Quality Of Depression Treatment Research Articles

Quality of Outpatient Depression Treatment in Patients With Comorbid Substance Use Disorder.

Clinical practice guidelines recommend concurrent treatment of co-occurring depression and substance use disorders; however, the degree to which patients with substance use disorders receive guideline-concordant treatment for depression is unknown. The authors investigated the provision of guideline-concordant depression treatment to patients with and without substance use disorders in a large integrated health care system. In a retrospective cohort study of 53,034 patients diagnosed with a depressive disorder in fiscal year 2017 in the U.S. Veterans Health Administration, the authors assessed the association of comorbid substance use disorders with guideline-concordant depression treatment, including both medication and psychotherapy, while adjusting for patient demographic and clinical characteristics. Guideline-concordant depression treatment was lower across metrics for patients with co-occurring depression and substance use disorders compared to those without substance use disorders. Consistent findings emerged in covariate-adjusted models of antidepressant treatment, such that patients with substance use disorders had 21% lower odds of guideline-concordant acute treatment (adjusted odds ratio=0.79, 95% CI=0.73, 0.84) and 26% lower odds of continuation of treatment (adjusted odds ratio=0.74, 95% CI=0.69, 0.79). With regard to psychotherapy, patients with co-occurring depression and substance use disorders had 13% lower odds (adjusted odds ratio=0.87, 95% CI=0.82, 0.91) of adequate acute-phase treatment and 19% lower odds (adjusted odds ratio=0.81; 95% CI=0.73, 0.89) of psychotherapy continuation. Despite the availability of effective treatments for depression, patients with co-occurring substance use disorders are less likely to receive guideline-concordant depression treatment. Efforts to improve the provision of care to those with co-occurring substance use disorders should focus on clinician-based interventions and use of integrated care models to improve the quality of depression treatment.

Analytical Evaluation of Treating Depression in Animal Models by Quantitative Pharmaco-EEG

The treatment of depressive disorders remains a relevant problem in medical practice. Depression is frequently treated by selective serotonin reuptake inhibitors (SSRIs), among which fluoxetine is one of the most popular drugs. In order to improve the pharmacotherapy of depression, combinations of SSRIs with other pharmaceutical groups, e.g. epiphyseal hormone melatonin, are practiced. The key aim in improving the quality of depression treatment remains the search and development of more powerful and fast-acting antidepressants. In this context, research attention has recently been focused on valdoxan, an agonist of melatonin MT 1 and MT 2 and serotonin 5-HT2c receptors. Quantitative pharmaco-EEG is the most efficient method for evaluating the efficacy of the pharmacotherapy of mental pathologies. In this study, EEG rhythms of rats with experimental depression were analyzed following the administration of the aforementioned drugs. It was found that valdoxan, compared to fluoxetine and its combination with melaxen, contributes to the fastest normalization of the brain’s bioelectric activity in animals. In particular, this drug contributes to a significant increase in the activity of the EEG theta rhythm, which dominates in animals in the norm.

Provider Contributions to Disparities in Mental Health Care.

Disparities in diagnosis of mental health problems and in access to treatment among racial-ethnic groups are apparent across different behavioral conditions, particularly in the quality of treatment for depression. This study aimed to determine how much disparities differ across providers. Bayesian mixed-effects models were used to estimate whether disparities in patient adherence to antidepressant medication (N=331,776) or psychotherapy (N=275,095) were associated with specific providers. Models also tested whether providers who achieved greater adherence to treatment, on average, among non-Hispanic white patients than among patients from racial-ethnic minority groups attained lower disparities and whether the percentage of patients from racial-ethnic minority groups in a provider caseload was associated with disparities. Disparities in adherence to both antidepressant medication and psychotherapy were associated with the provider. Provider performance with non-Hispanic white patients was negatively correlated with provider-specific disparities in adherence to psychotherapy but not to antidepressants. A higher proportion of patients from racial-ethnic minority groups in a provider's caseload was associated with lower adherence among non-Hispanic white patients, lower disparities in adherence to psychotherapy, and greater disparities in adherence to antidepressant medication. Adherence to depression treatment among a provider's patients from racial-ethnic minority groups was related to adherence among that provider's non-Hispanic white patients, but evidence also suggested provider-specific disparities. Efforts among providers to decrease disparities might focus on improving the general skill of providers who treat more patients from racial-ethnic minority groups as well as offering culturally based training to providers with notable disparities.

The association between geographic access to providers and the treatment quality of pediatric depression

ObjectiveTo examine the association of geographic access to providers with racial/ethnic variations in treatment quality among youth with depression. MethodsThe geographic access to providers who initiated the depression treatment was measured using the travel distance estimated based on Google Maps® and the provider density within a 5-mile radius of each patient residence. Depression treatment quality was measured as treatment engagement, defined as having ≥2 prescriptions or psychotherapy with 2-month following a new depression diagnosis, and treatment completion defined as having ≥8 sessions of psychotherapy within 12 weeks or received ≥84 days of continuous treatment with antidepressants within 114 days following the treatment initiation. ResultsThe results of multivariate logistic regression analysis have demonstrated that the travel distance to provider was only negatively associated with the treatment engagement of Hispanics (5.0 - 14.9 vs ≤ 4.9 miles: OR=0.74, 95% CI [0.54–0.88]; ≥15 vs ≤ 4.9 miles: OR=0.82, 95% CI [0.56–0.97]), while a higher mental health specialist density was only positively associated with the treatment engagement of Blacks (1.00–1.99 vs < 1.00: OR=1.63, 95% CI [1.03–4.51]; 2.00–4.99 vs < 1.0: OR=2.28, 95% CI [1.21–7.11]). Among those who have engaged in the treatment, travel distance was associated with a lower likelihood of treatment completion in all racial/ethnic groups. LimitationsThe study did not account for types of transportation used by patients. ConclusionGeographic access barriers had a negative association with treatment quality of pediatric depression. Minority children were more sensitive to the barriers than Whites.

Racial and Ethnic Differences in Minimally Adequate Depression Care Among Medicaid-Enrolled Youth

To examine racial and ethnic disparities in the receipt of minimally adequate depression treatment in Medicaid-enrolled youth. Medicaid claims data of 2008 through 2011 were used to derive a cohort of youth (5-17 years old) who were diagnosed with a new episode of major depression (N= 45,816) across 9 states. Dichotomous outcomes measured the receipt of minimally adequate psychotherapy (≥4 psychotherapy visits within 12 weeks of initiation); minimally adequate medication (filled antidepressants for 84 of 144 days); any minimally adequate treatment (psychotherapy or medication); and no psychotherapy or medication. Racial/ethnic disparities in the outcome measures were estimated using logistic regression models that controlled for predisposing, enabling, and need-related factors. Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. Adjusted percentages of black (42.3%; p< .001) and Hispanic (48.2%; p< .001) youth who received minimally adequate treatment were significantly smaller than for non-Hispanic whites (54.7%) because of lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. In addition, adjusted percentages of black (20.2%; p< .001) and Hispanic (15.0%; p< .01) youth who received no treatment were significantly larger than for non-Hispanic white youth (12.9%). The percentage of Medicaid-enrolled youth who receive minimally adequate treatment for depression is small overall and even smaller for racial/ethnic minorities than for whites. Future research is needed to identify strategies that improve the overall quality of depression treatment in Medicaid-enrolled youth and decrease disparities in care.

Measurement of Perceived and Technical Quality of Care for Depression in Racially and Ethnically Diverse Groups.

Measurement of patient satisfaction is now considered essential for providing patient centered care and is an important tool for addressing health care disparities. However, little is known about how ethnically and racially diverse (ERD) groups differ in how they perceive quality, and widely used instruments for measuring perceived quality give little attention to cultural elements of care. This study examined the relationship between the culturally determined beliefs and expectations of four ERD groups (African Americans, Latinos, Portuguese-speakers, and Haitians, total N=160) and the technical quality of treatment for depression provided in four "culturally-specific" primary care clinics. Using data from the Experiences of Care and Health Outcomes survey, chart reviews and focus groups, the study addressed a set of questions related to the psychometric properties of perceived care measures and the technical quality of care. The groups differed in preferred cultural elements except all preferred inclusion of religion. They did not differ in overall perceived quality. Technical quality was higher for Portuguese and Haitians than for African Americans and Latinos. Implications of group differences for measuring quality are discussed.

Intervention impact on depression product appraisal and purchasing behavior by employers: a randomized trial.

BackgroundEmployers can purchase high quality depression products that provide the type, intensity and duration of depression care management shown to improve work outcomes sufficiently for many employers to achieve a return on investment. The purpose of this randomized controlled trial was to test an intervention to encourage employers to purchase a high quality depression product for their workforce.MethodsTwenty nine organizations recruited senior health benefit professional members representing public or private employers who had not yet purchased a depression product for all 100+ workers in their company. The research team used randomization blocked by company size to assign eligible employers to: (1) a presentation encouraging employers to purchase a high quality depression product accompanied by a scientifically-derived return on investment estimate, or (2) a presentation encouraging employers to work with their most subscribed health plan to improve depression treatment quality indicators. Two hundred ninety three employers (82.3% of 356) completed baseline data immediately before learning that 140 employers had been randomized to the evidence-based (EB) depression product presentation and 153 had been randomized to the usual care (UC) depression treatment quality indicator presentation. Analysis of 250 (85.3% of 293) employers who completed web-based interviews at 12 and/or 24 months was conducted to determine presentation impact on depression product appraisal and purchasing behavior.ResultsThe intervention had no impact on depression product appraisal in 232 subjects (F = 2.36, p = .07) or depression product purchasing (chisquare = 1.82, p = .44) in 250 subjects. Depression product appraisal increased in companies with greater health benefit generosity whose benefit professionals were male. Depression product purchasing behavior increased in small companies compared to large companies, companies who knew a vendor that sold depression products at baseline, companies with greater health benefit risk taking, and companies with less politicalization of health care benefit decision making.ConclusionsPolicy makers need to build innovative bridges to the employer community to convince them to purchase evidence-based benefits, even when benefits offer potential financial savings.Trial registrationClinical Trials Registration Number: NCT01013220.

Improving Depression Care in OB-GYN Settings

Improving Depression Care in OB-GYN Settings

Quality of depression treatment in Black Americans with major depression and comorbid medical illness

ObjectiveThe objective was to evaluate how comorbid type 2 diabetes (T2DM) and hypertension (HT) influence depression treatment and to assess whether these effects operate differently in a nationally representative community-based sample of Black Americans. MethodsData came from the National Survey of American Life (N=3673), and analysis is limited to respondents who met lifetime criteria for major depression (MD) (N=402). Depression care was defined according to American Psychiatric Association (APA) guidelines and included psychotherapy, pharmacotherapy and satisfaction with services. Logistic regression was used to examine the effects of T2DM and HT on quality of depression care. ResultsOnly 19.2% of Black Americans with MD alone, 7.8% with comorbid T2DM and 22.3% with comorbid HT reported APA-guideline-concordant psychotherapy or antidepressant treatment. Compared to respondents with MD alone, respondents with MD+T2DM/HT were no more or less likely to receive depression care. Respondents with MD+HT+T2DM were more likely to report any guideline-concordant care (odds ratio=3.32; 95% confidence interval, 1.07–10.31). ConclusionsAlthough individuals with MD and comorbid T2DM+HT were more likely to receive depression care, guideline-concordant depression care is low among Black Americans, including those with comorbid medical conditions.

Association Between Chronic Illness Complexity and Receipt of Evidence-based Depression Care

The rate of guideline concordance with antidepressant treatment for persons with depression is low. The problem may be even more pronounced for patients with depression and other multiple chronic conditions (MCC). To study, for persons with new depressive episodes, the association between MCC and the likelihood of receiving guideline-concordant depression treatment. Retrospective cohort study using Veterans Affairs administrative data. A total of 43,189 Veterans Affairs patients who had a new depressive episode during 2007 were included. We assessed whether patients had an adequate supply of antidepressants during acute and continuation phases of depression treatment, which indicates guideline-concordant care. We determined the association between comorbid conditions and receipt of adequate antidepressant supplies after adjusting for potential confounders. Compared with patients with depression alone, those with comorbid cardiovascular/cerebrovascular disease, peptic ulcer/gastroesophageal reflux disease (GERD), or arthritis were 8%-13% more likely to receive adequate antidepressant supplies during the acute phase. Patients with depression and substance/alcohol abuse were 15% less likely to receive adequate supplies in the acute treatment phase. Those with cardiovascular/cerebrovascular disease or peptic ulcer/GERD were 9%-10% more likely to receive continuation phase guideline-concordant depression treatment. Patients with comorbid substance/alcohol abuse were 19% less likely to receive continuation phase guideline-concordant depression treatment. Relatively few of the most prevalent MCC clusters were significantly associated with receipt of guideline-concordant depression treatment. There was no consistent association between specific clusters of chronic conditions and adequate antidepressant supplies. There continues to be need for practice-level and system-level interventions to increase quality of depression treatment, particularly among persons with certain comorbid conditions such as cardiovascular/cerebrovascular disease, peptic ulcer/GERD, and arthritis.

What is the association between quality of treatment for depression and patient outcomes? A cohort study of adults consulting in primary care

BackgroundThe association between adequate treatment for a Major Depressive Episode (MDE) and improvements in depressive symptoms is not well established in naturalistic practice conditions. The main objective of this study was to examine the association between receiving at least one minimally adequate treatment for MDE (i.e. according to clinical guidelines) in the previous 12 months and evolution of depressive symptoms at 6- and 12-months. Associations with receiving pharmacotherapy and/or psychotherapy and the role of severity of depression were examined. MethodsThis cohort study included 908 adults meeting criteria for previous-year MDE and consulting at one of 65 primary care clinics in Quebec, Canada. Multilevel analyses were performed. ResultsResults show that (i) receiving at least one minimally adequate treatment for depression was associated with greater improvements in depression symptoms at 6 and at 12 months; (ii) adequate pharmacotherapy and adequate psychotherapy were both associated with greater improvements in depression symptoms, and (iii) the association between adequate treatment and improvement in depression symptoms varied as a function of severity of symptoms at the time of inclusion in the cohort with worse symptoms at the time of inclusion being associated with greater reductions at 6 and 12 months. LimitationsMeasures are self-reported. Participants were recruited at different stages over the course of their MDE. ConclusionsThis study shows that adequate treatment for depression is associated with improvements in depressive symptoms in naturalistic primary care practice conditions, but that those with more severe depressive symptoms are more likely to receive adequate treatment and improve across time.

Collaborative Care for the Treatment of Depression in Primary Care With a Low-Income, Spanish-Speaking Population

This study sought to (1) evaluate the effectiveness of a collaborative care model with a predominantly Hispanic, low-income population in a primary care setting and (2) examine depression outcomes with a subpopulation of preferentially Spanish-speaking patients compared with non-Hispanic white participants. The data were collected from September 2006 through September 2009 at the study site, the People's Community Clinic, Austin, Texas. Data collection was part of an evaluation of the Integrated Behavioral Health program, a collaborative care model of identifying and treating mild-to-moderate mental disorders in adults in a primary care setting. A bilingual care manager provided supportive counseling and patient education and systematically tracked patient progress in a patient registry. A consulting psychiatrist evaluated patients with diagnostic or treatment concerns. The study retrospectively examined changes in depression scores among 269 subjects as measured by the Patient Health Questionnaire (PHQ-9), the primary outcome measure. The PHQ-9 is a self-report of frequency of symptoms for each of the 9 DSM-IV criteria for depression. Logistic regression models compared race/ethnicity and language group combinations on their odds of achieving clinically meaningful depression improvement when background characteristics were controlled for. Spanish-speaking Hispanic patients had significantly greater odds of achieving a clinically meaningful improvement in depression at 3-month follow-up (odds ratio [OR] = 2.45, P = .013) compared to non-Hispanic whites. The finding for greater improvement in the Spanish-speaking population remained after controlling for age, sex, medical comorbidities, prior treatment, and baseline depression scores. The results suggest a model of care that is effective for a population at great risk for marginal mental health care, non-English-speaking Hispanics. Attention to patient preferences in primary care is essential to improve quality of depression treatment and may improve outcomes. In light of previous research that demonstrates insufficient evidence-based guidelines for patients with limited English proficiency and evidence that evaluation of patients in their nonprimary language or through an interpreter can lead to inaccurate mental health assessments, this study suggests an opportunity to improve the quality of mental health care for non-English-speaking Hispanics in the United States.

Are patient characteristics associated with quality of depression care and outcomes in collaborative care programs for depression?

Objective To determine whether demographic or clinical characteristics of primary care patients are associated with depression treatment quality and outcomes within a collaborative care model. Methods Collaborative depression care, based on principles from the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial, was implemented in six community health organizations serving disadvantaged patients. Over 3 years, 2821 patients were treated. Outcomes were receipt of quality treatment and depression improvement. Results Logistic regression analyses revealed that patients who were older, more depressed or more anxious were more likely to be retained in treatment and to receive appropriate pharmacotherapy. Whereas gender and depression severity were unrelated to depression outcomes, significantly more patients who preferred Spanish (59.1%) than English (48.5%, P<.01) improved within 12 weeks in multivariate analyses. High baseline anxiety was associated with a lower probability of improvement, and older age showed a similar trend. Survival analyses demonstrated that patients who preferred Spanish or were less anxious improved significantly more rapidly than their counterparts ( P<.001). Conclusions Patients with more anxiety received higher quality care but experienced worse depression outcomes than less anxious patients. Spanish language preference was strongly associated with depression improvement. This collaborative care program attained admirable outcomes among disadvantaged Spanish-speaking patients without extensive cultural tailoring of care.

Quality Indicators for Depression Treatment in Primary Care: A Systematic Literature Review

Introduction: Depression is a mental disorder that is common and chronic, especially if it is initially undertreated. It is now widely recognized that primary care providers have an important role to play in the detection and treatment of depression. However, ensuring quality depression care remains a challenge. Quality indicators for the treatment of depression can help monitor the treatment received by people suffering from depression in primary care and guide improvements needed in that sector. Objectives: To systematically review indicators used to measure the quality of depression treatment in primary care and explore factors leading to divergent results. Method: The literature on the quality of depression treatment was reviewed using “360search”, a federated search engine for searching across multiple databases from a single interface. Databases searched included Pubmed, Embase and PsycINFO and keywords were depression, depressive disorder, quality, treatment, indicator, adequacy, adherence, concordance, clinical guideline and guideline. Additional articles were also identified through a manual search of the reference section of retrieved articles. Results: Though mostly based on recommendations from clinical practice guidelines, a great variety of indicators were observed. Most studies used rudimentary indicators to measure the quality of depression treatment, especially for psychotherapy. Studies also differed greatly with respect to the methods used, thus limiting the comparability of results. However, whatever the chosen method, most studies reveal that a large proportion of people with depression do not receive minimally adequate treatment in primary care settings. Conclusion: The implications of these findings and future research directions are discussed. Keywords: Adequacy of treatment, Depression, Clinical guideline, Primary care, Quality Indicator, Quality of care, psychotherapy, concordance, appropriate guideline adherence, conformance with evidence-based recommendations, treatment completion, drug dosage, antidepressants, cognitive-behavioral therapy, DSM

Quality of Mental Health Care at a Student-Run Clinic: Care for the Uninsured Exceeds that of Publicly and Privately Insured Populations

Diagnosing and treating depression in a primary care practice is an important, yet difficult task, especially for safety-net practices serving the uninsured. In the United States healthcare system, there is a mismatch between the need for mental health care and access to services. This disparity is most striking among the uninsured. Mental health disorders are more prevalent among the uninsured, and even when diagnosed with mental illness, they are less likely to obtain necessary treatment than insured patients. Given the increasing burden of depression on society, growing numbers of uninsured and negative repercussions of untreated mental illness, improvements in screening and management protocols are becoming more important in primary care practices serving this population. The quality of depression treatment at commercial and public insurance plans in New York City (NYC) and New York State (NYS) were compared to that of the East Harlem Health Outreach Partnership (EHHOP), the student-run clinic of the Mount Sinai School of Medicine. Based on the comparison, the study made recommendations for an integrated, on-site mental health service program at the community health clinic. A cohort of 49 depressed patients were evaluated and treated at the EHHOP clinic. The quality of the mental health care was evaluated according to variables from the Healthcare Effectiveness Data and Information Set (HEDIS). Indicators of quality included demographics, method of diagnosis, type of pharmacological treatment, referral to specialty care, patient adherence to follow-up care and adherence to pharmacologic treatment. When compared to insured patients in NYS, more EHHOP patients had the appropriate number of physician contacts after being diagnosed with depression than patients with commercial health plans (P=0.008) and Medicaid (P=0.09). Similarly, a greater number of EHHOP patients had better acute phase (P=0.001; P=0.096) and continuous phase (P=0.049; P=0.88) pharmacologic treatment than patients with commercial health plans and Medicaid, respectively. EHHOP meets and, in some areas, exceeds the quality of depression treatment when compared to insured populations. Even though EHHOP already surpasses these indicators, the clinic can improve its diagnostic capabilities, prescription medication adherence, and referral care follow-through by creating an on-site mental health clinic.

Disparities in Depression Care: Implications for Population-Based Surveys

Back to table of contents Previous article Next article LetterFull AccessLetterBrason Lee M.S.W., M.S.Brason Lee M.S.W., M.S.Search for more papers by this authorPublished Online:13 Jan 2015https://doi.org/10.1176/ps.2009.60.2.268AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Disparities in Depression Care: Implications for Population-Based SurveysTo the Editor: I applaud the work of Alegría and colleagues described in their article, "Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States," in the November 2008 issue ( 1 ). In examining whether individuals who could benefit from depression treatment received no treatment or inadequate treatment, these investigators touched on an important policy issue that warrants further discussion. Namely, given the lack of population-based studies that take an expanded look at issues related to depression, what are some of the lessons that health professionals in the policy and research arena can learn from their findings? In terms of population health, one lesson is that we may need to broaden the focus from using a single indicator to using multiple indicators to improve the detection of the need for mental health care and the assessment of the quality of mental health care. The Behavioral Risk Factor Surveillance System (BRFSS), conducted by the Centers for Disease Control and Prevention, is arguably the largest annual telephone health survey in the world. The BRFSS contains one general item related to the number of days in which the respondents rated their mental health as not good. In addition, eight items related to the severity of depressive symptoms are included in a list of optional questions, which means that states can elect not to include these items in their surveys. Although the eight optional questions measure some of the aspects of global functioning that are addressed in most depression scales, none of the BRFSS questions specifically ask for information related to the number of days in which respondents felt totally unable to carry out daily activities. In the study by Alegría and colleagues this variable was associated with the strongest likelihood of receipt of depression treatment and of receipt of adequate depression treatment. The strength of this association was second only to that of insurance type. In addition, none of the BRFSS questions attempt to look at the frequency or quality of depression treatment. Our awareness of mental health care disparities is not new. The continued call by the Healthy People 2010 initiative to reduce racial and ethnic disparities in mental health care requires us to seriously reevaluate how we approach the identification of mental health care need in a racially and ethnically diverse society and how we measure the quality of that care as a way to engage and retain people in treatment. In a society that is increasingly more diverse, health policy makers and researchers must recognize the need to be sensitive and flexible in the use of language that is understandable to patients ( 2 ) and that recognizes how the expression of depression and depressive symptoms may be culturally shaped ( 3 ). Mr. Lee is an independent researcher who is also affiliated with the California Department of Public Health, Sacramento. The views expressed are those of the author and may not necessarily represent the policies of the California Department of Public Health.

Myelinolyse centropontine

We examined whether the treatment and follow-up care for depression in routine primary care differs between adults with higher chronic physical comorbidity burden compared to adults with lower chronic physical comorbidity burden and explored factors leading to divergent results across studies.We conducted a systematic review of English and French articles using Medline, Embase, PsycINFO, CINAHL and Cochrane Controlled Trials Register from inception to July 2013. Reference list and reverse citation searches were also conducted. Search terms included depression, primary care, general practitioner, chronic disease and comorbidity. Study eligibility required inclusion of relevant quality indicators and data contrasting participants with higher and lower chronic physical comorbidity burden. Study selection and quality appraisal were carried out independently by two review authors. A narrative synthesis of results was performed.Our search yielded 5817 unique citations and 46 studies met inclusion criteria. Studies provided data on quality of pharmacotherapy (n = 28), psychotherapy (n = 4), combined measures of treatment quality (n = 14), and follow-up care (n = 9). Across studies, evidence that higher chronic physical comorbidity burden was associated with lower depression treatment or follow-up care quality was reported in 13 studies whereas evidence for the opposite relationship was reported in 15 studies. Four studies reported mixed results and 14 studies observed no relationships between comorbidity burden and depression treatment or follow-up care quality.Review findings suggest that chronic physical comorbidity does not consistently lead to lower quality of depression treatment or follow-up care in primary care.

Datapoints: Receipt of Psychotherapy by Adolescents Taking Antidepressants

Back to table of contents Previous article Next article ColumnFull AccessDatapoints: Receipt of Psychotherapy by Adolescents Taking AntidepressantsTami L. Mark Ph.D., M.B.A.Tami L. Mark Ph.D., M.B.A.Search for more papers by this authorPublished Online:1 Sep 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Two recent major randomized clinical trials of adolescent depression treatment, the Treatment for Adolescents with Depression Study ( 1 ) and the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Randomized Controlled Trial ( 2 ), have found enhanced efficacy and safety from combining cognitive-behavioral therapy with antidepressant therapy. This column presents data on the percentage of children with Medicaid or private insurance taking antidepressants with and without psychotherapy. Low rates of psychotherapy receipt may signal opportunities for improving the quality of depression treatment for adolescents.The data are from the 2004–2006 MarketScan Commercial Claims and Encounters and Medicaid Databases. The commercial database captures claims from four million to 22 million individuals annually. The Medicaid database includes over eight million individuals per year from seven geographically dispersed states.The study included children ages 13 to 17 who filled a new prescription for an antidepressant medication and who were continuously enrolled over the study period. A new prescription was defined as a prescription fill with no antidepressant prescription fills in the prior three months. The percentage of children receiving any psychotherapy in the six months after the index prescription was calculated by using CPT codes for psychotherapy (90804–90824, 90826–90829, 90843–90849, 90853, 90855, 90857, M0064, H004, and H1011). As shown in Table 1 , the data reveal that 28.2% of adolescents with Medicaid coverage and 33.6% of adolescents with private insurance who filled a new antidepressant prescription received psychotherapy within six months of the fill. Even among adolescents who filled three or more antidepressant prescriptions, less than one-third with Medicaid and less than one-half with private insurance received psychotherapy. Table 1 Receipt of psychotherapy within six months of antidepressant initiation among adolescents ages 13 to 17, from 2004 to 2006Table 1 Receipt of psychotherapy within six months of antidepressant initiation among adolescents ages 13 to 17, from 2004 to 2006Enlarge tableThe study limitations include the fact that psychotherapy paid for completely out of pocket and not submitted for insurance reimbursement was not captured. Additionally, the data do not indicate use of particular types of antidepressants or psychotherapy.Clearly, there is a need for more guidance regarding when psychotherapy should be provided with antidepressant treatment and the potential benefits from increasing the relatively low rates of receipt in real-world settings.Acknowledgments and disclosuresThe author thanks Laurie Costa, M.P.H., for programming support and Mark Olfson, M.D., for providing helpful comments.The author reports no competing interests.Dr. Mark is the director of analytic strategies at Thomson Reuters, 4301 Connecticut Ave., N.W., Suite 330, Washington, D.C. 20008 (e-mail: [email protected] reuters.com). Amy M. Kilbourne, Ph.D., and Dr. Mark are editors of this column.

Datapoints: Receipt of Psychotherapy by Adolescents Taking Antidepressants

Back to table of contents Previous article Next article ColumnFull AccessDatapoints: Receipt of Psychotherapy by Adolescents Taking AntidepressantsTami L. Mark Ph.D., M.B.A.Tami L. Mark Ph.D., M.B.A.Search for more papers by this authorPublished Online:1 Sep 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Two recent major randomized clinical trials of adolescent depression treatment, the Treatment for Adolescents with Depression Study ( 1 ) and the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) Randomized Controlled Trial ( 2 ), have found enhanced efficacy and safety from combining cognitive-behavioral therapy with antidepressant therapy. This column presents data on the percentage of children with Medicaid or private insurance taking antidepressants with and without psychotherapy. Low rates of psychotherapy receipt may signal opportunities for improving the quality of depression treatment for adolescents.The data are from the 2004–2006 MarketScan Commercial Claims and Encounters and Medicaid Databases. The commercial database captures claims from four million to 22 million individuals annually. The Medicaid database includes over eight million individuals per year from seven geographically dispersed states.The study included children ages 13 to 17 who filled a new prescription for an antidepressant medication and who were continuously enrolled over the study period. A new prescription was defined as a prescription fill with no antidepressant prescription fills in the prior three months. The percentage of children receiving any psychotherapy in the six months after the index prescription was calculated by using CPT codes for psychotherapy (90804–90824, 90826–90829, 90843–90849, 90853, 90855, 90857, M0064, H004, and H1011). As shown in Table 1 , the data reveal that 28.2% of adolescents with Medicaid coverage and 33.6% of adolescents with private insurance who filled a new antidepressant prescription received psychotherapy within six months of the fill. Even among adolescents who filled three or more antidepressant prescriptions, less than one-third with Medicaid and less than one-half with private insurance received psychotherapy. Table 1 Receipt of psychotherapy within six months of antidepressant initiation among adolescents ages 13 to 17, from 2004 to 2006Table 1 Receipt of psychotherapy within six months of antidepressant initiation among adolescents ages 13 to 17, from 2004 to 2006Enlarge tableThe study limitations include the fact that psychotherapy paid for completely out of pocket and not submitted for insurance reimbursement was not captured. Additionally, the data do not indicate use of particular types of antidepressants or psychotherapy.Clearly, there is a need for more guidance regarding when psychotherapy should be provided with antidepressant treatment and the potential benefits from increasing the relatively low rates of receipt in real-world settings.Acknowledgments and disclosuresThe author thanks Laurie Costa, M.P.H., for programming support and Mark Olfson, M.D., for providing helpful comments.The author reports no competing interests.Dr. Mark is the director of analytic strategies at Thomson Reuters, 4301 Connecticut Ave., N.W., Suite 330, Washington, D.C. 20008 (e-mail: [email protected] reuters.com). Amy M. Kilbourne, Ph.D., and Dr. Mark are editors of this column.

The prevalence and correlates of workplace depression in the national comorbidity survey replication.

To review evidence on the workplace prevalence and correlates of major depressive episodes, with a particular focus on the National Comorbidity Survey Replication, the most recent national survey to focus on these issues. Nationally representative survey of Diagnostic and Statistical Manual, 4th Revision Mental Disorders. A total of 6.4% of employed National Comorbidity Survey Replication respondents had 12-month major depressive disorder. An additional 1.1% had major depressive episodes due to bipolar disorder or mania-hypomania. Only about half of depressed workers received treatment. Fewer than half of treated workers received care consistent with published treatment guidelines. Depression disease management programs can have a positive return-on-investment from the employer perspective, but only when they are based on best practices. Given the generally low depression treatment quality documented here, treatment quality guarantees are needed before expanding workplace depression screening, outreach, and treatment programs.