title: Psychiatric practice variations in the diagnosis and treatment of major depression.
abstract: OBJECTIVE
  Practice variations in the diagnosis, treatment, and outcomes of patients with major depression were examined within six psychiatric practices participating in a national outcomes-management project.
  
  
  METHODS
  Six of 20 psychiatric clinics met selection criteria for this study and provided a database of 5, 106 patients. Patients completed the BASIS-32, the Short-Form-36 Health Survey, and a Beginning Services Survey. Treatment information was also obtained directly from the clinician or through a medical record review.
  
  
  RESULTS
  Although 73.1 to 77 percent of patients screened positive for a depressive disorder, only 18.5 to 36.8 percent were diagnosed with major depression (p<.001). Between 39 and 72 percent of patients received psychotropic medications, a significant difference across sites (p<.001). In addition, the number of psychotherapy sessions was significantly different across sites (p<.001).
  
  
  CONCLUSIONS
  Patient care varies considerably across psychiatric practices, a finding that is particularly relevant for developers of performance indicators and risk-adjustment strategies for mental health.
authors.affiliation: Center for Outcomes Research and Effectiveness, University of Arkansas for Medical Sciences, Little Rock, AR 72204, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Kramer
authors.forename: A S
authors.initials: AS
authors.lastname: Daniels
authors.forename: G L
authors.initials: GL
authors.lastname: Zieman
authors.forename: C
authors.initials: C
authors.lastname: Williams
authors.forename: N A
authors.initials: NA
authors.lastname: Dewan
mesh_terms: D000328:Adult; D002391:Catchment Area, Health; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010818:Practice Patterns, Physicians'; D011570:Psychiatry / Q000639:trends*; D011613:Psychotherapy / Q000379:methods; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States
chemical_list: D011619:Psychotropic Drugs