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July 2003

Depression and Bipolar Support Alliance Consensus Statement on the Unmet Needs in Diagnosis and Treatment of Mood Disorders in Late Life

Author Affiliations

From the National Institute of Mental Health, Bethesda, Md (Drs Charney, Cuthbert, Lebowitz, Niederehe, Olin, Pearson, and Sunderland); the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Drs Brown, Mulsant, Pollock, C. F. Reynolds, and Schulz); Depression and Bipolar Support Alliance, Chicago, Ill (Ms Lewis and Dr M. Reynolds); the Department of Psychiatry, Weill Medical College of Cornell University, White Plains, NY (Drs Alexopoulos, Bruce, Charlson, Meyers, and Young); the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC (Drs Blazer and Krishnan); the Department of Psychiatry, University of Pennsylvania, Philadelphia (Drs Katz and Oslin); the Department of Psychiatry, University of California at San Francisco (Dr Arean); the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Dr Borson); the Department of Medicine, Indiana University School of Medicine, Indianapolis (Dr Callahan); the Department of Psychiatry, University of Rochester Medical Center, Rochester, NY (Dr Conwell); the Departments of Psychiatry (Drs Devanand and Weissman) and Neurology (Dr Devanand), College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York; AARP Public Policy Institute, Washington, DC (Mss Gibson and Raetzman); the Department of Psychiatry, Harvard Medical School, Boston, Mass (Drs Gottlieb and Salzman); Scientific Therapeutics Information Inc, Springfield, NJ (Ms Laden); the Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, Md (Dr Lyketsos); Consumer Advocate, Philadelphia (Ms Persky); the Department of Family Medicine, University of Michigan Medical School, Ann Arbor (Dr Schwenk); Merck Research Laboratories, West Point, Pa (Dr Scolnick); and the Department of Psychiatry, UCLA Neuropsychiatric Institute (Dr Unützer).

Arch Gen Psychiatry. 2003;60(7):664-672. doi:10.1001/archpsyc.60.7.664

Objectives  To review progress made during the past decade in late-life mood disorders and to identify areas of unmet need in health care delivery and research.

Participants  The Consensus Development Panel consisted of experts in late-life mood disorders, geriatrics, primary care, mental health and aging policy research, and advocacy.

Evidence  (1) Literature reviews addressing risk factors, prevention, diagnosis, treatment, and delivery of services and (2) opinions and experiences of primary care and mental health care providers, policy analysts, and advocates.

Consensus Process  The Consensus Development Panel listened to presentations and participated in discussions. Workgroups considered the evidence and prepared preliminary statements. Workgroup leaders presented drafts for discussion by the Consensus Development Panel. The final document was reviewed and edited to incorporate input from the entire Consensus Development Panel.

Conclusions  Despite the availability of safe and efficacious treatments, mood disorders remain a significant health care issue for the elderly and are associated with disability, functional decline, diminished quality of life, mortality from comorbid medical conditions or suicide, demands on caregivers, and increased service utilization. Discriminatory coverage and reimbursement policies for mental health care are a challenge for the elderly, especially those with modest incomes, and for clinicians. Minorities are particularly underserved. Access to mental health care services for most elderly individuals is inadequate, and coordination of services is lacking. There is an immediate need for collaboration among patients, families, researchers, clinicians, governmental agencies, and third-party payers to improve diagnosis, treatment, and delivery of services for elderly persons with mood disorders.

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