چکیده (انگلیسی):

Background:The prevalence of depressive symptoms in older people may be as high as 20 %. Depression in older
people is associated with loss, loneliness and physical co-morbidities; it is known to be under-diagnosed and
under-treated. Older people may find it difficult to speak to their GPs about low mood, and GPs may avoid
identifying depression due to limited consultation time and referral options for older patients.
Methods:A nested qualitative study in a randomised controlled trial for older people with moderate to severe
depression: the CASPER Plus Trial (Collaborative Care for Screen Positive Elders). We interviewed GPs, case managers
(CM) and patient participants to explore perspectives and experiences of delivering and receiving a psychosocial
intervention, developed specifically for older adults in primary care, within a collaborative care framework.
Transcripts were analysed thematically using principles of constant comparison.
Results:Thirty three interviews were conducted and, across the three data-sets, four main themes were identified:
revealing hidden depression, reducing the ‘blind spots’, opportunity to talk outside the primary care consultation
and‘moving on’ from depression.
Conclusions:Depression in older people is commonly hidden, and may coexist with physical conditions that are
prioritised by both patients and GPs. Being invited to participate in a trial about depression may allow older people
to disclose their feelings, name the problem, and seek help. Offering older people an opportunity to talk outside
the primary care consultation is valued by patients and GPs. A psychosocial intervention delivered by a case
manager in the primary care setting may fill the gap in the care of older people with depression.
Trial registration:Current Controlled Trials ISRCTN45842879.