Sunday, 15 January 2006 - 9:29 AM

Challenges of Screening for Depression in Community Long-Term Care

Enola Proctor, PhD, Washington University in Saint Louis, Nancy Morrow-Howell, Ph.D., Washington University in Saint Louis, and Sunha Choi, MSW, Washington University in Saint Louis.

Objectives. Significant numbers of social service clients experience mental health problems; yet the responsiveness of social service providers or agencies to clients' mental disorder has received little systematic study. Methods. This paper addresses this issue by examining the extent to which client depression is reflected in the agency records of a public social service agency, community long-term care. Guided by a conceptual model of competing demands, we examine factors associated with case managers' detection of depression. Using a telephone interview protocol, researchers assessed depression and self-reported associated factors among 1,171 new elderly clients entering community long-terms care over a 52 month period. Major depression was assessed using DIS criteria and high depression symptoms using the modified CES-D. Case managers' detection of depression was then examined using data in provider case records. Results. The results indicate that sensitivity and specificity of depression notation are 25.21% and 92.80%, respectively. Among depressed clients, having cognitive impairments, having low social supports, taking prescription psychotropic medications, and seeing mental health specialists are associated with accurate notation of depression. Conclusions. The notation rates in this study were comparable to those reported in medical settings. Contrary to the competing demand notion, workers tend to accurately note depression among the depressed with more adverse conditions, as well as those showing evidence of mental illnesses. Introducing screening and early intervention programs in readily accessible and low-stigma settings where a high level of risk for mental health problems exists will ensure access and earlier treatment to persons with undetected mental disorder. Yet there is room for improvement in screening for depression in community long-term care. Low rates of detection may be related with worker training or job expectation. These challenges need to be addressed in order to maximize the potential of the system of care for securing depression treatment for older clients.

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