The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #69539

Bruce Friedman, PhD¹, Yeates Conwell, MD², Rachel Ritz, MS¹, Lance McCoy, MD³, Brenda Wamsley, MSW⁴, and Gerald M. Eggert, PhD⁵. (1) Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (585) 273-2618, Bruce_Friedman@urmc.rochester.edu, (2) Department of Psychiatry, University of Rochester, 300 Crittenden Blvd., Room 1-9016, Rochester, NY 14642, (3) Integrated Geriatric Care, 2801 Dudley Avenue, Suite B, Parkersburg, WV 26101, (4) Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, (5) Executive Director, Monroe County Long Term Care Program, Inc./ACCESS, 349 West Commercial Street, Suite 2250, East Rochester, NY 14445

Over 5.5 million Americans under the age of 65 are enrolled in Medicare, the vast majority because they qualified for Social Security Disability Insurance for at least two years. It is well known that depression, suicidal ideation, and suicide attempts are important public health issues. We are unaware of any studies of these issues that have focused exclusively on Medicare beneficiaries under age 65, and none in that population in primary care. The Medicare Primary and Consumer-Directed Care Demonstration tested the acceptability and effectiveness of three models of consumer-directed care among Medicare beneficiaries, cared for by primary care physicians, who were functionally disabled and at increased risk for high healthcare costs. According to the 15-item Geriatric Depression Scale, 58.3% of the under 65 Medicare beneficiaries in the Demonstration (N = 164) were classified as depressed at study baseline - 20.5% as severely depressed and another 37.8% as mildly or moderately depressed. Using the Mini International Neuropsychiatric Interview – Major Depression Episode module, 34.6% was found to have been experiencing a Major Depressive Episode at that time. Suicidal ideation was reported by 37.0% of the beneficiaries, including 14.8% with active suicidal ideation in the past year. A total of 4.9% indicated that they had attempted suicide during the year prior to study entry, while 25.9% indicated at least one attempt during their lifetime. The prevalence of depression and suicidal behavior ranges from about 2 to 5 times higher than that found in several major studies of non-elderly American adults.

Learning Objectives:

• To gain an understanding of the extent of depressive symptoms, major depressive episode, suicidal ideation, and self-reported suicide attempts among a group of Medicare beneficiaries under age 65 cared for by primary care physicians who are functionally impaired and at increased risk of high healthcare costs.

Keywords: Depression, Disability

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.