Date of Award

Fall 12-1-2006

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

First Advisor

Jennifer Boothby

Second Advisor

June Sprock

Third Advisor

Jean Kristeller

Abstract

Depression is a common condition that is often poorly detected in primary care medical settings. The elderly often fail to receive appropriate attention to their mental health needs, possibly due to physician's interpretation of physical and emotional changes as part of the normal aging process. The purpose of this study was to explore physicians' identification of depression and to determine whether age-related factors and gender impact recommendations for patient care. The respondents were full-time primary care physicians (N = 46; 63% male) who were randomly selected from a national listing of family medicine practitioners and primary care physicians (family medicine, general internal medicine) employed at a VA hospital. Physicians read two vignettes depicting male and female patients, ranging in age from 42 to 74, with medical problems and comorbid depressive symptoms. They also read two control vignettes in which patients were described as having medical problems but no depressive symptoms. They provided primary diagnoses, recommended treatment options, and completed a demographic questionnaire and the Anxiety About Aging Scale. Mixed results were found with respect to the role of patient age on diagnosis, such that physicians diagnosed older patients with a depressive disorder less frequently than younger patients in one vignette but not the other. Gender of the patient did not impact physicians' detection of depression. Patient age and gender were also not associated with physicians' recommendations for a mental health referral. Potential moderating effects of IV physician variables (age, years of medical experience, anxiety about their own aging) were not found in relation to a depressive diagnosis or mental health referral. Contrary to what was predicted, physicians with more years of experience were less likely to refer patients to a mental health provider. Clinical implications and limitations of the findings are discussed.

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