A prospective study of mental health care for comorbid depressed mood in older adults with painful osteoarthritis

BMC Psychiatry. 2011 Sep 12:11:147. doi: 10.1186/1471-244X-11-147.

Abstract

Background: Comorbid depression is common among adults with painful osteoarthritis (OA). We evaluated the relationship between depressed mood and receipt of mental health (MH) care services.

Methods: In a cohort with OA, annual interviews assessed comorbidity, arthritis severity, and MH (SF-36 mental health score). Surveys were linked to administrative health databases to identify mental health-related visits to physicians in the two years following the baseline interview (1996-98). Prescriptions for anti-depressants were ascertained for participants aged 65+ years (eligible for drug benefits). The relationship between MH scores and MH-related physician visits was assessed using zero-inflated negative binomial regression, adjusting for confounders. For those aged 65+ years, logistic regression examined the probability of receiving any MH-related care (physician visit or anti-depressant prescription).

Results: Analyses were based on 2,005 (90.1%) individuals (mean age 70.8 years). Of 576 (28.7%) with probable depression (MH score < 60/100), 42.5% experienced one or more MH-related physician visits during follow-up. The likelihood of a physician visit was associated with sex (adjusted OR women vs. men = 5.87, p = 0.005) and MH score (adjusted OR per 10-point decrease in MH score = 1.63, p = 0.003). Among those aged 65+, 56.7% with probable depression received any MH care. The likelihood of receiving any MH care exhibited a significant interaction between MH score and self-reported health status (p = 0.0009); with good general health, worsening MH was associated with increased likelihood of MH care; as general health declined, this effect was attenuated.

Conclusions: Among older adults with painful OA, more than one-quarter had depressed mood, but almost half received no mental health care, suggesting a care gap.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antidepressive Agents / therapeutic use
  • Depression / complications
  • Depression / drug therapy
  • Depression / epidemiology
  • Depression / psychology*
  • Female
  • Health Status
  • Health Surveys
  • Humans
  • Mental Health Services / statistics & numerical data*
  • Osteoarthritis / complications
  • Osteoarthritis / psychology*
  • Pain / complications
  • Pain / psychology*
  • Prescriptions / statistics & numerical data
  • Prevalence
  • Prospective Studies
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Severity of Illness Index
  • Sex Characteristics

Substances

  • Antidepressive Agents