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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

3102 — The Prevalence and Predictors of Acute Phase Depression Treatment in a National Sample of Veterans: Medications, Psychotherapy and Combined Treatment

Chermack ST (SMITREC, VA Ann Arbor), Zivin K (SMITREC, VA Ann Arbor), Valenstein M (SMITREC, VA Ann Arbor), Ilgen M (SMITREC, VA Ann Arbor), Austin K (SMITREC, VA Ann Arbor), Wryobeck J (University of Toledo), Blow F (SMITREC, VA Ann Arbor)

Few studies of acute depression care have examined the provision of psychotherapy or combined treatment in addition to medication management. This study examined acute phase treatment of depression in the VA healthcare system, including measures of Medication treatment (MT), Psychotherapy (PT), and Combined Treatment (CT – MT plus PT). Both low threshold care as well as adequate care based on clinical guidelines were examined. Analyses examined the relationship between demographics and psychiatric comorbidities [substance use disorders (SUD), PTSD, both SUD and PTSD] on measures of care (low threshold and adequate MT, PT and CT).

The sample included 41,412 patients with new depression diagnoses. Low threshold MT, PT and CT were based on whether veterans received any acute phase antidepressant medications (MT), any outpatient mental health visits (PT), or both (CT). Adequate MT involved sufficient antidepressant medication coverage, adequate PT involved > = 10 outpatient mental health visits, and adequate CT involved having both adequate MT and PT.

The majority (70%) received at least low threshold treatment, with 26% receiving MT, 18% PT and 26% CT. Rates of adequate care were substantially lower: 30% adequate MT, 3% adequate PT and 1.7% adequate CT. Overall, those with comorbidities were more likely to receive MT, PT, and CT, older veterans were less likely to receive each type of care, and African Americans were less likely to receive MT but more likely to receive PT and CT than whites. Supplemental analyses conducted with less stringent adequate PT requirements (“ > = 6” or “ > = 8” mental health visits) yielded only modest increases in the percent of veterans receiving adequate PT and CT.

The majority of veterans receive some acute phase depression treatment, but only a minority appear to receive adequate or guideline concordant care (particularly PT and CT). The VA performs as well or better than other healthcare systems in providing acute phase MT to depressed patients, although PT and CT appear to be suboptimal.

Improving access to and receipt of PT and CT for depression could improve overall quality of care and quality of life for veterans with depression.

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