The prevalence and predictors of mental health treatment services in a national sample of depressed veterans.
BACKGROUND
Few studies of acute depression care have examined the provision of psychotherapy or combined treatment in addition to medication management. This study examined acute phase depression treatment in the VA healthcare system, including measures of medication treatment (MT), psychotherapy (PT), and combined treatment (CT = MT plus PT). Both low level care (receipt of any MT, PT, or CT, but all below guideline levels) as well as guideline concordant care (GC MT, PT, and CT) were examined.


METHODS
The sample included 41,412 patients with new depression diagnoses. Analyses examined the relationship between demographics and psychiatric comorbidities (eg, substance use disorders, post-traumatic stress disorder, depression with both substance use disorders and post-traumatic stress disorder) and receipt of each type of care (low level and guideline concordant MT, PT, and CT).


RESULTS
The majority (75%) received at least some treatment, with 35% of the sample receiving guideline concordant care (particularly GC MT). Those with psychiatric comorbidities generally were more likely to receive GC care, older veterans were less likely to receive each type of care, and African Americans were less likely to receive GC MT but more likely to receive GC PT and GC CT than whites.


CONCLUSIONS
Although it is difficult to benchmark, the VA overall seems similar or better than the private sector in providing guideline concordant acute phase treatment for its depressed patients. The majority of veterans received some acute phase depression treatment, but only a minority seem to receive guideline concordant care (particularly PT and CT).
Chermack
Stephen T
ST
Department of Veterans Affairs, Ann Arbor Center of Excellence (COE), Serious Mental Illness Treatment, Research, and Evaluation Center (SMITREC), Ann Arbor, Michigan 48108, USA. Chermack@umich.edu
Zivin
Kara
K
Valenstein
Marcia
M
Ilgen
Mark
M
Austin
Karen L
KL
Wryobeck
John
J
Blow
Frederic C
FC
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D019985:Benchmarking; D015897:Comorbidity; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011613:Psychotherapy; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans
D000928:Antidepressive Agents