Older Men Resist Depression Treatment

(WebMD)  Older men are significantly less likely than older women to acknowledge symptoms of depression, new research shows.

Older men are also less likely than older women to have received previous treatment for depression and to be referred to depression-management programs.

As a result, many older depressed men are falling through the cracks and have an increased risk of suicide, says Ladson Hinton, M.D., an associate professor of psychiatry at the University of California-Davis. Hinton is a researcher on the study, which appears in the October issue of the American Journal of Geriatric Psychiatry.

"We have an epidemic of suicide among older men in this country, and depression is an important contributing factor," Hinton tells WebMD. "So we have to develop ways to more effectively engage older men."

Men aged 65 and over are almost eight times as likely to commit suicide as their female counterparts. They have a suicide rate of 31.8 per 100,000, while older women have a suicide rate of 4.1 per 100,000.

To quantify older men's resistance to depression treatment, the researchers studied data on 1,600 depressed older adults from IMPACT (Improving Mood: Providing Access to Collaborative Treatment for Depression), a study addressing the management of late-life depression.
They also conducted interviews with 30 IMPACT-connected doctors, depression-care managers, and study recruiters.

"This study is valuable and novel for several reasons," says Colin Depp, M.D., of the Sam and Rose Stein Institute for Research on Aging at the University of California in San Diego and the VA San Diego Healthcare System. Depp was not connected with the study.

"First, the patients in the study were broadly representative of older adults in primary care, as opposed to many other treatment studies of depression in older people," Depp tells WebMD. "Second, the study used a mix-method approach in which quantitative and qualitative data were gathered to determine the barriers to engaging services among men.

"Both kinds of data led to the same answer: older men are less likely than older women to engage in treatment for depression," Depp says. "The implications of this study are that treatments for depression, no matter how effective in clinical trials, will not make an impact on older men if they're not referred to appropriate care and followed up."

Across many measures of treatment-seeking behaviors, Hinton's team observed a consistent gap between older men and older women.

They found that older men were significantly less likely to report "any antidepressant use in the past three months" (38 percent vs. 46 percent), "any depression care in the past three months" (41 percent vs. 50 percent) and "any lifetime depression care" (60 percent vs. 71 percent).

"But the most important of these measures was 'any potentially effective depression care in the past three months,'" Hinton says. "Because only 21 percent of older men and 31 percent of older women reported receiving such care, this shows that depression undertreatment affects both sexes, but especially affects older men."

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