Depressed adults not getting care

Yet many on antidepressants may not need them

More than two-thirds of adults with depression don’t receive any treatment for their condition, researchers reported.
In an analysis of data from the Medicare Expenditure Panel Surveys (MEPS), only about 29% of adults who screened positive for depression were being treated for it in 2012-2013, Mark Olfson, MD, MPH, of Columbia University, and colleagues reported online in JAMA Internal Medicine.

At the same time, patients with less serious psychological distress were more likely than those with serious distress to be prescribed antidepressants — and the clinical reasons for that aren’t clear, the researchers said.
The findings suggest there are “problems aligning depression care with patient needs,” Olfson told MedPage Today, and that there is a greater need for “more careful clinical attention to ensure depressed patients receive care their symptoms require.”
Previous work that had indicated that about half of adults with a lifetime medical history of major depressive disorder had never been treated for depression — but there has been a recent spike in antidepressant prescribing over the past few years in the U.S., and more emphasis has recently been placed on depression screening following a recommendation from the U.S. Preventive Services Task Force, the researchers said.
“With the recent increase in prescribing of antidepressants, some physicians may assume that under treatment of depression is no longer a widespread problem,” Olfson said.
To assess depression treatment trends, Olfson and colleagues analyzed data from 46,417 adults who responded to the Medical Expenditure Panel Surveys in 2012 and 2013.

A total of 8.4% screened positive for depression — but only 28.7% reported receiving any treatment for depression, the researchers reported.
Yet among all respondents who were receiving treatment for depression, only about 30% actually screened positive for depression — and only about 22% had serious psychological distress, they found.
“The clinical reasons for this pattern are unclear, but may include a tendency to overestimate the effectiveness of antidepressants in treating mild depression, insufficient time to provide alternative interventions for mild depression, and errors in clinical assessment,” the researchers wrote. “The reported treatment patterns suggest a need to increase routine assessment of depression severity.”
Those with serious psychological distress who were treated for depression were more likely to receive care from psychiatrists (33.4% versus 17.3%, P<0.001) or other mental health specialists (16.2% versus 9.6%, P<0.001) than those with less serious psychological distress.
They were also less likely to receive depression care exclusively from general practitioners, and more likely to receive psychotherapy (32.5% versus 20.6%, P<0.001) — but less likely to receive antidepressants (81.1% versus 88.6%, P<0.001).

The researchers noted that racial and ethnic minorities had a particularly low likelihood of receiving treatment for depression.
They acknowledged that the study was limited because the surveys were based on recall, and because updates on treatment outcomes weren’t available.
Still, they concluded that critical treatment gaps in depression care exist, and it’s important to deliver the right kind of care to the right patient.
“The results underscore ongoing challenges in aligning depression care with patient needs,” Olfson said. “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.”
Jonathan Becker, DO, of Vanderbilt University Medical Center, who was not involved in the study, said the findings highlight a concern that healthcare professionals and patients have recognized for quite some time — that many people who suffer from depression aren’t receiving the treatment they need.
“[This] is particularly true for minorities and patients with lower incomes, less education, and lack of insurance,” Becker told MedPage Today. “I hope this paper leads to the development of strategies to improve access to treatment for those that need it.”

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