Primary care patients with depression are less accepting of treatment than those seen by mental health specialists.
OBJECTIVE
This study examined whether depressed patients treated exclusively in primary care report less need for care and less acceptability of treatment options than those depressed patients treated in the specialty mental health setting after up to 6 months of treatment.


METHODS
Cross-sectional study.


METHODS
Forty-five community primary care practices.


METHODS
A total of 881 persons with major depression who had received mental health services in the previous 6 months and who enrolled in 3 of the 4 Quality Improvement for Depression Collaboration Studies.


RESULTS
Patients were categorized into 1 of 2 groups: 1) having received mental health services exclusively from a primary care provider (45%), or 2) having received any services from a mental health specialist (55%) in the previous 6 months. Compared with patients who received care from mental health specialists, patients who received mental health services exclusively from primary care providers had 2.7-fold the odds (95% confidence interval [CI], 1.6 to 4.4) of reporting that no treatment was definitely acceptable and had 2.4-fold the odds (95% CI, 1.5 to 3.9) of reporting that evidence-based treatment options (antidepressant medication) were definitely not acceptable. These results were adjusted for demographic, social/behavioral, depression severity, and economic factors using multiple logistic regression analysis.


CONCLUSIONS
Patients with depression treated exclusively by primary care providers have attitudes and beliefs more averse to care than those seen by mental health specialists. These differences in attitudes and beliefs may contribute to lower quality depression care observed in comparisons of primary care and specialty mental health providers.
Van Voorhees
Benjamin W
BW
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Cooper
Lisa A
LA
Rost
Kathryn M
KM
Nutting
Paul
P
Rubenstein
Lisa V
LV
Meredith
Lisa
L
Wang
Nae-Yuh
NY
Ford
Daniel E
DE
D016009:Chi-Square Distribution; D003156:Community Mental Health Services; D003430:Cross-Sectional Studies; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D014481:United States