CHICAGO -- Treatment rates for major depression have improved significantly over the last two decades, but more than half of patients nationwide are getting inadequate therapy, a new study suggests.
The findings suggest that while the stigma of mental illness may be easing, many doctors may not be aware of treatment advancements, and many patients may be seeking unproven therapies, said Harvard Medical School researcher Ronald Kessler, the study's lead author.
"That's the most disturbing thing of all," Kessler said. "After all these years of trying to get them in, ... we've screwed up."
The nationally representative study of 9,090 people aged 18 and up found that about 57 percent of participants with recent major depression had received treatment. That rate is nearly 40 percent higher than rates reported in the early 1980s, the researchers said.
Treatment was considered adequate or adhering to accepted guidelines in only 21 percent of patients with recent depression.
The findings, published in today's Journal of the American Medical Association, are based on face-to-face psychiatric evaluations conducted from February 2001 to December 2002.
Overall, 6.6 percent of patients had major depression sometime within the previous year, which equals up to about 14 million U.S. adults.
The overall prevalence is slightly higher than rates reported a decade ago but whether it represents a true increase or just better recognition of depression is uncertain, Kessler said.
The National Institute of Mental Health estimates that depression afflicts 9.5 percent of adults in any given year, or about 19 million, but those figures are based on old data that were less strict than the current survey's criteria, Kessler said.
Depression was moderate to severe in 90 percent of study participants, while the older data may have included mild cases that would not be diagnosed as depression today, he said.
Depression was more common in women and adults aged 18-44 than in men and adults over 60. Rates were similar nationwide.
The increases in people seeking treatment show recent campaigns by the government and others to raise awareness about depression are paying off, said co-author Kathleen Merikangas, a researcher at the National Institute of Mental Health. "The increase makes me optimistic, but I do think there's room for improvement," she said.
Dr. William McKinney, a Northwestern Memorial Hospital psychiatrist who directs a depression research and treatment center at Northwestern University's medical school, said the results mean that, "unfortunately, a lot of people with this illness are going to their doctors and being put on some anti-depressant, maybe an inadequate dose for inadequate time. These people are left with a lot of disability."
Research has shown that a combination of medication and psychotherapy is best, but treatment needs to be tailored to the individual patient, Kessler said.
Another JAMA study estimates that depression costs U.S. employers $44 billion yearly in absenteeism and lost productivity, $31 billion more per year than related costs from nondepressed workers.
Those costs don't include labor costs associated with disability leave, said lead researcher Walter Stewart, an epidemiologist with Geisinger Health Systems in Danville, Pa. He did the research while at AdvancePCS Center for Work and Health in Hunt Valley, Md.
Dr. Alberto Colombi, medical director at Pittsburgh's PPG Industries, said the connection between depression and workplace productivity is something PPG already knows about. As part of a plan to improve treatment for depression, the firm has trained company nurses in how to screen for the condition, and a $25,000 grant awarded in April from the American College of Occupational Medicine has furthered the effort.
The training represents a shift in responsibility for the 31 nurses who work at PPG sites in the region, Colombi said. A manufacturing company that makes glass, chemicals and coatings, PPG has traditionally used in-house health care services to treat work-related injuries. "Now, it's not only that the work affects health, but health affects work," Colombi said.
The idea that untreated depression is costly both in financial and human terms has prompted a Downtown non-profit group, the Pittsburgh Regional Healthcare Initiative, to bring employers such as PPG together with doctors and health plans to create a regional plan for addressing the problem. One result is a database that will allow area physicians to get timely information about their diabetic and depressed patients.
Too often, care for these chronic conditions is compromised because doctors can't easily track whether patients are taking their medicines and receiving needed tests, according to the group. The database will allow them to see whether patients are getting the tests and filling prescriptions.
The JAMA report shows that "it would pay for employers to do more to make sure that people get treated," said Geoff Webster, associate director of the healthcare initiative.
Depression "is mostly invisible," Geisinger's Stewart said. "Co-workers don't know about it, employers aren't aware of it," and doctors don't always question patients with possible symptoms about it." The challenge is "trying to understand how to motivate ... workers and employers and health care providers how to better manage this condition," he said.
The researchers conducted phone interviews last year with a nationally representative sample of U.S. workers aged 18 to 65.
Depressed workers reported an average of about 5 1/2 hours weekly of lost productivity or absenteeism, compared with 1 1/2 hours weekly among nondepressed workers. Stewart said the researchers assumed depression was a major factor in those rates, but don't know for certain.
Post-Gazette Staff Writer Christopher Snowbeck contributed to this report.
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