Providers are failing to meet needs of depressed patients

Despite an increase in the number of Americans on antidepressants, many who screen positive for depression don't receive treatment, according to a study published in JAMA Internal Medicine. Furthermore, most who did receive treatment don't appear to have the disease.

Although the percentage of Americans on antidepressants each month has increased from 6.8% in 1999 to 2000 to 13% in 2011 to 2012, more than two-thirds (71%) of Americans who screen positive for depression do not receive treatment for their symptoms during the course of one year, while most (70%) who receive depression treatment do not report depressive symptoms.

Mark Olfson, professor of psychiatry at the Columbia University Medical Center and researchers based the study on the to the Medical Expenditure Panel Surveys, a nationally representative survey of 46,417 adults that was conducted in 2012 and 2013. Detailed information was collected from household respondents three times during each survey year and health services reportedly used are checked against medical records. The survey included a widely used depression screening tool and a measure of serious psychological distress.

Men as well as adults without health insurance, with less education, and ethnic and racial minorities were particularly unlikely to receive treatment for their symptoms, according to Olfson.

Olfson

“Compared to patients with more serious distress, those with less serious distress were less likely to be treated by psychiatrists or to receive psychotherapy as one might expect, but they were significantly more likely to receive antidepressants,” says Olfson.

These findings suggest that there are problems in aligning depression care with patient needs, according to Olfson.

“More attention is needed to help put systems of care in place that help depressed patients receive appropriate treatments for their symptoms,” he says.  

Based on the study, Olfson offers these takeaways for executives:

1.  Despite the recent increase in prescribing of antidepressant medications, most American adults who screen positive for depression receive no treatment for their symptoms. “Expanding the use of simple depression screening tools in primary care is a good first step to increase identification of depression and to guide matching patients to appropriate depression treatment,” Olfson says.  

2.  The findings suggest that some primary care physicians are overprescribing antidepressant medications and underusing other treatments, such as exercise and counseling, for the care of less severe depression. Increasing access to these alternative treatments may improve the quality of depression care.

3.  The finding that substantial numbers of people with serious psychological distress receive their depression care from primary care clinicians rather than from mental health specialists suggests that a need exists for strengthening referral pathways from general to specialty care for these patients, Olfson says.