Effect of patient gender on late-life depression management
Department of Quantitative Health Sciences
Medical Subject Headings
Adult; Attitude of Health Personnel; Depression; Diagnosis, Differential; Female; Humans; Male; Middle Aged; New England; Physician's Practice Patterns; *Physician-Patient Relations; Primary Health Care; Quality Assurance, Health Care; Questionnaires; Sex Factors; Time Factors; Videotape Recording; *Women's Health
Biostatistics | Epidemiology | Health Services Research
PURPOSE: To determine whether patient gender influences physicians' management of late-life major depression in older and younger elderly patients.
METHODS: In 1996-2001, physician subjects viewed a professionally produced videotape vignette portraying an elderly patient meeting diagnostic criteria for major depression, then answered interviewer-administered questions about differential diagnosis and treatment. Patient gender and other characteristics were systematically varied in different versions of the videotape, but clinical content was held constant. This was a stratified random sample of 243 internists and family physicians with Veterans Health Administration (VA) or non-VA ambulatory care practices in the Northeastern United States. Outcomes were whether physicians followed a guideline-recommended management approach: treating with antidepressants or mental health referral or both and seeing the patient for follow-up within 2 weeks.
RESULTS: Only 19% of physicians recommended treating depression (12% recommended antidepressants and 7% mental health referral), and 43% recommended follow-up within 2 weeks. Patient gender did not influence management recommendations in either younger old (67 year old) or older old (79 year old) patients (p > 0.12 for all comparisons).
CONCLUSIONS: Gender disparities previously documented in the management of major conditions are not seen for the management of depression, a potentially stigmatized condition that does not require resource-intense interventions.
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Citation: J Womens Health (Larchmt). 2004 Oct;13(8):919-25. Link to article on publisher's site