Quality of treatment and disability compensation in depression: comparison of 2 nationally representative samples with a 10-year interval in Finland.
OBJECTIVE
Depressive disorders cause substantial work impairment that can lead to disability compensation. The authors compared treatment received for depression preceding disability pension between 2 nationally representative samples with a 10-year interval.


METHODS
The medical statements for 2 random samples drawn from the Finnish national disability pension registers, representing populations granted a disability pension for DSM-III-R major depression during a 12-month period from October 1993 through September 1994 (N = 277) and for ICD-10 depressive disorders (F32-F33) from October 2003 through September 2004 (N = 265) were examined. The proportions of persons receiving weekly psychotherapy, antidepressants, adequate antidepressant dosage, sequential antidepressant trials, lithium augmentation, and electroconvulsive therapy (ECT) were compared.


RESULTS
No significant differences emerged between the 2 samples, except for the adequacy of antidepressant dosage. Few subjects in either of the samples (8.7% for 1993-1994 vs. 10.6% for 2003-2004, p = .45) had received weekly psychotherapy. Most had received antidepressants (87.4% vs. 85.6%, p = .55) with increasingly adequate dosage (75.6% vs. 85.0%, p = .02), but only a minority had received sequential antidepressant trials (39.5% vs. 44.5%, p = .24). Lithium augmentation and ECT were rare (1.1% vs. 1.5%, p = .66 and 4.0% vs. 1.5%, p = .08, respectively). Even in 2003-2004, over half of the subjects were granted a disability pension without sequential antidepressant trials.


CONCLUSIONS
This nationally representative study indicates that, despite an increased antidepressant use and improved practice guidelines for depression, a considerable proportion of the people granted long-term compensation for depression seem to be suboptimally treated. Given the enormous costs of the disability, attention to the quality of treatment provided for depression is warranted before long-term disability compensations are granted.
Honkonen
Teija I
TI
Finnish Institute of Occupational Health, Helsinki, Finland. teija.honkonen@ttl.fi
Aro
Timo A
TA
Isometsä
Erkki T
ET
Virtanen
E Marianna
EM
Katila
Heikki O
HO
D000928:Antidepressive Agents / Q000627:therapeutic use; D003625:Data Collection; D003866:Depressive Disorder / Q000150:complications / Q000191:economics* / Q000628:therapy*; D006233:Persons with Disabilities / Q000523:psychology*; D004565:Electroconvulsive Therapy; D005260:Female; D005387:Finland; D006801:Humans; D018868:Insurance, Disability / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011613:Psychotherapy; D011787:Quality of Health Care; D014942:Workers' Compensation / Q000706:statistics & numerical data*
D000928:Antidepressive Agents