Szücs Anna, Lee V Vien, Loh Victor W K, Lazarus Monica, Leong Choon Kit, Lee Vivien M E, Ong Alicia H, Leong Foon Leng, Goldsmith Laurie J, Young Doris, Valderas Jose M, Maier Andrea B
National University of Singapore, Yong Loo Lin School of Medicine, Department of Medicine, Singapore, Singapore.
Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, Netherlands.
Lancet Reg Health West Pac. 2024 Aug 12;51:101170. doi: 10.1016/j.lanwpc.2024.101170. eCollection 2024 Oct.
Detection and management of late-life depression largely relies on primary care. Yet in Singapore, older adults are unlikely to seek help for their mental health from their primary care providers. This qualitative descriptive study explores how late-life depression manifests to general practitioners (GPs) in the Singaporean primary care setting.
Twenty-eight private GPs practicing in Singapore were asked about their clinical experience with late-life depression during semi-structured group and individual discussions conducted online. Participants were purposively sampled across age, gender, and ethnicity (Chinese, Malay, Indian). Transcripts were analysed with reflexive thematic analysis.
To GPs, depression in older patients often manifests through somatic symptoms or subtle behavioural changes, only detectable through follow-ups or collateral history. GPs reported that older patients attribute depressive symptoms to normal ageing or do not mention them, particularly within an Asian culture encouraging stoic endurance. GPs perceived late-life depression as reactions to ageing-related stressors, with male, low-income, or institutionalised patients being at particular risk of insidious, severe depression. GPs noted ethnic differences regarding families' involvement in care, which they described as helpful, but sometimes stress-provoking for patients. Fear of burdensomeness or loss of autonomy/social role could prompt rejection of diagnosis and treatment in patients. GPs considered good patient-doctor rapport as a facilitator at every step of the care process, noting more favourable prognosis in care-concordant patients.
Depression in older adults in Singapore can be covert, with favourable outcomes relying on GPs' ability to pick up on subtle changes, assess patients holistically, and build rapport with patients and families.
This work was funded by the Division of Family Medicine Research Capabilities Building Budget under the project "Technology and Compassion: Improving Patient Outcomes Through Data Analytics and Patients' Voice in Primary Care" [NUHSRO/2022/049/NUSMed/DFM].
老年抑郁症的检测与管理很大程度上依赖于初级保健。然而在新加坡，老年人不太可能向其初级保健提供者寻求心理健康方面的帮助。这项定性描述性研究探讨了在新加坡初级保健环境中，老年抑郁症在全科医生（GP）眼中是如何表现的。
在通过在线方式进行的半结构化小组和个人讨论中，询问了在新加坡执业的28名私人全科医生关于他们在老年抑郁症方面的临床经验。参与者按年龄、性别和种族（华人、马来人、印度人）进行了有目的的抽样。对访谈记录进行了反思性主题分析。
在全科医生看来，老年患者的抑郁症通常通过躯体症状或细微的行为变化表现出来，只有通过随访或间接病史才能察觉。全科医生报告称，老年患者将抑郁症状归因于正常衰老或根本不提这些症状，尤其是在鼓励坚忍的亚洲文化背景下。全科医生认为老年抑郁症是对与衰老相关的压力源的反应，男性、低收入或入住机构的患者尤其有隐匿性严重抑郁症的风险。全科医生注意到在家庭参与护理方面存在种族差异，他们认为这有帮助，但有时也会给患者带来压力。对成为负担或失去自主性/社会角色的恐惧可能促使患者拒绝诊断和治疗。全科医生认为良好的医患关系是护理过程每一步的促进因素，并指出在护理协调良好的患者中预后更有利。
新加坡老年人的抑郁症可能很隐蔽，良好的结果依赖于全科医生识别细微变化、全面评估患者以及与患者及其家人建立融洽关系的能力。
这项工作由家庭医学研究能力建设预算部门资助，项目为“技术与关怀：通过数据分析和患者声音改善初级保健中的患者结局”[NUHSRO/2022/049/NUSMed/DFM]。
