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Identification and recognition of depression in community care assessments: impact of a national policy in England

Published online by Cambridge University Press:  04 August 2011

Paul Clarkson ,
Michele Abendstern ,
Caroline Sutcliffe ,
Jane Hughes  and
David Challis
Paul Clarkson*
Affiliation:
Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK
Michele Abendstern
Affiliation:
Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK
Caroline Sutcliffe
Affiliation:
Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK
Jane Hughes
Affiliation:
Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK
David Challis
Affiliation:
Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK
*
Correspondence should be addressed to: Dr Paul Clarkson, Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Dover Street Building, Oxford Road, Manchester, M13 9PL, UK. Phone: +44 (0)161-275 5674; Fax: +44 (0)161 275 5790. Email: paul.clarkson@manchester.ac.uk.
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Abstract

Background: Depression continues to be under-recognized in older people. Most policies addressing this issue focus on the primary health care team. However, recognition may be improved by use of assessment tools and collaboration between secondary health and social care, particularly at the assessment stage. This study aimed to evaluate whether the Single Assessment Process (SAP), introduced in England from April 2004, promoting such processes, improved the identification and correct recognition of depression by enhancing the content of statutory community care assessments by social services care managers.

Methods: An observational study compared depression identification and its accuracy (“correct recognition”) in samples of older people before and after SAP introduction. Participants were interviewed using standardized measures including the Geriatric Depression Scale (GDS). Depression elicited from the GDS was compared with that recorded in community care assessments with calculation of inter-rater reliabilities (kappa statistic) pre- and post-SAP. Logistic regression examined the associations between the policy's introduction, potential confounding factors (depression, cognitive impairment, function, behavior and characteristics) and the identification and correct recognition of depression.

Results: Whilst the identification of depression was more likely after SAP, its correct recognition did not improve after the policy, with only slight agreement between GDS and community care assessments. The existence of depression and cognitive impairment made identification, but not correct recognition, more likely.

Conclusions: Correct recognition of depression was not improved in these statutory care assessments following the policy. Recognizing and thus responding to depression in a coordinated and appropriate way in the community requires further action.

Keywords

old age depressionsocial carecommunity-based care
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 2 , February 2012 , pp. 261 - 269
Copyright
Copyright © International Psychogeriatric Association 2011

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