A new study published in the Journal of General Internal Medicine finds that only about one in three individuals newly diagnosed with depression actually begin treatment.
According to the findings, of more than 240,000 patients who received a new diagnosis of depression in a primary care setting, only 35.7 percent initiated antidepressant medication or psychotherapy within 90 days of their diagnosis. The numbers are a little better among those with more severe depression — around half start treatment.
The study also found significant differences between various racial, ethnic, and age groups. The odds of Asians, non-Hispanic blacks, and Hispanics starting treatment were at least 30 percent lower than non-Hispanic whites. The researchers also discovered that patients who were 60 years or older at the time of diagnosis were half as likely to begin treatment as patients under the age of 44.
“There was some older, more limited evidence that many people who are diagnosed with depression do not begin treatment, for reasons ranging from stigma to challenges accessing behavioral health services,” said Beth Waitzfelder, Ph.D., lead author and investigator with the Kaiser Permanente Center for Health Research in Honolulu.
She noted that additional evidence has shown that some patient populations are particularly vulnerable to being untreated.
“Our study, which was much larger than previous studies, provides important new evidence about the current scope of the problem among leading health care systems across the country that are striving to improve depression care in primary care settings,” said Waitzfelder.
“Screening for depression in primary care is a positive step toward improving detection, treatment, and outcome for depression, but disparities persist. We need a better understanding of the patient and other factors that influence treatment initiation.”
The researchers analyzed electronic health records, insurance claims and demographic data, to identify patients who received a new diagnosis of depression in primary care settings in five large health care systems between 2010 and 2013.
Among depressed patients who did begin treatment, more than 80 percent started taking antidepressant medication rather than psychotherapy. Older patients in particular were less likely to choose psychotherapy. For example, only seven percent of patients age 75 and older started counseling, compared to 25 percent of patients age 18-29.
All racial and ethnic minorities were more likely than non-Hispanic whites to start psychotherapy rather than medication — an important reminder that health care providers and organizations need to consider the preferences of patients when developing treatment strategies and recommendations.
“Over the last decade, there has been a growing effort to raise awareness about mental health and to integrate mental health care into primary care,” said Waitzfelder.
“This is a positive development, since most people receive care from primary care providers. However, our study shows there is a lot more work to do to understand why many depressed patients do not begin treatment.”
Source: Kaiser Permanente