Physician attitudes toward treatment of depression in older medical inpatients.

OBJECTIVES: To better understand low treatment (<50%) and psychiatry referral rates (<10%) of depressed older medical patients, we examined medical physicians' characteristics, attitudes and practices regarding treatment.
METHODS: Physicians caring for a consecutive series of 1000 depressed older patients during medical hospitalization and/or after discharge were asked about their general attitudes and behaviors related to the treatment of depression in older patients.
RESULTS: Of 422 physicians responding to questionnaires, less than half (48%) usually started more than two patients a month on antidepressants. Even fewer (14%) referred more than two patients a month for counseling; 37% usually referred none. Only 11% referred more than two patients a month to psychiatrists; nearly 40% usually referred none. Antidepressants, counseling, and psychiatric referral were seldom thought very effective. Physicians out of their training and those in primary care specialties (especially family practice) were more likely to treat patients. Common reasons for not treating these patients were perceived resistance to treatment (62.3%), lack of time (61.1%), uncertainty of depression diagnosis (56.2%), belief that patients couldn't afford treatment (50.5%), and concern about medication/disease interactions (58.8%). One-third (33.5%) emphasized that they were unsure about treatment effectiveness and one-third (34.4%) that they were poorly prepared to treat depression in older patients. Non-white physicians were more likely to refer to psychiatrists.
CONCLUSIONS: Many older depressed patients in medical settings are not treated or referred. Physician experience and specialty may affect the decision to treat, and physician race may affect the decision to seek consultation. Therapeutic nihilism may be influential.