Background: Depression costs the United States $40 billion annually. Primary care physicians play a key role in the identification and treatment of depression. This study focused on the treatment options recommended by physicians and whether physicians were following the recommended treatment guidelines.Methods: We recorded treatment recommendations by examining charts for all patients with newly detected depression. The patients were from 44 family medicine practitioners and 23 general internal medicine practitioners in a Midwest university medical center setting.Results: For both medical specialties combined, pharmacotherapy was the most widely used intervention (recommended for 52% of patients), whereas psychotherapy alone was the least frequently used intervention (recommended for 4% of patients). Family medicine practitioners recommended combination treatment (pharmacotherapy and psychotherapy) more frequently than did general internal medicine practitioners (P ‫؍‬ .022), and female physicians recommended combination treatment more frequently than did male physicians (P ‫؍‬ .010).Conclusions: Pharmacotherapy was found to be the most widely used treatment despite current evidence-based recommendations. Barriers to effective treatment plan are discussed. The implications for mental health interventions, combination therapy, and cost offset are also discussed.

Due to a shortage of mental health professionals (MHPs) in rural areas, primary care physicians (PCP) are often the first, and in many cases, the only providers of depression treatment for rural individuals. This study was an investigation of the acceptability of behavioral telehealth to PCPs and patients with depression as a way of making mental health treatments more accessible to rural patients. The researchers conducted 10 focus groups across rural Nebraska with PCPs and patients they had treated for depression. A qualitative multiple-case study approach was used to analyze the transcriptions. The participants felt that behavioral telehealth is a reasonable solution to the access-to-care problem. They expressed concern that professional and therapeutic relationships would be difficult to maintain at a distance and they provided suggestions for how to preserve these relationships when using technology to deliver treatment such as focusing on fostering collaborative relationships between MHPs and PCPs. It is essential for MHPs and PCPs to develop and maintain a collaborative working relationship that will facilitate frequent communication.

In a study of 142 couples, we gathered survey data to show how sexual communication influences sexual and relationship satisfaction as well as sexual and orgasm frequency. In two dyadic data path analyses, we observed the significant paths of influence that sexual communication has on sexual and relationship satisfaction, as well as sexual and orgasm frequency. Our findings revealed greater amounts of sexual communication were associated with increased orgasm frequency in women and greater relationship and sexual satisfaction in both sexes. We also observed important differences in the associations of sexual communication and general communication on satisfaction levels. With these analyses, we expand the current literature to broaden our understanding of the role that sexual communication plays in committed relationships.

Few studies have examined the theoretical underpinning of contextual theory. Using structural equation modeling, the relationship among relational ethics (recognized as the most important aspect of contextual theory), marital satisfaction, depression, and illness was examined. Data came from a national sample of 632 mid-life, married individuals. Results supported Nagy's contextual theory. The total score of the Relational Ethics Scale was a significant predictor of marital satisfaction, and marital satisfaction was significantly associated with depression and health problems. Vertical and horizontal subscales of relational ethics also were significant predictors of depression and health problems through the mediating variable of marital satisfaction.

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