howe, A., Clarke, P., Maisey, S., Moore, M. and Smith, P. W. 2009. Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data. British Medical Journal, 338, b750.
Liu, S., Lu, R. and Lee, M. 2008. Non-psychiatric physicians’ knowledge, attitudes and behaviour towards depression. Journal of the Formosan Medical Association, 107, 12, 921–31.
McLellan, E., MacQueen, K. and Neidig, J. 2003. Beyond the qualitative interview: data preparation and transcription. Field Methods, 15, 1, 6384.
Menchetti, M., Murri, M. B., Bertakis, K., Bortolottis, B. and Berardi, D. 2009. Recognition and treatment of depression in primary care: effect of patients’ presentation and frequency of consultation. Journal of Psychosomatic Research, 66, 4, 335–41.
Mitchell, A. J., Vaze, A. and Rao, S. 2009. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet, 374, 9690, 609–19.
Murray, J., Banerjee, S., Byng, R., Tylee, A., Bhugra, D. and MacDonald, A. 2006. Primary care professionals’ perceptions of depression in older people: a qualitative study. Social Science & Medicine, 63, 5, 1363–73.
National Institute for Clinical Excellence 2004. Depression: Management of Depression in Primary and Secondary Care. National Clinical Practice Guideline No. 23, British Psychological Society and Gaskell, London.
Office of National Statistics 2003. Mental Health of Older People. The Stationery Office, London.
O'Keeffe, M., Hills, A., Doyle, M., McCreadie, C., Scholes, S., Constantine, R., Tinker, A., Manthorpe, J., Biggs, S. and Erens, B. 2007. UK Study of Abuse and Neglect of Older People. Prevalence Survey Report. National Centre for Social Research, London.
Orrell, M., Scurfield, P., Cloke, L. and Renshaw, J. 2000. The management of depression in older people in primary care: a survey of general practitioners. Aging and Mental Health, 4, 4, 305–8.
Penninx, B. W., Guralnik, J. M., Ferrucci, L., Simonsick, E. M., Deeg, D. J. and Wallace, R. B. 1998. Depressive symptoms and physical decline in community-dwelling older persons. Journal of the American Medical Association, 279, 21, 1720–6.
Royal College of Psychiatrists 2006. Raising the Standard: Specialist Services for Older People with Mental Illness. Report of the Faculty of Old Age Psychiatry. Royal College of Psychiatrists, London.
Schulz, R., Drayer, R. and Rollman, B. 2002. Depression as a risk factor for non-suicide mortality in the elderly. Biological Psychiatry, 52, 3, 205–25.
Schwenk, T. L. 2002. Diagnosis of late life depression: the view from primary care. Biological Psychiatry, 52, 3, 157–63.
Scotland's Census Results OnLine 2013. Available online at http://www.scrol.gov.uk/scrol/browser/profile.jsp?profile=Population&mainArea=Scottish+Borders&mainLevel=CouncilArea [Accessed 4 September 2013].
Scottish Executive 2006. Delivering for Mental Health. Scottish Executive, Edinburgh.
Smith, J. A. and Osborn, M. 2008. Interpretive phenomenological analysis. In Smith, J. A. (ed.), Qualitative Psychology: A Practical Guide to Research Methods. 2nd Edition. Sage, London, 5380.
World Health Organisation 2009. Mental health, poverty and development. Discussion paper, World Health Organisation, Geneva.

Keywords

General practitioners’ assessment of, and treatment decisions regarding, common mental disorder in older adults: thematic analysis of interview data

  • JENNIFER STRACHAN (a1), GILL YELLOWLEES (a2) and APRIL QUIGLEY (a2)

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