BRIEF REPORT: Patient cognitive status and the identification and management of depression by primary care physicians

OBJECTIVES: No known study has examined the role of patients' cognitive impairment in the identification and management of depression by primary care physicians. DESIGN: A cross-sectional survey conducted between 2001 and 2003. PARTICIPANTS: A sample of 330 adults aged 65 and older from Maryland primary care practices with complete information on cognitive and psychological status, and physician assessments. MEASUREMENTS: Primary care physicians were asked to rate cognition and depression on a Likert scale, as well as report management of depression within 6 months of the index visit. Patient interviews included standardized measures of psychological and cognitive status. RESULTS: Older adults identified as depressed by their physician were more likely to be identified as cognitively impaired (unadjusted odds ratio [OR]=3.71, [95% confidence interval] [CI] [1.93, 7.16]). Older adults identified as cognitively impaired had a tendency to be managed for depression (unadjusted OR=2.62, 95% CI [0.96, 7.19]). In adjusted multivariate models, these associations remained unchanged. CONCLUSIONS: When physicians identified a patient as cognitively impaired, they were more likely to identify the patient as depressed and to report treatment of the depression. An understanding of how physicians think about depression in the context of cognitive impairment is important for designing depression interventions for older adults.