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Gender Disparities in the Treatment of Late-Life Depression: Qualitative and Quantitative Findings From the IMPACT Trial

From the Department of Psychiatry and Behavioral Sciences, University of California-Davis School of Medicine, Sacramento, California (LH); Southern California Permanente Medical Group & Department of Psychiatry, University of California-San Diego School of Medicine, San Diego, California (MZ); Health Service Research Center, NPI—Semel Institute for Neuroscience, University of California-Los Angeles, Los Angeles, California (LT); and Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington (JU).

Objectives: The objectives of this study were to examine gender differences in recruitment, depression presentation, and depression treatment history in a large effectiveness trial; and to use qualitative data to generate hypotheses about reasons for observed gender differences.

Methods: Data from IMPACT, a multisite trial of a disease management program for late-life depression in primary care were used to examine gender differences quantitatively. Qualitative interviews were conducted with 30 key informants from IMPACT (referring physicians, depression care managers, and study recruiters) to learn more about challenges in recruiting and treating depressed older men and then analyzed thematically.

Results: Compared with older women, older men were significantly less likely to be referred to IMPACT, to endorse core depressive symptoms, and to have received prior depression treatment. Gender differences in prior depression treatment persisted after adjustment for covariates. Qualitative themes identified as important contributors to gender disparities included 1) how men experience and express their depression, 2) traditional masculine values, and 3) the stigma of chronic mental illness.

Conclusion: This study provides further evidence of the gender gap in depression care, identifies possible contributing factors, and suggests avenues for future research.

Key Words: Gender • late-life depression • treatment

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