Adult Depression Remains Undertreated

Depression is widely under treated; findings published in JAMA Internal Medicine estimated that less than one-third of adults with depression receive treatment.

Researchers from Columbia University Medical Center analyzed treatment data for approximately 46,000 adults between 2012 and 2013 to characterize the treatment of adult depression. Some of the variables included: depressive symptoms, serious psychological distress, treatment with antidepressants and psychotherapy, health care professionals providing treatment, and age, gender, race, education, marital status, income, and health insurance.

The researchers noted that although antidepressant use has increased in the country, people are still apprehensive that many adults with depression are still not receiving adequate treatment. In some cases, adults receive treatment that does not match the severity of their disease.

The researchers learned that among the 46,000 adults who were screened, about 8.4% had depression; a quarter of those patients received any depression treatment. Of all the patients treated with depression, nearly a third (29.9%) had screened positive for depression, while 21% had serious psychological distress.

“Greater clinical focus is needed on depression severity to align depression care with each patient's needs,” senior author Mark Olfson, MD, MPH explained in a press release. “These patterns suggest that more needs to be done to ensure that depression care is neither too intensive nor insufficient for each patient. Although screening tools provide only a rough index of depression severity, increasing their use might nevertheless help align depression care with each patient's needs.”

Adults with depression were more likely to receive care from psychiatrists or other mental health specialists if they had serious compared to less serious psychological distress, the researchers also reported. These adults were also more likely to receive psychotherapy, but not antidepressant medications.

“With the increase in antidepressant use over the last several years, it may come as a surprise to learn that widespread challenges persist in accessing depression care,” Olfson added in the statement. “There are also challenges in connecting depressed patients to the appropriate level of care.”

There were also differences in treatment among the patients, which the investigators categorized into groups by age. In adults with serious psychological distress, the statement continued, four times as many younger adults had psychotherapy and antidepressants than older adults. Additionally, two times as many college-educated adults with depression received both psychotherapy and antidepressants than adults with only a high school education.

“Among adults who receive depression care, it is important to align patients with appropriate treatments and health care professionals. With dissemination of integrated care models, opportunities exist to promote depression care that is neither too intensive nor insufficient for each patient’s clinical needs,” the study authors concluded.