Depression management in medical clinics: does healthcare sector make a difference?

Frayne SM, Freund KM, Skinner KM, Ash AS, Moskowitz MA. Depression management in medical clinics: does healthcare sector make a difference? American journal of medical quality : the official journal of the American College of Medical Quality. 2004 Jan 1; 19(1):28-36.

Related HSR&D Project(s)

• GEN 97-023 – Decision Making for Depression in Women Veterans: Patient and Physician Factors

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Abstract:

Medical providers often fail to treat depression. We examined whether treatment is more aggressive in a setting with accessible mental health resources, the Veterans Health Administration (VA). VA and non-VA primary care physicians and medical specialists viewed a videotape vignette portraying a patient meeting criteria for major depression and then answered interviewer-administered questions about management. We found that 24% of VA versus 15% of non-VA physicians would initiate guideline-recommended treatment (antidepressants or mental health referral, or both) (P = .09). Among those who identified depression as likely, 42% of VA versus 19% of non-VA physicians would treat (P = .002): 23% versus 3% recommended mental health referral (P < .001) and 21% versus 17% an antidepressant (P = .67). Although many patients with major depression may not receive guideline-recommended management, VA physicians do initiate mental health referral more often than do non-VA physicians. Access to mental health services may prove valuable in the campaign to increase physician adherence to depression clinical guidelines.