Background: This study investigated the influence of patients’ gender in the diagnosis, management and treatment of depression in a population aged over 75 years old in general care. The usefulness of BAT (Brief Assessment Tool), a clinical screening tool for eight geriatric syndromes, was assessed for depression by comparison to a routine consultation.
Methods: This retrospective analysis of baseline data from a cluster-randomized trial AGE3 (active geriatric evaluation, 3rd phase) testing the effectiveness of BAT included 42 general practitioners (GPs) in Switzerland. In total, 429 participants - 269 (62.7%) women and 160 (37.3%) men - aged over 75 years old (with a mean at 82.1 years) were recruited, with 217 participants in intervention arm having a BAT, leading when positive to a care plan. To screen depression, the two questions from PHQ-2 (Patient Health Questionnaire-2) were included in BAT. Results of the BAT were recorded in an electronic case report from by the GPs. Data such as diagnoses and prescribed medication were extracted in both arm from medical files or telephone interviews using a questionnaire.
Results: The prevalence of depression in AGE3 participants (N=429) according to the medical file was found at 8.4% (95%CI 5.8%-11.0%), without any significant difference according to gender (7.5% for men and 8.9% for women) (p=0.607). ADs (antidepressants) prescription was observed in a total of 94 (21.9%) patients and was statistically different according to gender, with 15% among men compared to 26% among women (p=0.008, OR=1.99). Most patients on ADs were not diagnosed with depression, particularly women, being at 20.1% in this case, compared to 10.6% of men (p=0.059). No gender variation was found for existence of a chronic psychological disorder (32.7% among women and 33.7% among men) (p=0.825), psychotherapy (1.9% among women and 0.6% among men) (p=0.535), anxiolytic (29.7% among women and 25.5% among men) (p=0.360) and hypnotic/sedative treatment (21.6% among women and 20.0% among men) (p=0.701). In intervention arm, the most frequent intervention was supportive therapy (77.3% in women and 60.0% in men), followed by ADs (58.8% in women and 33.3% in men), without any significant gender difference. In terms of detecting depression in the intervention arm, the use of BAT revealed more case of diagnosed depression than the baseline data for all AGE3 patients (13.3% vs 8.4%), for women (15.3% vs 8.9%) and for men (9.8% vs 7.5%), however these data were not collected at the same time, making difficult to compare them both. With BAT, psychotropic medication was similarly reassessed according to gender, being done in 81.5% patients (p=0.862).
Interpretation: ADs prescription is higher in women, which may be explained by a higher demand among them, or in contrary a lower demand among men. An over-diagnosis in women or an under-diagnosis of depression in men may also influence this prescription. A bias in prescribing ADs by GPs may exist as well, with over-prescribing in women or under-prescribing in men. More women received ADs even though no diagnosis of depression was associated. The exact etiology of this gender gap for ADs prescription will need to be further investigated. In contrast, supportive therapy was followed regardless of gender.