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      Older people coping with low mood: a qualitative study

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          Abstract

          Background:

          To gain new insight into support for older people with low mood, the perceptions, strategies, and needs of older people with depressive symptoms were explored.

          Methods:

          Two in-depth interviews were held with 38 participants (aged ≥77 years) who screened positive for depressive symptoms in general practice. To investigate the influence of the presence of complex health problems, 19 persons with and 19 without complex problems were included. Complex problems were defined as a combination of functional, somatic, psychological or social problems.

          Results:

          All participants used several cognitive, social or practical coping strategies. Four patterns emerged: mastery, acceptance, ambivalence, and need for support. Most participants felt they could deal with their feelings sufficiently, whereas a few participants with complex problems expressed a need for professional support. Some participants, especially those with complex problems, were ambivalent about possible interventions mainly because they feared putting their fragile balance at risk due to changes instigated by an intervention.

          Conclusion:

          Most older participants with depressive symptoms perceived their coping strategies to be sufficient. The general practitioners (GPs) can support self-management by talking about the (effectiveness of) personal coping strategies, elaborating on perceptions of risks, providing information, and discussing alternative options with older persons.

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          Most cited references18

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          Patients' preferences in the treatment of depressive disorder in primary care.

          Patients' preferences in the treatment of depression are important in clinical practice and in research. Antidepressant medication is often prescribed, but adherence is low. This may be caused by patients preferring psychotherapy, which is often not available in primary care. In randomized clinical trials, patients' preferences may affect the external validity. The aim of this article is to study patients' preferences regarding psychotherapy and antidepressant medication and the impact of these preferences on treatment outcome. A systematic review of the literature was performed. The majority of patients preferred psychotherapy in all available studies. Antidepressants were often regarded as addictive and psychotherapy was assumed to solve the cause of depression. Discussing and supporting preferences as part of a quality improvement program of depression care, resulted in more patients receiving the treatment that was most suitable to them. In two patient-preference trials, preferences did not influence treatment outcome. It can be concluded that a substantial percentage of well-informed patients prefer psychotherapy. Patients with strong preferences, mostly for psychotherapy, are likely not to enter antidepressant treatment or randomized clinical trials if their preferences are not supported.
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            Health beliefs and perceived need for mental health care of anxiety and depression--the patients' perspective explored.

            Patients' illness representations and beliefs about treatment for depression and anxiety, as well as their perceived needs, are important for treatment. A systematic review was conducted of 71 studies describing the beliefs or perceived needs of patients and non-patients. Patients give multi-dimensional explanations for depression and see both psychological and medication treatment as helpful. People who suffer from depression have more positive beliefs about biological etiology and medication treatment than healthy people, or those with less severe depressive symptoms. Anxiety patients view psychological interventions as their best treatment option. Between 49% and 84% of the patients with depression or anxiety perceive a need for treatment, mostly for counseling and medication. All patients prefer psychological treatment forms to medication. A majority of patients view antidepressants as addictive and many perceive stigma and see practical and economic barriers to care. The most vulnerable groups in terms of seeking and receiving mental health care for depression and anxiety seem to be minority groups, as well as younger and older patients. More research is required into the specific needs of anxiety and depression patients. Open communication between patient and provider could lead to valuable improvements in treatment.
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              Prevalence, correlates and recognition of depression in the oldest old: the Leiden 85-plus study.

              Various studies support the notion that the clinical picture of depression in the oldest old differs from that in younger elderly. Moreover, withstanding the serious negative effects of depression on well being and functioning, the detection rate of depression in several medical settings is low. Prevalence of depression, correlates and the rate of recognition by general practitioners were assessed in an 85-year-old community-based population. The GDS-S was applied in 500 participants with a MMSE >18, from a representative sample of 599 community based 85-year-old subjects. Demographic data, daily functioning, health correlates, use of medication and recognition of depression were recorded in home visits and from the general practitioner and pharmacists registers. The prevalence of depression, as measured with a GDS-S score of 5 points or more, was 15.4%, which is comparable to previous studies. No demographic factors were correlated with depression. Perceived health, loneliness, impaired mobility, cognitive decline and functional disability were major correlates of depression. From the participants who were seen by their general practitioner, 25% were recognised as depressed. Antidepressive pharmacotherapy was almost nonexistent. Formal diagnosis of depression was not available. The data were collected cross-sectionally. Depression is highly prevalent in the oldest old and strongly associated with functional disability and cognitive impairment. It is important to enhance recognition of depression in community based oldest old as a first step to possible interventions.
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                Author and article information

                Journal
                Int Psychogeriatr
                Int Psychogeriatr
                IPG
                International Psychogeriatrics / Ipa
                Cambridge University Press (Cambridge, UK )
                1041-6102
                1741-203X
                April 2016
                17 December 2015
                : 28
                : 4
                : 603-612
                Affiliations
                [1 ]Department of Public Health and Primary Care, Leiden University Medical Center , PO Box 9600, 2300 RC Leiden, the Netherlands
                [2 ]Department of Guideline Development and Research, Dutch College of General Practitioners , PO Box 3231, 3502 GE Utrecht, the Netherlands
                [3 ]Department of Psychiatry, Leiden University Medical Center PO Box 9600 , 2300 RC Leiden, the Netherlands
                [4 ]Department of Psychiatry, CAPRI-University of Antwerp , 2610 Antwerp, Belgium
                [5 ]Amsterdam Institute for Social Science Research , University of Amsterdam PO Box 15718 , 1001 NE Amsterdam, the Netherlands
                [6 ]The Children's Institute , University of Cape Town , Cape Town, South Africa
                Author notes
                Correspondence should be addressed to: J. Gussekloo, Department of Public Health and Primary Care, Postal zone V0-P, Leiden University Medical Center , PO Box 9600, 2300 RC Leiden, the Netherlands. Phone: +31 (0)71 526 8444; Fax: +31 (0)71 526 8259. Email: J.Gussekloo@ 123456lumc.nl .
                Article
                S1041610215002264 00226
                10.1017/S1041610215002264
                4825092
                26674197
                db3d24e1-ec37-4d02-85a5-62170b52363c
                © International Psychogeriatric Association 2015

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 May 2015
                : 08 July 2015
                : 07 November 2015
                : 15 November 2015
                Page count
                Tables: 1, References: 28, Pages: 10
                Categories
                Research Article

                Geriatric medicine
                qualitative research,older adults,depressive symptoms,coping,the netherlands
                Geriatric medicine
                qualitative research, older adults, depressive symptoms, coping, the netherlands

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