Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
권호 표지

A General Hospital-Based Model for Early Detection of Depression in the Geriatric Patients with Chronic Medical Diseases

만성적인 신체질환이 있는 노인 환자의 우울증 조기발견을 위한 병원기반 모델

  • Park, Seon-Cheol (Department of Psychiatry, Yong-In Mental Hospital) ;
  • Lee, Hwa-Young (Department of Psychiatry, College of Medicine, Soonchunhyang University, Cheonan Hospital) ;
  • Lee, Dong-Woo (Department of Psychiatry, College of Medicine, Inje University, Sanggye Paik Hospital) ;
  • Han, Sang-Woo (Department of Psychiatry, College of Medicine, Soonchunhyang University, Seoul Hospital) ;
  • Park, Sang-Ho (Department of Cardiology, College of Medicine, Soonchunhyang University, Cheonan Hospital) ;
  • Kim, Yeo-Joo (Department of Endocrinology, College of Medicine, Soonchunhyang University, Cheonan Hospital) ;
  • Choi, Jae Sung (Department of Pulmonology, College of Medicine, Soonchunhyang University, Cheonan Hospital) ;
  • Jung, Sung Won (Department of Psychiatry, School of Medicine, Keimyung University, Dongsan Medical Center) ;
  • Lee, Soyoung Irene (Department of Psychiatry, College of Medicine, Soonchunhyang University, Bucheon Hospital) ;
  • Na, Kyoung-Sae (Department of Psychiatry, College of Medicine, Soonchunhyang University, Bucheon Hospital) ;
  • Kwon, Young-Joon (Department of Psychiatry, College of Medicine, Soonchunhyang University, Cheonan Hospital)
  • 박선철 (용인정신병원 정신건강의학과) ;
  • 이화영 (순천향대학교 의과대학 천안병원 정신건강의학교실) ;
  • 이동우 (인제대학교 의과대학 상계백병원 정신건강의학교실) ;
  • 한상우 (순천향대학교 의과대학 서울병원 정신건강의학교실) ;
  • 박상호 (순천향대학교 의과대학 천안병원 심장내과학교실) ;
  • 김여주 (순천향대학교 의과대학 천안병원 내분비내과학교실) ;
  • 최재성 (순천향대학교 의과대학 천안병원 호흡기내과학교실) ;
  • 정성원 (계명대학교 의학전문대학원 동산의료원 정신건강의학교실) ;
  • 이소영 (순천향대학교 의과대학 부천병원 정신건강의학교실) ;
  • 나경세 (순천향대학교 의과대학 부천병원 정신건강의학교실) ;
  • 권영준 (순천향대학교 의과대학 천안병원 정신건강의학교실)
  • Received : 2013.02.18
  • Accepted : 2013.04.03
  • Published : 2013.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

The geriatric patients with chronic physical diseases are frequently associated with the continuous clusters of depression including nonpathological sadness, subsyndromal depression, minor depressive disorder, and major depressive disorder. Because of the complex and reciprocal relationships among depression, elderly, and chronic physical diseases, screening approaches with specific nosological methods should be needed in the realm of early detection of depression. Cognitive decline is frequently manifested in geriatric depression with medical or neurological diseases. Also, somatic symptoms of depression or emotional symptoms of physical diseases can play a role as a hampering factor in the early detection of depression. Furthermore, after-care has been regarded as an essential factor of depression screening in the geriatric patients with chronic physical diseases. We reviewed the most popular examples of integrated medicine for depression in primary care. Thus, we propose a general hospital-based model for early detection of depression which includes favorable response loop between screening and therapeutic intervention. Our model can be a basis for evidence-based detection and after-care for depression in the geriatric patients with chronic medical diseases.

Keywords

References

  1. Kim DH. Geriatric depression. Journal of Korean Geriatric Psychiatry 2004;8:90-95.
  2. Cho MJ, Lee JY. Epidemiology of depressive disorder. J Korean Med Assoc 2003;46:772-781. https://doi.org/10.5124/jkma.2003.46.9.772
  3. Cho MJ, Hahm BJ, Jhoo JH, Bae JN, Kwon JS. Prevalence of cognitive impairment and depressive symptoms among the elderly in an urban community. J Korean Neuropsychiatr Assoc 1998;37:352-362.
  4. Lee MS, Han CS. Mood disorder. In: Korean Association of Geriatric Psychiatry, editor. Geriatric psychiatry. Seoul: Joong Ang Moonhwa Co.;2004. p.197-206.
  5. Berardi D, Menchetti M, De Ronchi D, Rucci P, Leggieri G, Ferrari G. Late-life depression in primary care: a nationwide Italian epidemiological survey. J Am Geriatr Soc 2002;50:77-83. https://doi.org/10.1046/j.1532-5415.2002.50011.x
  6. Aragonès E, Piñol JL, Labad A. Depression and physical comorbidity in primary care. J Psychosom Res 2007;63:107-111. https://doi.org/10.1016/j.jpsychores.2007.05.008
  7. Wells KB, Rogers W, Burnam A, Greenfield S, Ware JE Jr. How the medical comorbidity of depressed patients differs across health care settings: results from the Medical Outcomes Study. Am J Psychiatry 1991;148:1688-1696. https://doi.org/10.1176/ajp.148.12.1688
  8. Yates WR, Mitchell J, Rush AJ, Trivedi MH, Wisniewski SR, Warden D, et al. Clinical features of depressed outpatients with and without co-occurring general medical conditions in STAR*D. Gen Hosp Psychiatry 2004;26:421-429. https://doi.org/10.1016/j.genhosppsych.2004.06.008
  9. Statistics Korea. Cause of death statistics [homepage on the internet]. Daejon: Statistics Korea; [cited 2013 Feb 18]. Available from: http: //kosis.kr/abroad/abroad_03List.jsp?parentId=MT_CTITLE_1,G000.
  10. Vourilehto M, Melartin T, Isometsa E. Depressive disorders in primary care: recurrent, chronic, and co-morbid. Psycho Med 2006;13: 226-232.
  11. Koenig HG, Cohen HJ, Blazer DG, Meador KG, Westlund R. A brief depression scale for use in the medically ill. Int J Psychiatry Med 1992;22:183-195. https://doi.org/10.2190/M1F5-F40P-C4KD-YPA3
  12. Blazer DG, Bachar JR, Manton KG. Suicide in late life. Review and commentary. J Am Geriatr Soc 1986;34:519-525. https://doi.org/10.1111/j.1532-5415.1986.tb04244.x
  13. Cole MG, Dendukuri N. Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. Am J Psychiatry 2003;160:1147-1156. https://doi.org/10.1176/appi.ajp.160.6.1147
  14. Lenze EJ. Comorbidity of depression and anxiety in the elderly. Curr Psychiatry Rep 2003;5:62-67. https://doi.org/10.1007/s11920-003-0011-7
  15. Salzman C. Practical considerations for the treatment of depression in elderly and very elderly long-term care patients. J Clin Psychiatry 1999;60 Suppl 20:30-33.
  16. Steffens DC, Potter GG. Geriatric depression and cognitive impairment. Psychol Med 2008;38:163-175.
  17. Panza F, Frisardi V, Capurso C, D'Introno A, Colacicco AM, Imbimbo BP, et al. Late-life depression, mild cognitive impairment, and dementia: possible continuum? Am J Geriatr Psychiatry 2010;18:98- 116. https://doi.org/10.1097/JGP.0b013e3181b0fa13
  18. Himelhoch S, Weller WE, Wu AW, Anderson GF, Cooper LA. Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries. Med Care 2004;42:512-521. https://doi.org/10.1097/01.mlr.0000127998.89246.ef
  19. Burvill PW. Recent progress in the epidemiology of major depression. Epidemiol Rev 1995;17:21-31. https://doi.org/10.1093/oxfordjournals.epirev.a036178
  20. Egede LE. Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry 2007;29:409-416. https://doi.org/10.1016/j.genhosppsych.2007.06.002
  21. Katon W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 2007;29:147-155. https://doi.org/10.1016/j.genhosppsych.2006.11.005
  22. Scott KM, Oakley Browne MA, McGee MA, Wells JE; New Zealand Mental Health Survey Research Team. Mental-physical comorbidity in Te Rau Hinengaro: the New Zealand Mental Health Survey. Aust N Z J Psychiatry 2006;40:882-888.
  23. Judd LL, Rapaport MH, Paulus MP, Brown JL. Subsyndromal symptomatic depression: a new mood disorder? J Clin Psychiatry 1994; 55 Suppl:18-28.
  24. Judd LL, Akiskal HS, Paulus MP. The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder. J Affect Disord 1997;45:5-17; discussion 17-18. https://doi.org/10.1016/S0165-0327(97)00055-4
  25. Lyness JM, Heo M, Datto CJ, Ten Have TR, Katz IR, Drayer R, et al. Outcomes of minor and subsyndromal depression among elderly patients in primary care settings. Ann Intern Med 2006;144:496-504. https://doi.org/10.7326/0003-4819-144-7-200604040-00008
  26. Millar T, Goldberg DP. Link between the ability to detect and manage emotional disorders: a study of general practitioner trainees. Br J Gen Pract 1991;41:357-359.
  27. Davenport TA, Hickie IB, Naismith SL, Hadzi-Pavloviv D, Scott EM. Variability and predictors of mental disorder rates and medical practitioner responses across Australian general practices. Med J Aust 2001;175 Suppl:S37-S41.
  28. Zantinge EM, Verhaak PF, de Bakker DH, Kerssens JJ, van der Meer K, Bensing JM. The workload of general practitioners does not affect their awareness of patients' psychological problems. Patient Educ Couns 2007;67:93-99. https://doi.org/10.1016/j.pec.2007.02.006
  29. Bogousslavsky J. William Feinberg lecture 2002: emotions, mood, and behavior after stroke. Stroke 2003;34:1046-1050. https://doi.org/10.1161/01.STR.0000061887.33505.B9
  30. Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, et al. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 2000;284:2907-2911. https://doi.org/10.1001/jama.284.22.2907
  31. Nissim R, Gagliese L, Rodin G. The desire for hastened death in individuals with advanced cancer: a longitudinal qualitative study. Soc Sci Med 2009;69:165-171. https://doi.org/10.1016/j.socscimed.2009.04.021
  32. Dickens C, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A, et al. Depression is a risk factor for mortality after myocardial infarction: fact or artifact? J Am Coll Cardiol 2007;49:1834-1840. https://doi.org/10.1016/j.jacc.2007.01.075
  33. Roh S, Park YC. Characteristics of depression in Korea and non-pharmacological treatment. Korean J Biol Psychiatry 2006;13:226-233.
  34. Kim KI. Clinical study of primary depressive symptom. Part II: Symptom pattern of Korean depressive. J Korean Neuropsychiatr Assoc 1977;16:46-52.
  35. Nam JH, Park YC, Kim KI. Clinical study of primary depressive symptom. Part V: Some characteristics of 251 depressive inpatients. Mental Health Res 1984;2:173-185.
  36. Cohen-Cole SA, Harpe C. Diagnostic assessment of depression in the medically ill. In: Stoudemire A, Fogel BS, editors. Principle of Medical psychiatry. New York: Grune and Stratton, Inc.;1987. p.23-36.
  37. Endicott J. Measurement of depression in patients with cancer. Cancer 1984;53(10 Suppl):2243-2249.
  38. National Collaborating Centre for Mental Health. NICE clinical guideline 91: Depression in adults with a chronic physical health problem. UK: National Institute for Health and Clinical Excellence;2009.
  39. Palmer SC, Coyne JC. Screening for depression in medical care: pitfalls, alternatives, and revised priorities. J Psychosom Res 2003; 54:279-287. https://doi.org/10.1016/S0022-3999(02)00640-2
  40. Clinical research center for depression. The clinical guideline of depression in primary care. Clinical research center for depression. Seoul: 2011.
  41. Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD, et al. Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002;136:765-776. https://doi.org/10.7326/0003-4819-136-10-200205210-00013
  42. MacMillan HL, Patterson CJ, Wathen CN, Feightner JW, Bessette P, Elford RW, et al. Screening for depression in primary care: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2005;172:33-35. https://doi.org/10.1503/cmaj.1030823
  43. Pirl WF, Muriel A, Hwang V, Kornblith A, Greer J, Donelan K, et al. Screening for psychosocial distress: a national survey of oncologists. J Support Oncol 2007;5:499-504.
  44. Clinical research center for depression. Korean version of evidencebased guideline for pharmacological treatment of depression, revised edition. Seoul: ML communications;2012.
  45. O'Connor EA, Whitlock EP, Gaynes B, Beil TL. Screening for depression in adults and older adults in primary care: an updated systematic review. Evidence Synthesis no. 75. AHRQ publication no. 10-05143-EF-1. Rockville, MD: Agency for Healthcare Research and Quality;2009.
  46. Unützer J, Katon W, Williams JW Jr, Callahan CM, Harpole L, Hunkeler EM, et al. Improving primary care for depression in late life: the design of a multicenter randomized trial. Med Care 2001;39:785- 799. https://doi.org/10.1097/00005650-200108000-00005
  47. Bower P, Gilbody S, Richards D, Fletcher J, Sutton A. Collaborative care for depression in primary care. Making sense of a complex intervention: systematic review and meta-regression. Br J Psychiatry 2006;189:484-493. https://doi.org/10.1192/bjp.bp.106.023655
  48. Jeong H, Yim HW, Jo SJ, Kim CM, Jeong S, Song H, et al. The screening and post-management of depression in primary care. Korean J Fam Pract 2012;2:15-23.