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Most US adults who screen positively for depression do not receive treatment
Despite increased access to depression care, more than 70% of adults who screened positive for depression did not receive any kind of treatment for their depression, according to data published in JAMA Internal Medicine.
Patients with less severe depression were also more likely to receive antidepressants than patients with more severe depression, Mark Olfson, MD, MPH, from Columbia University and the New York State Psychiatric Institute, and colleagues wrote.
Although antidepressants have become the most commonly prescribed medication class in America, Olfson and colleagues wrote that previous research and surveys have indicated a lack of treatment.
"Screening for depression has recently received increased attention," the researchers noted. "The US Preventive Services Task Force (USPSTF) now recommends screening adults for depression and adequate services for follow-up treatment that may be provided through a variety of different arrangements of clinicians and settings. The USPSTF recommendations, which support the effectiveness of antidepressants, specific psychotherapies, and their combination, highlight the need to integrate behavioral health services within primary care. In this context, it is important to assess national treatment patterns of screen-positive depression across treatment modalities and sectors of care."
Olfson and colleagues analyzed data from the Medical Expenditure Panel Surveys taken by adults in 2012 and 2013. Their analysis included 46,417 responses from adults aged at least 18 years regarding depression screening, psychological distress and treatment.
Results showed 8.4% of adults (95% CI, 7.9-8.8) screened positive for depression and of those adults, 28.7% received treatment.
The researchers also found that in adults who were being treated for depression, 21.8% had serious psychological distress and 29.9% screened positive for depression.
Among adults treated for depression, those with serious psychological distress were more likely to receive care from psychiatrists (33.4% vs. 17.3%; P < .001) or other mental health specialists (16.2% vs. 9.6%; P < .001) and less likely to receive care from general health care providers (59% vs. 74.4%; P < .001) compared with those with milder psychological distress. Those with serious psychological distress were also less likely to receive antidepressants (81.1% vs. 88.6%; P < .001), but more likely to receive psychotherapy (32.5% vs. 20.6%; P < .001).
Olfson and colleagues called for more research on using antidepressants in cases of mild depression, as previous studies have shown that they are not superior to placebo.
"The clinical reasons for this pattern are unclear, but may include a tendency to overestimate the effectiveness of antidepressants in treating mild depression, insufficient time to provide alternative interventions for mild depression, and errors in clinical assessment," the researchers wrote.
They urged providers to individualize depression care based on each patient's needs.
"Although access to depression care has expanded in recent years, critical treatment gaps persist, especially for racial/ethnic minorities, low income individuals, less educated adults, and uninsured people," Olfson and colleagues concluded. "Among adults who receive depression care, it is important to align patients with appropriate treatments and health care professionals. With dissemination of integrated care models, opportunities exist to promote depression care that is neither too intensive nor insufficient for each patient's clinical needs." – by Chelsea Frajerman Pardes
Disclosures: The researchers report no relevant financial disclosures.
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