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Author List:
Chermack ST (Ann Arbor VA/University of Michigan)
Wryobeck JM (Ann Arbor VA/University of Michigan)
Austin KL (Ann Arbor VA)
Valenstein M (Ann Arbor VA/University of Michigan)
Objectives:
Depression, the most prevalent mental disorder, is often comorbid with other psychiatric and substance abuse disorders and is second only to heart disease in terms of disabling effects. Research has shown that both pharmacotherapy and psychotherapy are similar in clinical and cost effectiveness, and that a combination of these treatments may be the most effective treatment approach. This study examined the extent to which veterans with depression received pharmacological treatment, psychotherapy, or a combination of both, and how the receipt of these services was impacted by mental health comorbidities and treatment setting.
Methods:
Data for 220,449 patients with depression diagnosed during the first quarter of 2002 were abstracted from the National Registry for Depression. Veterans were grouped into four diagnostic categories: 1) Depression alone or with Anxiety Disorder (D-A), 2) Depression with Substance Abuse (D-SA), 3) Depression with Post Traumatic Stress Disorder (D-PTSD), and 4) Depression with both PTSD and SA (D-PTSD-SA). Additional data included demographics, treatment setting (Mental Health, SA, PTSD, and Primary Care clinics), and type of treatment received [medication management (MM), psychotherapy (PT), combined medication management and psychotherapy (MP)].
Results:
Approximately 75% of the patient sample had D-A, 9% had D-SA, 12% had D-PTSD and 4% had D-PTSD-SA. The majority received medication management (MM), but most (> 70%) did not receive psychotherapy (PT) or combined MP treatment. Use of PT was lower in standard mental health settings than in specialty care settings (PTSD, Substance Abuse). According to multivariate analyses, the D-SA patients and those of minority status were less likely to receive MM and more likely to receive group PT. The D-SA, D-PTSD and D-PTSD-SA groups received more PT and MP treatment.
Implications:
The majority of depressed veterans are not receiving PT or MP treatment. PT and MP treatment were more common for more complex patients and in specialty mental health settings. However, most depressed veterans receive care in standard mental health settings where rates of PT were notably low.
Impacts:
It appears that psychotherapeutic and combined interventions for depression are under-utilized, and/or under-resourced within the VA system.
