Association of General Medical and Psychiatric Comorbidities With Receipt of Guideline-Concordant Care for Depression

Abstract

Objective The objective is to describe the effect of medical and psychiatric comorbidities on receipt of guideline-concordant depression care. Methods 2003-6 pharmacy, medical and behavioral claims and enrollment data from OptumHealth were linked for 1,835 adults with a new depression diagnosis or antidepressant fill. Multiple logistic regression was used to estimate the association of comorbidities with receipt of guideline-concordant pharmacotherapy, psychotherapy, and any therapy. Results Respectively 11%, 23% and 33% of study patients received guideline-concordant psychotherapy, pharmacotherapy and any therapy. Having a psychiatric but no medical comorbidity was associated with higher rates of guideline-concordant psychotherapy and overall guideline concordance; the converse was true for having a medical but no psychiatric comorbidity. Associations of comorbidities were with the probability of receiving any therapy, not improved guideline-concordance among patients already receiving therapy. Conclusions Patients with medical comorbidities may not receive psychotherapy referrals, perhaps due to well-established relationships with their primary care providers.

Effect of Treating Mothers’ Depression on Children’s Well-Being

“…Although access to depression treatment has improved, most adults do not receive guideline-concordant care (7,8). The majority of mothers in this and other such trials have had multiple untreated depressive episodes, and their children have had years of exposure to parental depression and its consequences.…”