Abstract:
The aim of this thesis was to explore factors relating to the treatment of depression in elderly people from the perspectives of New Zealand based general practitioners (GPs) and elderly people. Study 1 (N= 218) surveyed GPs’ management of depression in elderly patients and found that SSRIs were the most preferred choice and 36% prescribed drugs alone. Cost of treatment appeared to be an important factor in all treatment decisions; however patients’ lack of awareness, reluctance to accept diagnosis or engage in treatment and availability of other treatment options supported GPs’ decisions to treat by drugs alone. Study 2 (N=178) surveyed GPs’ management of patients with depressive symptoms via a series of vignettes varying by patient gender and age (70, 49 and 29 years). Findings suggested that the offer or uptake of medication or referral to other agencies were equally likely with all patients. Few GPs indicated that employment of screening instruments, risk assessments or explicit discussion of depression or nonphysical causes would occur. Few would explore patients’ alcohol and drug consumption, although this would be more likely to occur with the youngest patients and approximately 50% would explore psycho-social issues; this was however more likely to occur with the oldest patients. Study 3 (N= 337) surveyed GPs about their management of depressed patients via a yes/no response scale. In contrast to the findings of study 2 most (88.4% to 99.7%) responded positively to questions relating to the exploration of risk, drug and alcohol consumption and psycho-social issues with patients (70, 49 and 29 years of age). Study 4 (N=71) surveyed elderly people’s opinions of barriers to treatment and perceptions of help-seeking for depression by others in the same age group. Findings suggested that 66% believed GPs can recognise depression unprompted. Drugs were believed to be the treatment of choice by 59% due to issues of privacy, patient expectations, confidence in GPs, and ease of access and cost. The most commonly endorsed barriers were cost, loss of independence and stigma, however unprompted comments related to issues of pride, coping and control, family responsibilities and lack of awareness.