title: Treatment adequacy of anxiety and depressive disorders: primary versus specialised care in Spain.
abstract: 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.
authors.affiliation: Sant Joan de Déu-SSM, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain. afernandez@sjd-ssm.com
authors.forename: Anna
authors.initials: A
authors.lastname: Fernández
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.forename: Miquel
authors.initials: M
authors.lastname: Codony
authors.forename: Gemma
authors.initials: G
authors.lastname: Vilagut
authors.forename: Montserrat
authors.initials: M
authors.lastname: Martínez-Alonso
authors.forename: Jaume
authors.initials: J
authors.lastname: Autonell
authors.forename: Luis
authors.initials: L
authors.lastname: Salvador-Carulla
authors.forename: José Luis
authors.initials: JL
authors.lastname: Ayuso-Mateos
authors.forename: Miquel Angel
authors.initials: MA
authors.lastname: Fullana
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
mesh_terms: 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
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents