For over 40 years, GPs have been told that they fail to diagnose depression.1,2 Some studies, however, suggest2,3 that clinically significant depression (moderate to severe depressive illness) is detected by GPs at later consultations by virtue of the longitudinal patient–doctor relationship and it is milder forms, which may recover spontaneously, that go undetected and un-treated. More recent studies in primary care suggest that the probability of prescribing antidepressants was associated to the severity of the depression, although almost half of the patients who were prescribed antidepressants were not depressed.4 Other authors draw attention to the dangers of the erroneous diagnosis of depression in patients with a slight psychological malaise and little functional repercussion leading to the risk of unnecessary and potentially dangerous medicalisation.5
Depressive disorder affects about one in 10 people aged over 65 years,6 making it the most common mental health disorder of later life. Depression frequently coexists with long-term physical conditions7 and is itself associated with physical limitation, greater functional impairment, increased use of healthcare provision, and higher mortality.8 Older people have the highest suicide rate for women and second highest for men. In contrast with younger people, self-harm in older people usually signifies mental illness, mostly depression, with high-risk of completed suicide.9 Low levels of detection and treatment of late-life depression10 have been highlighted in primary care,11 where evidence suggests a relapsing or chronic course.12 Detection of depression may be poor if primary care clinicians lack the necessary consultation skills or confidence to diagnose late-life disorders correctly. However, two-thirds of older people …