Treatment Initiation for New Episodes of Depression in Primary Care Settings
Open accessAbstract
Background Depression is prevalent and costly, but despite effective treatments, is often untreated. Recent efforts to improve depression care have focused on primary care settings. Disparities in treatment initiation for depression have been reported, with fewer minority and older individuals starting treatment.Objective To describe patient characteristics associated with depression treatment initiation and treatment choice (antidepressant medications or psychotherapy) among patients newly diagnosed with depression in primary care settings.Design A retrospective observational design was used to analyze electronic health record data.Patients A total of 241,251 adults newly diagnosed with depression in primary care settings among five health care systems from 2010 to 2013.Main measures ICD-9 codes for depression, following a 365-day period with no depression diagnosis or treatment, were used to identify new depression episodes. Treatment initiation was defined as a completed psychotherapy visit or a filled prescription for antidepressant medication within 90 days of diagnosis. Depression severity was measured with Patient Health Questionnaire (PHQ-9) scores on the day of diagnosis.Key results Overall, 35.7% of patients with newly diagnosed depression initiated treatment. The odds of treatment initiation among Asians, non-Hispanic blacks, and Hispanics were at least 30% lower than among non-Hispanic whites, controlling for all other variables. The odds of patients aged ≥ 60 years starting treatment were half those of patients age 44 years and under. Treatment initiation increased with depression severity, but was only 53% among patients with a PHQ-9 score of ≥ 10. Among minority patients, psychotherapy was initiated significantly more often than medication.Conclusions Screening for depression in primary care is a positive step towards improving detection, treatment, and outcomes for depression. However, study results indicate that treatment initiation remains suboptimal, and disparities persist. A better understanding of patient factors, and particularly system-level factors, that influence treatment initiation is needed to inform efforts by heath care systems to improve depression treatment engagement and to reduce disparities.
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In a study involving more than 50,000 individuals across 21 countries, the vast majority of those affected by depression did not seek treatment due to stigma or lack of knowledge of the disorder.
“In a study involving more than 50 000 individuals across 21 countries, the vast majority of those affected by depression did not seek treatment due to stigma or lack of knowledge of the disorder.20”
From Digital health technologies and major depressive disorder (2023) · cites this paper as [20]
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- Authors
- Waitzfelder, B., Stewart, C., Coleman, K. J., Rossom, R., Ahmedani, B. K., Beck, A., Zeber, J. E., Daida, Y. G., Trinacty, C., Hubley, S., & Simon, G. E.
- Affiliations
- Kaiser Permanente Center for Health Research (US)
- Kaiser Permanente Washington Health Research Institute (US)
- Kaiser Permanente (US)
- HealthPartners (US)
- Henry Ford Health (US)
- Baylor Scott & White Medical Center - Temple (US)
- Corresponding author
- Waitzfelder, Beth
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2018-02-08
- Volume
- 33
- Issue
- 8
- Pages
- 1283-1291
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC6082193
- OpenAlex
- W2787219475
- Cited by
- 73
- References
- 63
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 9 · 2023: 10 · 2022: 9 · 2021: 15 · 2020: 11 · 2019: 5 · 2018: 2 · 2017: 1
- FWCI
- 11.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kaiser Permanente
- National Institute of Mental Health (U19MH092201)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, treatment initiation, primary care, antidepressants, psychotherapy, racial and ethnic disparities, older adults, depression severity, PHQ-9, newly diagnosed depression, health care disparities
- MeSH terms
- Adolescent, Adult, Aged, Antidepressive Agents, Depression, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Primary Health Care, Psychotherapy, Retrospective Studies, Delivery of Health Care, Integrated, Young Adult
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