Association of general medical and psychiatric comorbidities with receipt of guideline-concordant care for depression.
OBJECTIVE
This study described the association of general medical and psychiatric comorbidities with receipt of guideline-concordant depression care.


METHODS
Pharmacy, medical, and behavioral claims and enrollment data from OptumHealth in 2003-2006 were linked for 1,835 adults with a new depression diagnosis or a new antidepressant fill. Multiple logistic regression was used to estimate the association of comorbidities with receipt of guideline-concordant pharmacotherapy, guideline-concordant psychotherapy, and any guideline-concordant therapy.


RESULTS
Eleven percent of patients received guideline-concordant psychotherapy; 23%, guideline-concordant pharmacotherapy; and 33%, any guideline-concordant therapy. Having a psychiatric but no medical comorbidity was associated with higher rates of guideline-concordant psychotherapy and overall guideline concordance; conversely, having a general medical but no psychiatric comorbidity was associated with lower rates of guideline-concordant psychotherapy. Comorbidities were associated with the probability of receiving any guideline-concordant therapy, but they were not associated with improved guideline concordance among patients already receiving therapy.


CONCLUSIONS
Patients with general medical comorbidities may not receive psychotherapy referrals, perhaps because of well-established relationships with their primary care providers.
Department of Medicine, University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90095, USA. settner@mednet.ucla.edu
Susan L
SL
Ettner
Francisca
F
Azocar
Robert B
RB
Branstrom
Lisa S
LS
Meredith
Lily
L
Zhang
Michael K
MK
Ong
D000328:Adult; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D011613:Psychotherapy