Study Finds Striking Mismatch of Depression And Treatment

A new study finds that most Americans with depression get no treatment at all, while more than two-thirds of patients are treated — even though they do not report depressive symptoms or serious psychological distress.

Researchers from Columbia University Medical Center (CUMC) and the University of Pennsylvania discovered that less than one-third of American adults who screened positive for depression received treatment for their symptoms.

The study also found that among those who are treated for depression, less than one-half of those with severe psychological distress are seen by a mental health specialist.

Results of the study appear in JAMA Internal Medicine.

“Greater clinical focus is needed on depression severity to align depression care with each patient’s needs,” said Mark Olfson, M.D., M.P.H., professor of psychiatry at CUMC and senior author of the report.

“These patterns suggest that more needs to be done to ensure that depression care is neither too intensive nor insufficient for each patient. Although screening tools provide only a rough index of depression severity, increasing their use might nevertheless help align depression care with each patient’s needs.”

The researchers analyzed data from a national survey conducted in 2012 and 2013 of more than 46,000 adults which focused on the treatment of depression. They examined a bevy of variables including depressive symptoms, serious psychological distress, and treatment with antidepressants and psychotherapy.

Investigators also reviewed which health care professionals were providing treatment, as well as other variables including age, gender, race, education, marital status, income, and health insurance.

Approximately 8.4 percent of respondents screened positive for depression, and roughly eight percent of respondents had been treated for depression. Among adults who screened positive for depression, women, whites, privately insured adults, and college-educated individuals were more likely to receive depression treatment.

There were also differences among groups in the treatments received.

Among those with serious psychological distress, for example, four times as many younger adults received psychotherapy and antidepressants than older adults, and twice as many college-educated adults received both treatments than adults with a high school education.

The researchers did find that patients with serious psychological distress were more likely than those with less distress to receive combined treatment. In these patients, they noted, antidepressants combined with psychotherapy tend to work better than antidepressants alone.

“With the increase in antidepressant use over the last several years, it may come as a surprise to learn that widespread challenges persist in accessing depression care,” Olfson said.

“There are also challenges in connecting depressed patients to the appropriate level of care.”

Source: Columbia University