The Epidemiology Of Treatment For Depression

There are various ways in which the delivery of treatment for depression can be assessed (Bebbington et al., 1996). One is to assume that identified depressive disorders need treatment of one sort or another, and to establish how often they actually received it. This is technically a measure of utilization. Another approach is to establish directly whether treatment was actually needed before quantifying how often it was delivered. Need can be defined either by experts, or by the individual in question (when it is called want, demand, or subjective need). Investigations of general population samples are the obvious source of such information. The obvious questions are as follows. Did this person have a need for professional treatment? Did he or she seek psychiatric help at either primary or secondary care level? Was he or she then prescribed treatment? Did he or she take the treatment prescribed? Studies of any kind are rare, but give a clear picture of under-treatment.

The Australian National Survey of Mental Health and Well-Being (Andrews et al., 2001) reports data on service utilization. Thus, two-thirds of all subjects had no contact with services in the previous year, while 29% had seen GPs and 7.5% psychiatrists (Henderson et al., 2000). However, the survey gives data only from the combined category of major depressive disorder and dysthymia—the use of a broad category like theirs would reduce the likelihood of service contact.

Table 1.6 lists two direct studies of expert-defined need that provide data for depression. While the proportion of the population requiring treatment for depression was similar in Camberwell and Derry, it does appear that people were more likely to receive treatment in

Table 1.6 Need and utilization of treatment for depressive disorders

N One-year treatment needs Proportion of needs

Table 1.6 Need and utilization of treatment for depressive disorders

N One-year treatment needs Proportion of needs

Study

Location

stage2/stage 1

for depression

met

Bebbington et al., 1997 McConnell et al., 2002

Camberwell,

London Derry, N. Ireland

408 (760) 307 (923)

6.0% 7.1%

20% 48%

Study

Location

N

Contact with primary care services

Proportion treated

Antidepressant treatment

Other drugs

Counselling

Bebbington et al., 2000 Singleton et al., 2001

First British National Survey Second British

10108 8580

48% 62%

28% 44%

16% 34%

9% 12%

15% 17%

National Survey

National Survey the latter: Derry appears to have inner-city levels of depression, but small-town levels of primary-care services.

The other results listed in Table 1.6 are of particular interest—the two British National Surveys used the same methods, but the data were gathered seven years apart (1993 and 2000). There are significant improvements in the treatment of cases of depressive disorder at primary-care level: more people saw their GP with their mental health problem, and more received appropriate treatment, indicated by the noteworthy rise in antidepressant drug prescription.

Large surveys of this type offer rather crude indications of treatment levels, but the general finding of under-treatment is so marked that it clearly represents a serious public health problem, requiring education both of primary-care physicians and of the public at large.

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