Clinician approaches and strategies for engaging older men in depression care

Ester Carolina Apesoa-Varano, W Ladson Hinton, Judith C. Barker, Jürgen Unützer

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: The aim of this study is to explore primary care physicians(PCPs) and depression care managers(DCMs) approaches to diagnosing and treating depression in older men. The authors focus on older men because studies have shown that they are undertreated compared with women and younger groups. The authors contribute to previous research by identifying facilitators of care for older men from the perspective of clinicians. Methods: Participants in this study were part of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial, an effectiveness study of collaborative care for late-life depression in 18 diverse primary care practices. Nine PCPs and 11 DCMs were interviewed to collect information on specific roles in caring for depressed patients and their experiences in working with depressed older men. All interviews were tape-recorded, transcribed verbatim, and analyzed thematically in several steps using standard qualitative data analysis techniques. Results: The authors identified three general approaches to building trust and talking about the depression: 1) an indirect approach ("call it something else"), 2) a gradual approach ("building up to depression"), and 3) a direct approach ("shock and awe"). The authors also found specific strategies that PCPs and DCMs used to manage depression among elderly male patients, such as increased monitoring of mood, treating somatic symptoms first, medicalizing depression, and enlisting the cooperation of family. In our interviews, enlisting family involvement was the most prominent strategy used by clinicians. Conclusions: A variety of approaches and strategies are used by clinicians for diagnosing and treating depressed older men. Clinicians change strategies as a response to a patients compliance with treatment and the decision about which strategy to pursue is usually made on an "on-the-go" basis throughout the course of clinician-patient interaction. Based on clinicians experience, depression management requires concerted efforts and persistence, and the family seems to play an important role in how older men receive the diagnosis of depression and adhere to cliniciansDesign:prescribed treatment. However, more research is needed to discover the best way of engaging and working with family members to facilitate effective depression care for older adults.

Original languageEnglish (US)
Pages (from-to)586-595
Number of pages10
JournalAmerican Journal of Geriatric Psychiatry
Volume18
Issue number7
DOIs
StatePublished - Jul 2010

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Depression
Primary Care Physicians
Interviews
Patient Compliance
Research
Shock
Primary Health Care
Therapeutics

Keywords

  • Clinicians approaches
  • depression
  • facilitators of care
  • older men
  • qualitative methods

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Geriatrics and Gerontology

Cite this

Clinician approaches and strategies for engaging older men in depression care. / Apesoa-Varano, Ester Carolina; Hinton, W Ladson; Barker, Judith C.; Unützer, Jürgen.

In: American Journal of Geriatric Psychiatry, Vol. 18, No. 7, 07.2010, p. 586-595.

Research output: Contribution to journalArticle

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