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Social inequalities in depression and suicidal ideation among older primary care patients |
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| Authors: | Stephen E. Gilman Martha L. Bruce Thomas Ten Have George S. Alexopoulos Benoit H. Mulsant Charles F. Reynolds III Alex Cohen |
| Affiliation: | 1. Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA 2. Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA 3. Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA 4. Department of Psychiatry, Weill-Cornell Medical College, 21 Bloomingdale Road, White Plains, NY, 10605, USA 5. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA 6. Department of Psychiatry, Center for Addiction and Mental Health, University of Toronto, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada 7. Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA, 15213, USA 8. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E?7HT, UK |
| Abstract: | PurposeDepression and suicide are major public health concerns, and are often unrecognized among the elderly. This study investigated social inequalities in depressive symptoms and suicidal ideation among older adults.MethodsData come from 1,226 participants in PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), a large primary care-based intervention trial for late-life depression. Linear and logistic regressions were used to analyze depressive symptoms and suicidal ideation over the 2-year follow-up period.ResultsMean Hamilton Depression Rating Scale (HDRS) scores were significantly higher among participants in financial strain [regression coefficient (b) = 1.78, 95 % confidence interval (CI) = 0.67–2.89] and with annual incomes below $20,000 (b = 1.67, CI = 0.34–3.00). Financial strain was also associated with a higher risk of suicidal ideation (odds ratio = 2.35, CI = 1.38–3.98).ConclusionsThere exist marked social inequalities in depressive symptoms and suicidal ideation among older adults attending primary care practices, the setting in which depression is most commonly treated. Our results justify continued efforts to understand the mechanisms generating such inequalities and to recognize and provide effective treatments for depression among high-risk populations. |
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