KNOWLEDGE OF LATE-LIFE DEPRESSION AMONG STAFF IN LONG-TERM CARE FACILITIES by Julie Marie Pullen A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Nursing MONTANA STATE UNIVERSITY Bozeman, Montana June, 2004 © COPYRIGHT by Julie Marie Pullen 2004 All Rights Reserved ii APPROVAL of a thesis submitted by Julie Marie Pullen This thesis has been read by each member of the thesis committee and has been found to be satisfactory regarding content, English usage, format, citations, bibliographic style, and consistency, and is ready for submission to the College of Graduate Studies. Dr. Vonna Branam, Chairperson Approved for the College of Nursing Dr. Jean Ballantyne Approved for the College of Graduate Studies Dr. Bruce McLeod iii STATEMENT OF PERMISSION TO USE In presenting this thesis in partial fulfillment of the requirements for a master’s degree Montana State University, I agree that the Library shall make it available to borrowers under rules of the Library. If I have indicated my intention to copyright this thesis by including a copyright notice page, copying is allowable only for scholarly purposes, consistent with “fair use” as prescribed in the U.S. Copyright Law. Requests for permission for extended quotation from our reproduction of this thesis in whole or in part may be granted only by the copyright holder. Julie Marie Pullen June 1, 2004 iv This thesis is dedicated to my husband, Rick Pullen, a gifted physician who has spent many years healing those who suffer from depression and other mental illnesses. v The author wishes to thank committee members who guided me through this educational journey: Dr. Vonna Branam, Dr. Jean Ballantyne and Dr. Fredricka Gilje. Dr. Branam chaired the thesis committee and contributed endless humor and vitality. Dr. Ballantyne’s depth of knowledge on the topic of late-life depression greatly surpasses my own. The use of her personal library is appreciated. Dr. Gilje’s warm and supportive presence, as well as her interest and commitment to the mentally-ill, is unwavering. vi TABLE OF CONTENTS 1. LIST OF TABLES ......................................................................................................... ix 2. CHAPTER 1 INTRODUCTION.................................................................................... 1 Problem Statement .......................................................................................................... 5 Conceptual Framework ................................................................................................... 6 Significance to Nursing................................................................................................. 10 Purpose .......................................................................................................................... 11 Definition of Terms ...................................................................................................... 11 3. CHAPTER 2 LITERATURE REVIEW....................................................................... 14 Scope of Depression among the General Adult Population in the United States ......... 15 Research Includes Elders ..........................................................................................................15 High Lifetime Prevalence of Depression .............................................................................16 Special Populations Increase Lifetime Prevalence............................................................17 Women and Depression....................................................................................................17 Primary Care and Depression .........................................................................................18 Treatment Failure and Depression ................................................................................19 Scope of Depression among the Elderly Population in the United States .................... 20 Research On Elders ....................................................................................................................20 Elders in Urban Communities ........................................................................................20 Elders in Rural Communities..........................................................................................21 Elders in Long-Term Care Facilities ............................................................................21 Consequences of Depression........................................................................................ 23 Increasing Morbidity and Mortality.......................................................................................23 History and Impact of Omnibus Budget Reconciliation Act ........................................ 26 Historical Overview....................................................................................................................26 OBRA’s Impact ...........................................................................................................................27 Unmet Psychiatric Needs.................................................................................................27 Psychopharmacology. .......................................................................................................28 Knowledge Deficit in the Assessment of Depression ................................................... 30 Knowledge Deficit of Normal Aging....................................................................................31 Knowledge among Primary Care Physicians .............................................................31 Knowledge among Nurses...............................................................................................33 Knowledge among Patients.............................................................................................36 Attitudes, Myths and Misconceptions..........................................................................38 Knowledge of Co-Morbidity and Depression among Elder Care Providers................. 39 Physical Pain and Depression..................................................................................................41 Substance P, Serotonin, Norepinephrine..............................................................................43 Cardiovascular Disease and Depression...............................................................................44 Cerebrovascular Incidents and Depression..........................................................................45 vii TABLE OF CONTENTS CONTINUED Gastrointestinal Disorders and Depression..........................................................................46 Thyroid Disease and Depression ............................................................................................46 Diabetes Mellitus and Depression..........................................................................................46 Vitamin Deficiencies and Depression...................................................................................47 Allergic Rhinitis and Depression: Emerging Evidence ...................................................48 Late-Life Depression .................................................................................................. 48 Dualism in the Health Care System ........................................................................ 50 Shortage of Mental Health Providers ....................................................................................52 Deficit in Mental Health Expertise ........................................................................................53 Assessment Skills Lacking.......................................................................................................54 Intervention Skills Lacking ......................................................................................................57 Rural Settings: High Need........................................................................................................59 Poorer Availability of Mental Health Services..........................................................59 4. CHAPTER 3 METHODS............................................................................................. 62 Design............................................................................................................................ 62 Population and Sample.................................................................................................. 63 Protection of Human Rights.......................................................................................... 63 Data Collection Procedures........................................................................................... 64 Instruments .................................................................................................................... 65 Data Analysis ................................................................................................................ 66 5. CHAPTER 4 RESULTS............................................................................................... 67 Sample Description ....................................................................................................... 67 Research Questions ....................................................................................................... 70 Rural and Urban Sample ............................................................................................... 72 Summary.......................................................................................................................