Gap in depression treatment may exist in America

1. Based on a survey study, only one-third of participants who screened positive for depression were receiving treatment, whereas only one-third of participants who were being treated for depression screened positive for depression.

2. There currently exists a large gap in depression care in the US. Further study will be required to ensure that depression management appropriately meets each individual patient’s needs.

Evidence Rating Level: 3 (Average)

Study Rundown: Depression is very common in the United States. However, many adults may not be receiving adequate treatment according to their disease severity. Studies on this topic also show that the number of prescriptions for antidepressants has been rising. In order to gain increasing clarity on the management trends for depression in the US, this study performed a survey analysis of households to characterize treatment of adult depression.

Of those who screened positive for depression, fewer than one-third were receiving treatment (psychotherapy or antidepressant medication). However, of all those being treated for depression, only about one-third screened positive for depression. This national survey oversampled minorities and those with low socioeconomic status, which may have been a strength given that those subgroups are at increased risk of poor access to mental health care. Limitations included use of only self-reported data, which can be biased.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Combination of pharmacotherapy and psychotherapy in the treatment of chronic depression: A systematic review and meta-analysis

In-Depth [cross-sectional study]: From 2012 to 2013, the household component of the Medical Expenditure Panel Surveys (MEPS) was gathered for analysis of depression management trends. The MEPS screened for depressed mood or anhedonia by using the Patient Health Questionnaire-2 (PHQ-2). Treatment for depression was defined as outpatient visits to psychotherapy or mental health counselling, or use of antidepressant, antipsychotic, mood stabilizer, or anxiolytic medications. Patients with bipolar disorder were excluded. Psychological distress was assessed in the MEPS with the Kessler 6 (K6) score with regards to the individual’s mental health symptoms in the last 30 days. Individuals were classified by age, race, sex, level of education, and income. All questionnaires within the MEPS have been internally validated. Statistical analysis included logistic regression.

Approximately 8.4% of adults had screen-positive depression. Screen positive depression was 5-times more likely in individuals in the lowest income group as compared to the highest income group. However, fewer than one-third of adults with screen-positive depression received depression treatment in the survey year. Approximately 79% of adults with screen-positive depression who did not receive treatment had made 1 or more medical visits. However, 8.1% of all adults received treatment for depression regardless of depression screen status. Of those treated, only 30% had screen-positive depression or had serious psychological distress (22%). Adults with serious psychological distress were more likely to receive care from a psychiatrist or other mental health specialist, were less likely to receive depression care from general medical professionals. They were also more likely to receive psychotherapy.

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