Chartbook on Effective Treatment

Measures

• Process: Treatment for depression.
• Outcome: Suicide deaths.
• Process: Treatment for illicit drug use or alcohol problem.
• Process: Completion of substance abuse treatment.
• Outcome: Emergency department visits with a principal diagnosis related to mental health, alcohol or substance abuse, by age and income.

Treatment for Depression

• Treatment for depression can reduce symptoms and associated illnesses and return individuals to a productive lifestyle.
• Sequenced Treatment Alternatives to Relieve Depression (STAR*D) studied treatment:
  • Funded by the National Institute of Mental Health.
  • Involved both primary care and specialty care settings.
  • Included people with complex health conditions, such as multiple concurrent medical and psychiatric conditions.
  • Was the largest clinical trial ever of depression treatment.
  • Found that 28% to 33% of participants were symptom free after the first round of medication, and nearly 70% achieved remission after 12 months (Insel & Wang, 2009).
• Cost-benefit analyses show that compared with usual care, strategies for treating depression in primary care settings, such as the collaborative care model, have produced positive net social benefits (Glied, et al., 2010).

Outcomes of Treatment for Depression

• About 50% to 60% of patients have symptoms even after adequate first-line treatment for depression.
• Patients' thinking and behavior play a huge role in determining outcomes, making them candidates for psychosocial treatment.
• Evidence-based psychological therapies can help patients overcome interpersonal difficulties, health beliefs, stigmas, medication nonadherence, anhedonia (inability to feel pleasure), and rumination.
• Psychological therapies can help modify health beliefs, treat comorbid anxiety and other disorders, and incorporate environmental and contextual factors, thus enabling patients to facilitate their recovery (Casey, et al., 2013).

Barriers to High-Quality Mental Health Care

• Barriers to high-quality mental health care include:
  • Cost of care.
  • Lack of sufficient insurance for mental health services.
  • Discrimination and negative attitudes toward mental health problems.
  • Fragmented organization of services.
  • Mistrust of providers.
• In rural and remote areas, limited availability of skilled care providers is also a major problem.
• For racial and ethnic populations, lack of culturally and linguistically competent providers is a major barrier.

Receipt of Treatment for Depression

Adults

Adults with a major depressive episode in the past year who received treatment for depression in the past year, by race/ethnicity and sex, 2008-2012

Left Chart:

Right Chart:

Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2008-2012.
Denominator: Adults age 18 and over with a major depressive episode in the past year.
Note: Major depressive episode is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of the symptoms of depression described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Treatment for depression is defined as seeing or talking to a medical doctor or other professional or using prescription medication in the past year for depression. White and Black are non-Hispanic; Hispanic includes all races.

• Importance: The United States Preventive Services Task Force (USPSTF) recommends screening adults for depression when staff-assisted depression care supports are in place to ensure accurate diagnosis, effective treatment, and followup (USPSTF, 2015a).
• Overall Rate: In 2012, 68% of adults with a major depressive episode received treatment for depression.
• Groups With Disparities:
  • In all years, Black adults with depression were less likely than White adults to receive treatment.
  • In every year except 2010, Hispanic adults with depression were less likely than White adults to receive treatment.
  • From 2008 to 2012, females with a major depressive episode were more likely than males to receive treatment.

Adolescents

Adolescents with a major depressive episode in the past year who received treatment for depression in the past year, by race/ethnicity and sex, 2008-2012

Left Chart:

Right Chart:

Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2008-2012.
Denominator: Adolescents ages 12-17 with a major depressive episode in the past year.
Note: Major depressive episode is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of the symptoms of depression described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Treatment for depression is defined as seeing or talking to a medical doctor or other professional or using prescription medication in the past year for depression. White and Black are non-Hispanic; Hispanic includes all races.

• Importance:
  • Outpatient mental health treatment and psychotropic medication use in children and adolescents increased in the United States between 1996-1998 and 2010-2012. Although youths with less severe or no impairment accounted for most of the absolute increase in service use, youths with more severe impairment had the greatest relative increase in use, yet less than half accessed services in 2010-2012 (Olfson, et al., 2015).
  • The United States Preventive Services Task Force (USPSTF) recommends screening of adolescents ages 12-18 years for major depressive disorder when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and followup (USPSTF, 2015b).
• Overall Rate: In 2012, 37% of adolescents with a major depressive episode received treatment for depression.
• Groups With Disparities:
  • In 3 of 5 years (2008, 2009, and 2010), Black adolescents with depression were less likely than White adolescents to receive treatment.
  • In 3 of 5 years (2009, 2010, and 2012), females with depression were more likely than males to receive treatment.

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