Less Than One Third of Depressed Adults Receive Treatment

October 14, 2016

Paradox: a new study finds that despite wide us of antidepressants in the US, many who need treatment do not get it while others are overtreated.

Most American adults who screen positive for depression do not receive treatment, according to a new study.

The findings show that less than one third of American adults who screened positive for depression received treatment for their symptoms, and, conversely, more than two-thirds of those receiving treatment for depression did not report symptoms of depression or serious psychological distress.

In addition, among those who are treated for depression, less than half of those with severe psychological distress are seen by a mental health specialist.

“Greater clinical focus is needed on depression severity to align depression care with each patient’s needs,” said senior author Mark Olfson, MD, MPH, professor of psychiatry at Columbia University Medical Center, psychiatrist at New York-Presbyterian/Columbia. “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.”

Despite the 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,” the researchers state.

They set out to characterize the treatment of adult depression in the United States. They analyzed data from a national survey conducted in 2012 and 2013 of 46,417 adults, focusing on the treatment of depression. They examined depressive symptoms, serious psychological distress, treatment with antidepressants and psychotherapy, health care professionals providing treatment, and other variables including age, gender, race, education, marital status, income, and health insurance.

US antidepressant use is up but "concerns persist that many adults with depression do not receive treatment, whereas others receive treatments that do not match their level of illness severity.”

Approximately 8.4% of respondents screened positive for depression, and 28.7% of them received any depression treatment. Among all adults treated for depression, 29.9% had screened positive for depression and 21.8% had serious psychological distress.

Adults with serious, as compared with less serious, psychological distress who were treated for depression were more likely to receive care from psychiatrists (33.4% vs 17.3%) or other mental health specialists (16.2% vs 9.6%), and less likely to receive depression care exclusively from general medical professionals (59% vs 74.4%). Those with serious distress were also more likely to receive psychotherapy (32.5%) than those with less distress (20.6%), although not antidepressant medications (81.1% vs 88.6%).

Among adults who screened positive for depression, those more likely to receive depression treatment were women, whites, privately insured adults, and college-educated individuals. There were also differences among groups in the treatments received. Among those with serious psychological distress, for example, four times as many younger adults received psychotherapy and antidepressants than older adults, and twice as many college-educated adults received both treatments than adults with a high school education.  

“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 said. “There are also challenges in connecting depressed patients to the appropriate level of care.”

The researchers published their results in October 2016 JAMA Internal Medicine.