Primary Care Doctors May Overlook Elderly Patients’ Mental Health
• Science Update
Doctors spend little time discussing mental health issues with their older patients and rarely refer them to a mental health specialist even if they show symptoms of severe depression, according to an NIMH-funded study published December 2007 in the Journal of the American Geriatrics Society.
People age 65 and older represent 12 percent of the U.S. population, but they accounted for a disproportionate 16 percent of suicide deaths in 2004.1 Improved mental health screening in primary care may improve detection and treatment of mental disorders before drastic consequences, such as suicide, can occur.
To determine how doctors deliver mental health care to their elderly patients, researcher Ming Tai-Seale, Ph.D., of Texas A&M Health Science Center and colleagues analyzed 385 videotaped visits of 35 doctors with 366 of their elderly patients. The researchers identified topics discussed and how much time was devoted to each topic. Mental health-related topics occurred in 22 percent of visits, typically lasting about two minutes. An average visit lasted about 16 minutes overall. The majority of that time was spent discussing biomedical and other topics.
Efforts to treat or provide care for a mental health issue varied widely among the doctors participating in the study. Most fell into one of three patterns of care: 1) listening to the patient for an extended period of time and referring him or her to a mental health care specialist; 2) gathering information but providing inadequate treatment; or 3) being dismissive toward the patient and his or her emotional distress, and failing to follow up.
More female patients (27 percent) discussed a mental health topic during a typical visit than male patients (12 percent). In addition, the researchers found that the gender pairing of doctor and patient affected the likelihood of discussing mental health issues. Female-to-female doctor-patient pairs were most likely to discuss mental health, while male-to-male doctor-patient pairs were least likely.
The results indicate that primary care doctors need more support in how to identify, treat and refer patients to mental health specialists, concluded the researchers.
Tai-Seale M. McGuire T. Colenda C. Rosen D. Cook MA. Two-minute mental health care for elderly patients: inside primary care visits. Journal of the American Geriatrics Society. 2007 Dec. 55:1903-1911.
1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005). Available at: http://www.cdc.gov/ncipc/wisqars