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Original Investigation |

Treatment of Adult Depression in the United States ONLINE FIRST

Mark Olfson, MD, MPH1; Carlos Blanco, MD, PhD2; Steven C. Marcus, PhD3
[+] Author Affiliations
1Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York
2National Institute on Drug Abuse, Bethesda, Maryland
3School of Social Practice & Policy, University of Pennsylvania, Philadelphia
JAMA Intern Med. Published online August 29, 2016. doi:10.1001/jamainternmed.2016.5057
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Importance  Despite recent increased use of antidepressants in the United States, concerns persist that many adults with depression do not receive treatment, whereas others receive treatments that do not match their level of illness severity.

Objective  To characterize the treatment of adult depression in the United States.

Design, Setting, and Participants  Analysis of screen-positive depression, psychological distress, and depression treatment data from 46 417 responses to the Medical Expenditure Panel Surveys taken in US households by participants aged 18 years or older in 2012 and 2013.

Main Outcome and Measures  Percentages of adults with screen-positive depression (Patient Health Questionnaire-2 score of ≥ 3) and adjusted odds ratios (AORs) of the effects of sociodemographic characteristics on odds of screen-positive depression; percentages with treatment for screen-positive depression and AORs; percentages with any treatment of depression and AORs stratified by presence of serious psychological distress (Kessler 6 scale score of ≥13); and percentages with depression treatment by health care professional group (psychiatrists, other health care professionals, and general medical providers); and type of depression treatment (antidepressants, psychotherapy, and both) all stratified by distress level.

Results  Approximately 8.4% (95% CI, 7.9-8.8) of adults screened positive for depression, of which 28.7% received any depression treatment. Conversely, among all adults treated for depression, 29.9% had screen-positive depression and 21.8% had serious psychological distress. Adults with serious compared with less serious psychological distress who were treated for depression 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 depression care exclusively from general medical professionals (59.0% vs 74.4%, P < .001). They were also more likely to receive psychotherapy (32.5% vs 20.6%, P < .001), though not antidepressant medications (81.1% vs 88.6%, P < .001).

Conclusions and Relevance  Most US adults who screen positive for depression did not receive treatment for depression, whereas most who were treated did not screen positive. In light of these findings, it is important to strengthen efforts to align depression care with each patient’s clinical needs.

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Figure 1.
Percentages of Patients With Screen-Positive Depression and Serious Psychological Distress Treated For Depression by Health Care Professional Group

Data are from Medical Expenditure Panel Surveys (2012-2013). Analysis limited to ages 18 years or older. Percentages (95% CIs) of adult sample treated for depression with screen-positive depression are: total, 29.9% (27.9-31.9); general medical only, 25.3% (23.0-27.6); psychiatrist, 45.4% (40.5-50.3); and other mental health professional, 40.3% (33.9-46.8). Corresponding percentages for serious psychological distress are: total, 21.8% (19.9-23.6); general medical only, 18.1% (16.0-20.2); psychiatrist, 34.9% (30.1-39.7); and other mental health professional, 31.9% (25.5-38.3).

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Figure 2.
Percentage of Adults Treated for Depression by Level of Psychological Distress, Treatment Modality, and Health Care Professional

Data are from 2012 and 2013 MEPS. Statistics for comparisons: antidepressants: AOR, 0.65; 95% CI, 0.48-0.90; P < .001; psychotherapy: AOR, 1.77; 95% CIs, 1.34-2.34; P < .001; combined antidepressants and psychotherapy: AOR, 1.60; 95% CIs, 1.17-2.19; P < .001; treatment by psychiatrist: AOR, 2.37; 95% CIs, 1.82-3.08; P < .001; treatment by other mental health professionals: AOR, 1.82; 95% CIs, 1.28-2.61; P < .001; treatment by only general medical professionals: AOR, 0.53; 95% CIs, 0.42-0.68; P < .001.

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