title: General medical and specialty mental health service use for major depression.
abstract: OBJECTIVE
  While major depression is common, many depressed persons receive, at best, inadequate treatment. A first step in remedying inadequate detection and treatment of major depression requires understanding the pathways into treatment-from situations of no care, to disease recognition, to referral and appropriate treatment-as well as identifying factors associated with movement between these several stages.
  
  
  METHODS
  Using the Epidemiologic Catchment Area sample, we identified factors associated with treatment in the general medical or mental health specialist section, or no treatment in a subsample of individuals with current major depression.
  
  
  RESULTS
  Strikingly, one-fourth of the sample received no services, over half received care in the general medical sector, and only one-fifth accessed a mental health specialist. Among those receiving any health services (general or mental), men and respondents reporting suicidal symptoms were at risk of receiving no care, while perceived poor health and a cluster of core depressive symptoms were associated with increased odds of service use (general or mental). Among respondents receiving general medical services, perceived poor health, core depressive symptoms, a history of depression, and comorbid mental conditions increased the odds of treatment in the specialty mental health sector.
  
  
  CONCLUSIONS
  The findings emphasize the need for public health initiatives to 1) improve detection and movement into treatment among those at risk of receiving no care; and 2) insure that, once within the health care system, the processes of primary care treatment and specialty referrals conform to evidence-based treatment guidelines.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Burns
authors.forename: H
authors.initials: H
authors.lastname: Ryan Wagner
authors.forename: B N
authors.initials: BN
authors.lastname: Gaynes
authors.forename: K B
authors.initials: KB
authors.lastname: Wells
authors.forename: H C
authors.initials: HC
authors.lastname: Schulberg
mesh_terms: D000328:Adult; D000367:Age Factors; D002391:Catchment Area, Health; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012008:Recurrence; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012494:Sampling Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology