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Depression in elderly homecare patients: patient versus informant reports

Background. This study compares patient and informant reports of depressive disorders in a community sample of elderly medical homecare patients. The associations between specific patterns of agreement/disagreement and other patient and informant characteristics are examined. Method. A random sample of 355 elderly medical homecare patients and their informants were interviewed using the current mood section of the Structured Clinical Interview for DSM-IV (SCID). Results. Thirty-seven patients (10·4%) reported a depressive disorder (major or subsyndromal) that was also identified by their informant while 27 (7·6%) patients self-reported depression that the informant did not identify. There were 250 patients (70·4%) who were not depressed according to both patient and informant report and 41 patients (11·5%) were identified as depressed by informant report alone. Patients identified as depressed by informant report alone were similar to patients who self-reported depression on a number of the sociodemographic and clinical correlates of depression, but had significantly poorer performance on items assessing orientation and short-term recall. These patients also had poorer functioning in a number of domains (social, cognitive, and functional) when compared with patients who were not depressed according to both the patient and informant. Finally, patients with younger informants were more likely to be identified as depressed by their informant. Conclusions. Obtaining informant reports of depression may be a useful method for detecting clinically significant cases of late-life depression that would otherwise be missed when relying only on patient report.