Treatment adequacy of anxiety and depressive disorders: primary versus specialised care in Spain.
BACKGROUND
Literature suggests that a high proportion of the population with mental disorders remains either untreated or poorly treated. This study aimed to describe the adequacy of treatment for Anxiety and Depressive disorders in Spain, how this differs between providers (primary versus specialised care) and which factors are associated with appropriate care.


METHODS
Data were derived from the Spanish sample (N=5473) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross sectional study in a representative sample of adults. The subsample analyzed was composed by the 133 subjects with a mental disorder in the year prior to the interview who received treatment. Treatment adequacy was evaluated in two different ways: (1) considering definitions of minimally adequate treatment evidence based guidelines and criteria used in other epidemiological studies; (2) considering experts rating of treatment appropriateness based on the information contained in the case vignettes created from the CIDI answers. Generalised Estimating Equation (GEE) models and simple logistic regression were conducted to assess the correlates of adequate treatment.


RESULTS
Similar proportions of patients in specialty and general medical treatment received a minimally adequate treatment (31.8% and 30.5%, respectively). Associated factors to appropriateness were living in a large city, having a high educational level, and having a good self rated health state.


CONCLUSIONS
Treatment adequacy was based on simple information and criteria.


CONCLUSIONS
Only one third of the mental health treatment in Spain met minimal adequacy criteria. More research is needed in order to find out reasons for these low rates.
Fernández
Anna
A
Sant Joan de Déu-SSM, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain. afernandez@sjd-ssm.com
Haro
Josep Maria
JM
Codony
Miquel
M
Vilagut
Gemma
G
Martínez-Alonso
Montserrat
M
Autonell
Jaume
J
Salvador-Carulla
Luis
L
Ayuso-Mateos
José Luis
JL
Fullana
Miquel Angel
MA
Alonso
Jordi
J
D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D011570:Psychiatry / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013030:Spain; D014600:Utilization Review / Q000706:statistics & numerical data
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents