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Treatment of Adult Depression in the United States
Open accessAbstract
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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“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 DSM-5 Major Depressive Disorder and Its Specifiers in the United States (2018) · cites this paper as [79]
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“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]
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“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]
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“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]
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“The likelihood of treatment for depression is reduced in those with SUDs.79”
From Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States (2018) · cites this paper as [79]
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“However, there are several previous studies using the MEPS and their results are comparable with results generated from other sources (42–44).”
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Metadata
- 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
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2016-10-01
- Volume
- 176
- Issue
- 10
- Pages
- 1482
- ISSN
- 2168-6106 (ISSN-L)
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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