Treatment Initiation for New Episodes of Depression in Primary Care Settings

Abstract

Screening for depression in primary care is a positive step towards improving detection, treatment, and outcomes for depression. However, study results indicate that treatment initiation remains suboptimal, and disparities persist. A better understanding of patient factors, and particularly system-level factors, that influence treatment initiation is needed to inform efforts by heath care systems to improve depression treatment engagement and to reduce disparities.

Depression screening and treatment among uninsured populations in Primary Care

“…While it is possible that patients were referred to specialty care, that was not evident from the medical record. This finding is congruent with a recent analysis of depression treatment initiation patterns among primary care settings across five large, integrated US healthcare systems which reported only 35.70% of new episodes of diagnosed depression initiated antidepressant medication and/or psychotherapy, with all racial and ethnic minority groups having significantly lower odds of starting treatment, and the average delay in initiation of treatment being 6-8 years ( Waitzfelder et al, 2018 ).…”

Quality of Mental Health Care in Integrated Veterans Affairs Patient-Centered Medical Homes: a National Observational Study

“…Nonetheless, we highlight opportunities for mental health care quality improvement in primary care (i.e., less timely clinician follow-up for abnormal depression screening, compared with PTSD, respectively 64% and 79%). Contrary to findings from other large health care systems, 6 we observed no differences in mental health care quality for racial-ethnic minority patients, nor for vulnerable patients (i.e., homeless, serious mental illness), perhaps because the VA is an experienced safety-net provider. Our correlational study, however, does not permit causal inference.…”

Capsule Commentary on Waitzfelder et al., Treatment Initiation for New Episodes of Depression in Primary Care Settings

“…T he study by Waitzfelder and colleagues provides a unique opportunity to examine factors associated with initiation of depression treatment in primary care settings across five large integrated health systems in five states. 1 Leveraging electronic health record data, the findings mostly confirm documented mental health disparities. 2 The odds of engaging in treatment decreased with age and income and for persons of color, who were also more likely than white patients to choose psychotherapy over antidepressant medication.…”