Treatment of major depressive disorder in the Finnish general population.
BACKGROUND
Few general population studies of the treatment of major depressive disorder (MDD) have included the whole spectrum of treatments. We estimated the rates of different treatments and the effect of individual and disorder characteristics plus provider type on treatment received.


METHODS
In the Health 2000 Study, a representative sample (n=6,005) from the adult Finnish population (> or =30 years) were interviewed (CIDI) in 2000-2001 for the presence of DSM-IV mental disorders during the past 12 months. Logistic regression models were used to examine factors influencing the type of treatment: either pharmacotherapies (antidepressants, anxiolytics, sedatives/hypnotics, antipsychotics) or psychological treatment.


RESULTS
Of the individuals with MDD (n=288), currently 24% used antidepressants, 11% anxiolytics, 16% sedatives/hypnotics, 5% antipsychotics, and 17% reported having received psychological treatment. Overall, 31% received antidepressants or psychological treatment or both; 18% received minimally adequate treatment. Of those 33% (n=94) using health care services for mental reasons, 76% received antidepressants or psychological treatment or both; 54% received minimal adequate treatment. In logistic regression models, the use of antidepressants was associated with female sex, being single, severe MDD, perceived disability, and comorbid dysthymic disorder; psychological treatment with being divorced, perceived disability, and comorbid anxiety disorder.


CONCLUSIONS
Due to the low use of health services for mental reasons, only one-third of subjects with MDD use antidepressants, and less than one-fifth receives psychological treatment. The treatments provided are determined mostly by clinical factors such as severity and comorbidity, in part by sex and marital status, but not education or income.
Hämäläinen
Juha
J
Department of Mental Health and Alcohol Research, National Public Health Institute, 00300 Helsinki, Finland. Juha.Hamalainen@ktl.fi
Isometsä
Erkki
E
Sihvo
Sinikka
S
Kiviruusu
Olli
O
Pirkola
Sami
S
Lönnqvist
Jouko
J
D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D005387:Finland; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D055502:Secondary Prevention; D012959:Socioeconomic Factors
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs