National trends in the treatment for depression from 1998 to 2007.
BACKGROUND
The rate of outpatient treatment of depression increased markedly in the United States between 1987 and 1997; it is not known whether this trend has continued.


OBJECTIVE
To assess national trends in the outpatient treatment of depression between 1998 and 2007.


METHODS
Analysis of service utilization data from 2 nationally representative surveys of the US household population, the 1998 (n = 22 953) and 2007 (n = 29 370) Medical Expenditure Panel Surveys.


METHODS
Nationally representative sample of the US household population.


METHODS
The rate of depression treatment and, among patients who received treatment, the rate of antidepressant medication use, psychotherapy, number of outpatient treatment visits, and expenditures.


RESULTS
The rate of outpatient treatment for depression increased from 2.37 per 100 persons in 1998 to 2.88 per 100 persons in 2007 (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI], 1.03-1.35). The percentage of treated patients who used antidepressants was little changed from 73.8% (1998) to 75.3% (2007) (AOR, 1.14; 95% CI, 0.85-1.51), but the percentage of those receiving psychotherapy declined from 53.6% (1998) to 43.1% (2007) (AOR, 0.71; 95% CI, 0.53-0.95). National expenditures for the outpatient treatment of depression increased from $10.05 billion to $12.45 billion (z = 1.73, P = .08). This was primarily driven by an increase in medication expenditures from $4.59 billion (1998) to $6.60 billion (2007) (z = 2.88, P = .004), which in turn was related to an increase in Medicare expenditures for depression treatment from $0.52 billion (1998) to $2.25 billion (2007) (z = 5.62, P < .001).


CONCLUSIONS
Rapid increases in depression treatment from 1987 to 1997 were followed by more modest increases during the following decade. Although there was little change in the proportion of patients receiving antidepressants, treatment with psychotherapy has declined.
Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Pennsylvania, USA.
Steven C
SC
Marcus
Mark
M
Olfson
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000628:therapy; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data* / Q000639:trends; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
D000928:Antidepressive Agents