title: Impact of distance and facility of initial diagnosis on depression treatment.
abstract: OBJECTIVE
  To assess whether distance to services or diagnosis at a hospital-based medical center compared with a community clinic influences the receipt of psychotherapy versus pharmacotherapy for depression.
  
  
  METHODS
  Veterans Affairs (VA) administrative data for 132,329 depressed veterans between October 2003 and September 2004.
  
  
  METHODS
  Multivariable logistic and multinomial regression models were used to examine the relationship between distance to the nearest mental health facility and the facility of initial depression diagnosis on receipt of any and adequate psychotherapy and/or pharmacotherapy, adjusted for patient characteristics.
  
  
  RESULTS
  Compared with those living within 30 miles of the nearest mental health treatment facility, depressed patients living between 30 and 60 miles away had a decreased likelihood of receiving psychotherapy (OR=0.71; 95 percent CI: 0.66, 0.76) and a greater likelihood of receiving antidepressant treatment (OR=1.27; 95 percent CI: 1.22, 1.33). Initial diagnosis at a small community clinic compared with a VA medical center was not associated with a difference in receipt of any psychotherapy (OR=0.95; 95 percent CI: 0.83, 1.09), but it was associated with decreased likelihood of receiving eight or more psychotherapy visits (OR=0.46; 95 percent CI: 0.35, 0.61) or any antidepressant treatment (OR=0.69; 95 percent CI: 0.63, 0.75).
  
  
  CONCLUSIONS
  The VA and similar health systems should make efforts to insure adequate psychotherapy is provided to patients who initiate treatment at small community clinics and provide psychotherapy alternatives that may be less sensitive to travel barriers for patients living remote distances from mental health treatment. Extending services to small community clinics that support antidepressant treatment should also be considered.
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI 48109, USA. ppfeiffe@umich.edu
authors.forename: Paul N
authors.initials: PN
authors.lastname: Pfeiffer
authors.forename: Joseph
authors.initials: J
authors.lastname: Glass
authors.forename: Karen
authors.initials: K
authors.lastname: Austin
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D004363:Drug Utilization; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D015999:Multivariate Analysis; D011613:Psychotherapy; D012111:Residence Characteristics; D012189:Retrospective Studies; D014481:United States; D014728:Veterans / Q000523:psychology
chemical_list: D000928:Antidepressive Agents