Major depressive disorder, commonly referred to as clinical depression, is more than a temporary period of sadness. It is a psychiatric condition characterized by persistent low mood or loss of interest, together with symptoms that can include sleep disruption, changes in appetite, fatigue, impaired concentration, feelings of worthlessness, and thoughts of death or suicide. Evidence-based treatment typically involves antidepressant medication, psychotherapy, or a combination of approaches, depending on the patient’s symptoms, preferences, medical history, and risk profile. When people with diagnosed depression receive none of the care recommended by clinical standards, symptoms may persist or worsen and the likelihood of functional impairment can increase.

The study examined treatment patterns across a vast veteran population, making it one of the largest investigations of depression care in the VHA system. Rather than focusing on a small clinical sample, the researchers analyzed a nationwide cohort of veterans with MDD who received care through the Veterans Health Administration. This type of population-level analysis can reveal changes that may be invisible in individual clinics, including shifts in prescribing, psychotherapy access, referral practices, and the availability of mental health professionals. It can also show whether care is being distributed consistently across a health system that serves patients with widely varying medical, psychiatric, geographic, and socioeconomic circumstances.

The central finding was not that depression treatment had broadly collapsed. Most veterans in the cohort received recommended treatment. The concern was the direction of the trend: over the study period, the share of patients who did not receive recommended treatment gradually increased, reaching 10.2% in 2025. In a population this large, even a percentage that appears relatively modest represents a substantial number of people. A rate of 10.2% among more than 1.5 million veterans would correspond to well over 150,000 individuals if applied to the entire cohort, although the precise number in any given year would depend on the annual patient distribution and the study’s analytic definitions.

The researchers emphasize that the results require further investigation rather than offering a single explanation for the increase. A patient may not receive documented treatment for many different reasons. Some veterans may decline medication or psychotherapy, prefer to monitor symptoms, seek care outside the VHA, or experience barriers that prevent them from completing a referral. Others may face long travel distances, limited appointment availability, transportation problems, work or caregiving responsibilities, financial pressures, stigma, or concerns about medication side effects. Treatment may also be delayed while clinicians evaluate whether depressive symptoms are caused or intensified by another medical condition, substance use, trauma-related illness, bipolar spectrum symptoms, or medication effects.

Mental health service availability is therefore a key issue raised by the findings. Recommended depression care depends not only on clinical guidelines but also on whether the health system has enough psychiatrists, psychologists, social workers, primary care clinicians, and other trained professionals to provide that care. A patient can be correctly diagnosed yet remain untreated if the next available psychotherapy appointment is months away or if medication management is difficult to access. Even when services exist, shortages may create bottlenecks, particularly in rural areas and regions with high demand. Telehealth can reduce some geographic barriers, but it does not eliminate problems involving broadband access, privacy, digital literacy, scheduling, or the need for in-person assessment.

The study also highlights the technical challenge of measuring treatment in large health databases. Administrative and electronic health record data can identify diagnoses, prescriptions, visits, and referrals, but they may not fully capture what happened outside the health system or whether a patient actually took a prescribed drug or participated meaningfully in therapy. A medication listed in a record does not prove adherence, just as the absence of a prescription does not prove that no treatment was received elsewhere. Observational cohort studies are valuable for identifying patterns and generating hypotheses, but they cannot by themselves establish that reduced treatment caused worse outcomes or determine why an individual veteran did not receive care.

The implications are significant because untreated or undertreated depression can affect nearly every dimension of health. Depression is associated with impaired work and social functioning, poorer management of chronic diseases, increased substance use, sleep problems, and elevated suicide risk. Veterans may also experience depression alongside posttraumatic stress disorder, traumatic brain injury, chronic pain, cardiovascular disease, or other conditions that complicate treatment decisions. The study’s findings should therefore prompt a closer examination of how MDD is diagnosed, how treatment recommendations are recorded, how quickly patients can access services, and whether clinicians have practical alternatives when standard pathways are unavailable.

The authors call for additional research into the factors that influence treatment selection and access among VHA outpatients with MDD. Future studies could examine whether the upward trend differs by age, sex, race and ethnicity, rural or urban residence, disability status, comorbid illness, military service characteristics, or facility location. Researchers may also need to distinguish between clinically appropriate non-treatment and treatment that was missed because of system-level barriers. Understanding that difference will be essential: some patients may reasonably choose not to begin therapy or medication, while others may want care but be unable to obtain it. The nationwide cohort provides an important warning signal, but the next step is determining where the gap is occurring and what interventions can close it without sacrificing individualized, patient-centered decision-making.

Subject of Research: Recommended depression treatment and potential undertreatment among veterans with major depressive disorder in Veterans Health Administration outpatient care.

Web References: https://doi.org/10.1001/jamanetworkopen.2026.28853

References: Aslan M et al. Cohort study of treatment patterns among 1,582,834 veterans with major depressive disorder. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2026.28853.

Keywords: major depressive disorder, depression, veterans, Veterans Health Administration, mental health care, antidepressant treatment, psychotherapy, undertreatment, health services research, cohort study, treatment access, clinical decision-making.

It is essential to understand the context in which such a clinic operates, considering Nigeria’s complex socio-cultural landscape. The elderly often face unique challenges related to mental health, ranging from dementia to severe depression and anxiety. In Nigeria, where traditional beliefs about aging and mental health prevail, there has historically been resistance to seeking psychiatric help. This undercurrent of stigma has created barriers that the psychogeriatric clinic aims to dismantle. As the clinic evolved, it adopted various strategies to promote understanding and alleviate the fears surrounding mental health treatment, leading to a gradual increase in patient engagement.

Patient profiles have significantly changed over the years, reflecting broader sociocultural transformations in Nigeria. Initially, the clinic primarily served a demographic comprising traditionally marginalized groups who were often the last to access mental health services. Over time, this service has seen a more diverse patient population, illustrating the effectiveness of outreach programs aimed at educating families and communities about mental health. This expanding reach underscores the clinic’s commitment to inclusivity and highlights its role as a community resource, playing an integral part in the public health framework.

One of the most noteworthy developments over the 18 years has been the incorporation of modern technological solutions into the clinic’s operational framework. Telepsychiatry has risen to prominence, allowing practitioners to bridge the gap between patients and available resources effectively. Many elderly patients, who may have difficulty traveling to the clinic, can now receive consultations and follow-up care remotely. This shift not only improves accessibility but also enhances the continuity of care that is vital for chronic mental health conditions. As the clinic adapts to technological advancements, it has become a model for how mental health services can evolve in response to the unique needs of a geriatric population.

A significant part of the clinic’s success can be attributed to its multidisciplinary approach. Professionals from various backgrounds collaborate to form comprehensive care teams, integrating perspectives from psychiatry, psychology, nursing, and social work. This model fosters a holistic view of patient care, ensuring that treatment plans are tailored to meet the physical, emotional, and social needs of each individual. By leveraging the strengths of different disciplines, the clinic has succeeded in creating a supportive environment that empowers patients through a multi-faceted approach to mental health.

Education plays a pivotal role in addressing the stigma surrounding mental health in Nigeria. The clinic has invested heavily in community outreach programs aimed at raising awareness of psychogeriatric issues. Workshops and informational sessions that elucidate the signs and symptoms of mental health conditions offer families valuable insights, thereby reducing misconceptions about mental illness. Such efforts have not only increased community engagement but have also led to a more willing acceptance of treatment options among the elderly. This gradual shift in public perception has proven essential for enhancing the clinic’s efficacy.

Despite the challenges posed by limited resources, the clinic has employed innovative solutions to provide quality care. Through partnerships with local organizations and governmental agencies, the clinic has been able to procure funding and additional resources. This collaboration is vital in a context where the demand for mental health services often exceeds available supply. Moreover, this model of resource-sharing fosters a sense of community ownership, ensuring that mental health remains a priority within the public discourse.

The evolution of the psychogeriatric clinic has also been marked by a continuous commitment to research and evidence-based practices. By documenting patient outcomes, treatment methodologies, and the general effectiveness of interventions, the clinic contributes to the growing body of literature on geriatric mental health. This emphasis on research ensures that care protocols remain aligned with best practices and that staff remains informed about the latest advancements in the field. The clinic’s research initiatives not only improve local practices but also have the potential to influence wider mental health care strategies within Nigeria and beyond.

As the clinic moves forward, the importance of sustainability cannot be overstated. Strategies for long-term viability must take into account factors such as evolving patient demographics and the changing landscape of mental health care. The clinic is actively exploring avenues to establish a sustainable model that can adapt to shifting needs while maintaining high standards of care. This commitment to sustainability will ensure that the clinic continues to serve as a vital resource for the elderly population in Southwestern Nigeria for years to come.

Furthermore, developing the clinic’s workforce represents a crucial element of its evolution. By investing in training and development programs for healthcare professionals, the clinic not only enhances the skills of its staff but also fosters a culture of compassion and understanding among caregivers. This nurturing environment proves beneficial not only for the staff but equally for the patients, as it promotes a community of care that prioritizes both professional development and patient satisfaction.

As mental health issues continue to rise among senior citizens globally, the lessons learned from this clinic’s journey are increasingly relevant. Its model demonstrates that a culturally sensitive, inclusive, and multi-disciplinary approach can yield positive outcomes for mental health treatment in geriatric populations. The experience further illustrates the need for comprehensive mental health policies that consider local cultural contexts and provide necessary resources and support.

In conclusion, the evolution of the outpatient psychogeriatric clinic in Southwestern Nigeria stands as a testament to the transformative power of dedicated mental health services. By adapting to the unique challenges posed by cultural stigma, limited resources, and the growing demand for care, the clinic not only provides essential services but also paves the way for future innovations in geriatric mental health care. The journey over the past 18 years exemplifies a collaborative effort to improve the lives of elderly patients and reflects a hopeful outlook for mental health treatment in Nigeria and similar settings around the world.

Subject of Research: Outpatient Psychogeriatric Clinic in Southwestern Nigeria

Article Title: The Evolution of an Outpatient Psychogeriatric Clinic in Southwestern Nigeria: an 18-Year Overview

Article References:

Elugbadebo, O., Oyinlola, O., Alonge, T. et al. The Evolution of an Outpatient Psychogeriatric Clinic in Southwestern Nigeria: an 18-Year Overview.
Ageing Int 50, 62 (2025). https://doi.org/10.1007/s12126-025-09642-8

Image Credits: AI Generated

DOI: 10.1007/s12126-025-09642-8

Keywords: Psychogeriatric clinic, mental health, elderly care, Nigeria, outpatient services, telepsychiatry, multidisciplinary approach, community outreach, mental health stigma