Most people newly diagnosed with depression by their primary care physician do not start treatment, and older people and non-white individuals are even less likely to initiate care, According to a study published in the Journal of General Internal Medicine.
“It’s really encouraging that depression is being recognized in primary care settings,” said Dr. Beth Waitzfelder of Kaiser Permanente Center for Health Research Hawaii in Honolulu, one of the study’s authors.
“I think that physicians and healthcare systems are doing a good job in screening for and detecting depression in primary care,” said Dr. Beth Waitzfelder. “It’s a great place for screening; it’s a challenging place to initiate mental health treatment.”
Previous research has shown that older people and minorities are less likely to start treatment for depression, Dr. Waitzfelder, and her team note.
To investigate whether these disparities persist and factors associated with treatment initiation and choice, they looked at more than 241,000 adults diagnosed with depression in primary care settings in five healthcare systems in 2010-2013.
The overall rate of treatment initiation, defined as a psychotherapy visit or filled the antidepressant prescription within 90 days of diagnosis, was 35.7%.
More than 80% of those who started treatment were taking medication, with the rest starting psychotherapy.
People 60 or older were less than half as likely to start treatment than those 44 or younger.
Compared to non-Hispanic whites, all minority groups were significantly less likely to get treatment, with adjusted odds ratios (aORs) ranging from 0.65 for Asians to 0.83 for Native Americans.
Men were significantly more likely than women to start treatment (aOR, 1.07), although depression is more common among women than men.
“This finding of gender-related differences in treatment initiation is particularly important and positive, given that men account for more than three-quarters of suicides among middle-aged adults,” the authors write.
Social stigma is still a factor in whether or not some patients follow through on treatment, Dr. Waitzfelder noted.
Kaiser Permanente has developed a program, findyourwords.org, to help people feel more comfortable about seeking help for depression.
Dr. Jeanne Miranda, a professor of psychology and biobehavioral science at UCLA in Los Angeles, said the high number of people going untreated is not a new finding.
“We’ve found this for well over 30 years, and we haven’t made a lot of progress,” said Dr. Miranda. Future initiatives need to “think more out of the box,” she added, which could include enlisting the help of churches and other community resources.