Gender differences in the recognition of depression in old age.

OBJECTIVE: The study should answer the question of whether identical symptom presentations of depression in male and female patients leads to similar recognition rates in primary care. METHOD: We performed a survey in primary care. Two written case vignettes were presented to 170 family physicians in a face-to-face interview which took place in their practices. The case vignettes described either a mildly depressed otherwise healthy old patient (case 1) or a severely depressed patient with somatic comorbidity (case 2). For each case different versions with regard to patients' gender were used: in case 1 only the gender of the patient varied; in case 2 both the gender and the anamnesis (stroke/hypothyroidism) varied. Afterwards the interviewers asked standardised open questions. The physicians were not aware of the mental health focus and the gender focus of the study. RESULTS: The study is representative with a response rate of 77.6%. For primary diagnosis, the female versions were given the diagnosis of depression more often. There was a non-significant trend that female physicians considered depression more often. CONCLUSION: The results show that gender-related experience and stereotypes on the physicians' side influence the diagnosis of (old age) depression in primary care. Further studies should elucidate the influence of the physicians' gender on the management of psychiatric disorders.

Family physicians and the risk of suicide in the depressed elderly.

BACKGROUND: Depression is the most frequent psychiatric disorder in the elderly. It is the reason for most suicides in this age group. METHOD: We performed a representative survey in primary care. Two written case vignettes were presented to 170 family physicians in face-to-face interviews which took place in their practices. The case vignettes described either (Case 1) a mildly depressed otherwise healthy old patient or a severely depressed patient (Case 2) with somatic comorbidity. Afterwards the interviewers asked standardized open questions. The physicians were not let into the mental health focus of the study. RESULTS: The response rate was 77.6%. Depression was considered for primary or differential diagnosis by 91.2% of the physicians in Case 1 and by 70% in Case 2 (chi2-test; p < 0.01). For further anamnesis, only 2.4% of the physicians were interested in suicidal ideation of the patient. When directly asked at the end of the interview, 76.9% of the physicians said they would talk about suicide. Those who would not, thought that the patient would communicate suicidal intent himself/herself, or they feared to induce suicide by asking directly. CONCLUSION: Thinking of suicidality and its prevention is not uppermost in the physicians' mind. Therefore, and also with regard to the relatively high rate of depression recognition, we conclude that educational means should not only focus on the recognition and screening of depression, but also on the management--'how to talk about...'--of complex problems like suicide in the elderly, in order to change suicide rates.

Interferometry: a new method for no-touch measurement of the surface and volume of ulcerous skin lesions.

A new interferometry procedure (Holon View measuring system) permits non-invasive and objective measurement of the surface, height/depth and volume of ulcerous lesions. The method, which uses a combination of the so-called phase-shift and gray-code technique, is new in dermatology. The measuring system consists of a diffraction grating projection system, a video camera and a computer-aided, digital image processing and analysis system. A diffraction grating consisting of 320 lines is projected onto the skin surface or a silicone impression of the ulcerous lesion. The course of the light-intersection lines is recorded by a video camera and read into an image computer. The special feature of the method is the combination of grey-code projection and a phase-shift procedure. For evaluation of the method in dermatology, 2,000 interferometric measurements of volume were carried out on objects of known volume, on silicone impressions and on leg ulcers. The accuracy of the method has been proven by means of the evaluation of objects of known volume. The results of interferometric measurements were compared with the values of the volume determined by water capacity and those of the surface determined by image analysis. The healing of a leg ulcer was followed over an 8-week period. The Holon View measuring system permits no-touch measurement of the volume and surface of ulcerous skin lesions with a high degree of accuracy and precision, in a short time.