Prevalence and predictors of depression treatment in an international primary care study.
OBJECTIVE
The purpose of the study was to evaluate the prevalence and predictors of depression treatment in a diverse cross-national sample of primary care patients.


METHODS
At primary care facilities in six countries (Spain, Israel, Australia, Brazil, Russia, and the United States), a two-stage screening process was used to identify 1,117 patients with current depressive disorder. At baseline, all patients completed a structured diagnostic interview as well as measures of anxiety symptoms, alcohol use, chronic comorbid physical conditions, and perceived barriers to treatment. Primary care physicians were advised if the research interview indicated a probable depressive disorder in their patients. Three and 9 months later, participants reported all health services (including specialty mental health care and antidepressant medication) used in the preceding 3 months.


RESULTS
Across the six sites, the proportion of patients receiving any antidepressant pharmacotherapy ranged from a high of 38% in Seattle to a low of 0% in St. Petersburg; the proportion receiving any specialty mental health care varied from a high of 29% in Melbourne to a low of 3% in St. Petersburg. Patient characteristics were not consistently associated with receipt of either pharmacotherapy or specialty mental health care. Out-of-pocket cost was the most commonly reported barrier to treatment for depression; the percentage of patients who reported this barrier ranged from 24% in Barcelona to 75% in St. Petersburg.


CONCLUSIONS
Depression screening and physician notification are not sufficient to prompt adequate treatment for depression. The probability of treatment may be more influenced by characteristics of health care systems than by the clinical characteristics of individual patients. Financial barriers may be more important than stigma as impediments to appropriate care.
Simon
Gregory E
GE
Center for Health Studies, Group Health Cooperative of Puget Sound, 1730 Minor Ave., Number 1600, Seattle, WA 98101, USA. simon.g@ghc.org
Fleck
Marcelo
M
Lucas
Ramona
R
Bushnell
Donald M
DM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use*; D003431:Cross-Cultural Comparison; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D016527:Drug Costs; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales
D000928:Antidepressive Agents