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 We know that depression is common, costly, and has a significant impact on functioning and quality of life. Effective treatment is available and treatment guidelines for major depression have been in place for several years. In spite of our knowledgebase and clinical capabilities, it has been common for individuals with depression to receive no treatment or to be undertreated. This has been particularly true of the elderly, minorities and underinsured/uninsured.
Rather than assess the quality of care, a study in December Psychiatric Services looked at why depressed individuals do not come for treatment. Using data from the Agency for Healthcare Research and Quality (AHRQ), researchers describe that a total of 1,371 individuals in a 2 year sample had self-reported depression. Of these, 833 had at least one antidepressant prescription filled during the year, 384 had at least one psychotherapy or counseling session during the year, and 938 used some form of treatment during the year.
It appears, for the most part, that once depression treatment is initiated, disparities in adequate care are not significant. This study found that, among individuals who received psychotherapy or counseling, African Americans were more likely to receive an adequate course of treatment than Caucasians. Among individuals who received an antidepressant, no racial differences were observed in the probability of receiving adequate pharmacotherapy. Latinos were significantly less likely to receive any treatment and also significantly less likely to receive an adequate course of psychotherapy or counseling.
Young adults were the only age group consistently less likely to receive any treatment, less likely to fill an adequate number of prescriptions among antidepressant users, and less likely to receive an adequate number of counseling sessions. This finding may be due to the fact that young adults are less likely to use health services in general. The authors point out that this is in contrast with previous studies, which have found that older persons use depression care less frequently than younger ones, this study showed no significant differences in obtaining depression care among the elderly.
Like previous studies, this study also found that people who used both psychotherapy or counseling and antidepressant medications were significantly more likely to receive adequate depression care. Some limitations were inherent in the study. For example, identification of persons with depression was based on self-report. It is possible that some patients with depression were not identified as having depression and, similarly, some patients who were identified as having depression did not meet the diagnostic criteria for depression. Also some individuals with bipolar disorder were included in the analysis and the duration of the individual psychotherapy or mental health counseling was not known.
The nature of a study like this unfortunately cannot account for stigma or cultural differences in approaches to mental health care. The researchers conclude that initiating depression treatment may be the primary hurdle in overcoming disparities in depression care. The research suggested that ethnic disparities in depression treatment result primarily from the reduced likelihood of receiving any treatment. While data showed large ethnic differences in the probability of receiving any care, there were few significant differences in the likelihood of receiving an adequate course of depression care among different sociodemographic groups.
Even if there are few differences in the rates at which adequate depression care is provided for those who seek depression treatment, there remains much room for improvement in the overall rate of adequate depression care.
Psychiatr Serv 55:1379-1385, December 2004
10:43:34 PM 
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