Depressive symptoms and reduced preventive care use in older adults: the mediating role of perceived access

Joshua M Thorpe; Carolyn T Thorpe; Korey A Kennelty; Betty A Chewning

doi:10.1097/MLR.0b013e31821a933f

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Depressive symptoms and reduced preventive care use in older adults: the mediating role of perceived access

Journal article

Open access

Peer reviewed

Depressive symptoms and reduced preventive care use in older adults: the mediating role of perceived access

Joshua M Thorpe, Carolyn T Thorpe, Korey A Kennelty and Betty A Chewning

Medical care, Vol.50(4), pp.302-310

04/2012

DOI: 10.1097/MLR.0b013e31821a933f

PMCID: PMC3240709

PMID: 21577167

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https://www.ncbi.nlm.nih.gov/pmc/articles/3240709View

Open Access

Abstract

Depressive symptomatology is common in older adults and is associated with reduced adherence to recommended preventive care, but little is known as to why. Understanding how depressive symptoms may interfere with adherence can help to identify leverage points for interventions to increase preventive service use. This study examined perceived access to medical care as a possible mediator linking depressive symptomatology to reduced preventive service use in older adults. We analyzed data from 5465 respondents completing the 1993 and 2003/2004 waves of the Wisconsin Longitudinal Study. Depressive symptomatology was assessed using the Center for Epidemiologic Studies Depression Scale. Perceived access survey items were organized through factor analysis to represent key dimensions of access: availability/accessibility, affordability, acceptability, and accommodation. The primary outcome was the total number of 7 recommended preventive services that respondents received. Multivariate path analysis was used to estimate direct and indirect effects between depressive symptomatology, perceived access, and preventive service use. Older adults with depressive symptomatology received fewer recommended services. Depressive symptomatology reduced preventive service use by adversely affecting 2 dimensions of perceived access: (1) acceptability, pertaining to poor patient-provider trust and communication, and (2) accommodation, pertaining to inconveniently organized services. Depressive symptomatology may negatively alter older adults' perceptions of access and, in turn, negatively impact their preventive service use. In addition to treating depression, interventions designed to mitigate the impact of depression on the patient-provider relationship, and organizational changes to practice that better accommodate the needs of depressed patients, may increase adherence to preventive care guidelines in depressed older adults.

Health Services Accessibility

Humans

Middle Aged

Depression - psychology

Female

Male

Patient Acceptance of Health Care - psychology

Preventive Health Services - utilization

Wisconsin

Details

Title: Subtitle: Depressive symptoms and reduced preventive care use in older adults: the mediating role of perceived access
Creators: Joshua M Thorpe - Division of Social and Administrative Sciences, University of Wisconsin, Madison School of Pharmacy, USA. thorpe2@wisc.edu
Carolyn T Thorpe
Korey A Kennelty
Betty A Chewning
Resource Type: Journal article
Publication Details: Medical care, Vol.50(4), pp.302-310
DOI: 10.1097/MLR.0b013e31821a933f
PMID: 21577167
PMCID: PMC3240709
NLM abbreviation: Med Care
ISSN: 0025-7079
eISSN: 1537-1948
Publisher: United States
Grant note: UL1 RR025011 / NCRR NIH HHS UL1 RR025011-05 / NCRR NIH HHS
Language: English
Date published: 04/2012
Academic Unit: Family and Community Medicine; Pharmacy Practice and Science; Injury Prevention Research Center
Record Identifier: 9984065502502771

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