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

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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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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: Olfson, Mark
Blanco, Carlos
Marcus, Steven C.
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: bronze
doi.org
Locations: JAMA Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Agency for Healthcare Research and Quality
National Institute on Drug Abuse
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Health Sciences › Medicine › Pharmacology (medical) › 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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