A record-based analysis of 803 patients treated for depression in psychiatric care.
BACKGROUND
New antidepressants emerged and became widely used during the 1990s. The present study investigated quality-of-care problems in the treatment of depression in a current psychiatric setting.


METHODS
We investigated the treatment received for depression by all 803 inpatients or outpatients with a clinical diagnosis of ICD-10 depressive episode or recurrent depressive disorder in 1996 in the Peijas Medical Care District, which provides psychiatric services for citizens of Vantaa, a city in southern Finland.


RESULTS
Most patients (84%) in the sample were found to have received antidepressants, generally in adequate, albeit low, doses. Inadequate antidepressant treatment was common only with tricyclic antidepressants. Most patients received a single antidepressant for extended periods; only 22% had 2 or more antidepressant trials. During the treatment period, disability pension was granted to 19% of those not already pensioned, two thirds (67%) of whom had received only 1 antidepressant trial prior to being granted a pension.


CONCLUSIONS
The present study supports the emerging perception of improved quality of pharmacotherapy in psychiatric settings, with the exception of treatment with tricyclic antidepressants. Problems of quality of care now appear to be related to the suboptimal intensity and monitoring of the treatment provided. which may eventually result in considerable costs to society due to permanent disability.
Rytsälä
H J
HJ
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
Melartin
T K
TK
Leskelä
U S
US
Lestelä-Mielonen
P S
PS
Sokero
T P
TP
Isometsä
E T
ET
D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000191:economics / Q000592:standards / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000191:economics / Q000627:therapeutic use; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D004185:Disability Evaluation; D005260:Female; D005387:Finland; D006302:Health Services Research / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D010415:Pensions / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012720:Severity of Illness Index; D016312:Treatment Refusal / Q000706:statistics & numerical data
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic