Use of psychotherapy for depression in older adults.
OBJECTIVE
The authors examine national patterns in psychotherapy for older adults with a diagnosis of depression and analyze correlates of psychotherapy use that is consistent with Agency for Health Care Policy and Research guidelines for duration of treatment.


METHODS
Linked Medicare claims and survey data from the 1992-1999 Medicare Current Beneficiary Survey were used. The data were merged with the Area Resource File to assess the effect of provider-supply influences on psychotherapy treatment. An episode-of-care framework approach was used to analyze psychotherapy use and treatment duration. Multiple logistic regression analysis was used to predict psychotherapy use and its consistency.


RESULTS
The authors identified 2,025 episodes of depression treatment between 1992 and 1999. Overall, psychotherapy was used in 25% (N=474) of the episodes, with 68% of episodes with psychotherapy involving services received only from psychiatrists. (Percentages were weighted for the complex design of the Medicare Current Beneficiary Survey.) Use of psychotherapy was correlated with younger patient age, higher patient educational attainment, and availability of local psychotherapy providers. Among episodes in which psychotherapy was used, only a minority (33%, N=141) involved patients who remained in consistent treatment, defined as extending for at least two-thirds of the episode of depression. Availability of local providers was positively correlated with consistent psychotherapy use. In analyses with adjustment for provider-related factors, patients' socioeconomic and demographic characteristics did not affect the odds of receiving consistent psychotherapy.


CONCLUSIONS
Use of psychotherapy remains uncommon among depressed older adults despite its widely acknowledged efficacy. Some of the disparities in psychotherapy utilization suggest supply-side barriers. Increasing the geographic availability of mental health care providers may be one way of increasing access to psychotherapy for depressed older adults.
Wei
Wenhui
W
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 30 College Ave., New Brunswick, NJ 08901, USA. wwh@rci.rutgers.edu
Sambamoorthi
Usha
U
Olfson
Mark
M
Walkup
James T
JT
Crystal
Stephen
S
D000367:Age Factors; D000368:Aged; D003695:Delivery of Health Care; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004522:Educational Status; D017050:Episode of Care; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006282:Health Personnel / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D011336:Probability; D011613:Psychotherapy / Q000706:statistics & numerical data*; D014481:United States; D016270:United States Agency for Healthcare Research and Quality / Q000592:standards; D014600:Utilization Review