The nature of depression among older people in inner London, and the contact with primary care.

Ninety-six people of pensionable age from an inner-London electoral ward who had been identified by short-CARE screening as having 'probable pervasive depression' were interviewed further to ascertain their GMS-AGECAT and self-CARE status, comorbid features, and current primary-care psychiatric management. Estimated incidence rates of 30.8 per 1000 per year for 'probable pervasive depression' and 15.4 per 1000 per year for GMS diagnostic depression were calculated using results from a short-CARE screen in 1988. Among GMS diagnostic depression cases, anxiety was the major psychiatric comorbid feature (95%) and organic features were uncommon (8.4%). Of 66 self-CARE cases, 48 (73%) were also GMS-AGECAT cases; of 24 self-CARE non-cases, 15 (62.5%) were not GMS-AGECAT cases. Among subjects who had 'probable pervasive depression', 38% said that they had declared their symptoms to their general practitioner. Only 14% of subjects were prescribed antidepressants; 24% were prescribed hypnotics. Half the GMS-AGECAT-case subjects who stated that they had declared to their general practitioner were on specific therapy. Screening for depression and health education aimed at increasing psychological declaration are seen as ways forward in the management of this depression.