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Cited by 352Mental Health Treatment and AccessTreatment of Major DepressionPsychological Treatments and Disorders

Treatment of Adult Depression in the United States

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Olfson, Mark, Blanco, Carlos, Marcus, Steven C.·2016·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2016.5057
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Abstract

IMPORTANCE: Despite recent increased use of antidepressants in the United States, concerns persist that many adults with depression do not receive treatment, whereas others receive treatments that do not match their level of illness severity. OBJECTIVE: To characterize the treatment of adult depression in the United States. DESIGN, SETTING, AND PARTICIPANTS: Analysis of screen-positive depression, psychological distress, and depression treatment data from 46 417 responses to the Medical Expenditure Panel Surveys taken in US households by participants aged 18 years or older in 2012 and 2013. MAIN OUTCOME AND MEASURES: Percentages of adults with screen-positive depression (Patient Health Questionnaire-2 score of ≥ 3) and adjusted odds ratios (AORs) of the effects of sociodemographic characteristics on odds of screen-positive depression; percentages with treatment for screen-positive depression and AORs; percentages with any treatment of depression and AORs stratified by presence of serious psychological distress (Kessler 6 scale score of ≥13); and percentages with depression treatment by health care professional group (psychiatrists, other health care professionals, and general medical providers); and type of depression treatment (antidepressants, psychotherapy, and both) all stratified by distress level. RESULTS: Approximately 8.4% (95% CI, 7.9-8.8) of adults screened positive for depression, of which 28.7% received any depression treatment. Conversely, among all adults treated for depression, 29.9% had screen-positive depression and 21.8% had serious psychological distress. Adults with serious compared with less serious psychological distress who were treated for depression were more likely to receive care from psychiatrists (33.4% vs 17.3%, P < .001) or other mental health specialists (16.2% vs 9.6%, P < .001), and less likely to receive depression care exclusively from general medical professionals (59.0% vs 74.4%, P < .001). They were also more likely to receive psychotherapy (32.5% vs 20.6%, P < .001), though not antidepressant medications (81.1% vs 88.6%, P < .001). CONCLUSIONS AND RELEVANCE: Most US adults who screen positive for depression did not receive treatment for depression, whereas most who were treated did not screen positive. In light of these findings, it is important to strengthen efforts to align depression care with each patient's clinical needs.

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Crossref · 10.1001/jamainternmed.2016.5057

Cites

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  • The NESARC-III treatment rates are plausible given the extent of direct-to-consumer advertising of antidepressants and widespread distribution through primary care.

    “The NESARC-III treatment rates are plausible given the extent of direct-toconsumer advertising of antidepressants 83 and widespread distribution through primary care.79”

    From Epidemiology of Adult <i>DSM-5</i> Major Depressive Disorder and Its Specifiers in the United States (2018) · cites this paper as [79]

  • Approximately 90% of suicides have a current diagnosable psychiatric disorder, most commonly major depression untreated at time of death.

    “Approximately 90% of suicides have a current diagnosable psychiatric disorder, most commonly a major depression that was untreated at time of death.(111, 143, 144)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [111]

    The Abstract and Discussion report depression screening and treatment among US adults, not psychiatric diagnoses among people who died by suicide. Searches for the 90% figure, suicide, and untreated major depression at death found no passage addressing the claim. (LLM, conf=0.78)

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  • The greatest risk of suicidal behavior is after discharge from the emergency room or hospital inpatient units.

    “The greatest risk of suicidal behavior is after discharge from the emergency room (ER) or hospital inpatient units.(110–112)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [111]

    The Treatment Modalities and Discussion passages address depression treatment and psychological distress, not suicidal behavior after discharge. Searches for suicide, emergency-room discharge, and inpatient discharge found no passage in our copy addressing when suicidal-behavior risk is greatest; page numbers were unavailable. (LLM, conf=0.76)

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  • The greatest risk for repeating a suicide attempt is in the month following an index attempt, particularly after discharge of a psychiatric patient from an emergency department or inpatient hospital unit.

    “The greatest risk for repeating a suicide attempt is in the month following an index attempt, and particularly after discharge of a psychiatric patient from an emergency department or inpatient hospital unit.(110–112)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [111]

    The Treatment Modalities and Discussion passages address depression care and psychological distress, not repeat suicide attempts. Searches for risk in the month after an index attempt and for risk after emergency-department or inpatient discharge found no passage addressing either point in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • The likelihood of treatment for depression is reduced in those with substance use disorders.

    “The likelihood of treatment for depression is reduced in those with SUDs.79”

    From Epidemiology of Adult <i>DSM-5</i> Major Depressive Disorder and Its Specifiers in the United States (2018) · cites this paper as [79]

    The Statistical Analyses section examines depression treatment by sociodemographic characteristics and psychological distress, not substance use disorder. The Discussion identifies low treatment likelihood among racial and ethnic minorities but does not address whether substance use disorders reduce the likelihood of depression treatment. Searches for substance use disorders, SUDs, and alcohol or drug dependence found no passage establishing the claimed association. (LLM, conf=0.74)

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Cites

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Research works printed but not linked: 1

  1. [35]35. Arean PA, Hegel MT, Reynolds CF. Treatment depression in older medical patients with psychotherapy. J Clin Geropsychol. 2001;7:93-104.

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Authors
Olfson, M., Blanco, C., & Marcus, S. C.
Affiliations
  • New York State Psychiatric Institute (US)
  • National Institute on Drug Abuse (US)
  • University of Pennsylvania (US)
Corresponding author
Olfson, Mark
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2016-10-01
Volume
176
Issue
10
Pages
1482
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2016.5057
OpenAlex
W2516765934
Cited by
352
References
51
Citations by year
2026: 21 · 2025: 34 · 2024: 21 · 2023: 40 · 2022: 27 · 2021: 48 · 2020: 48 · 2019: 35 · 2018: 40 · 2017: 36
FWCI
58.18
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Agency for Healthcare Research and Quality
  • National Institute on Drug Abuse
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
Keywords
adult depression, depression treatment, antidepressants, psychotherapy, serious psychological distress, underdiagnosis of depression, access to mental health care, psychiatrists, sociodemographic disparities, United States adults, Medical Expenditure Panel Survey, Patient Health Questionnaire, Kessler 6 scale, mental health service utilization
MeSH terms
Adolescent, Adult, Aged, Antidepressive Agents, Depression, Drug Utilization, Educational Status, Female, Humans, Male, Mass Screening, Middle Aged, Psychiatry, Psychotherapy, Stress, Psychological, Antipsychotic Agents, Anti-Anxiety Agents, United States, Medically Uninsured, Marital Status, Insurance Coverage, Health Care Surveys, Young Adult, General Practitioners

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