Major depression, depression treatment and quality of primary medical care

ObjectiveThis study investigated the association between diagnosis of major depression, treatment for major depression and receipt of appropriate primary medical care.MethodAs part of the 1999 National Health Interview Survey, a nationally representative sample of 30,801 adults was administered the Composite International Diagnostic Interview — Short Form. Multivariate analyses examined the association between 12-month major depression and each of the four cardinal features of primary care (access, comprehensiveness, coordination and continuity) stratified by whether depressed individuals received care for depression in primary care, specialty mental health care or no treatment.ResultsOverall, persons with depression had statistically significant problems in all four domains of primary care (8/10 indicators in total). However, patterns differed substantially based on depression treatment status. Persons with untreated depression had difficulties in access to (3/3 measures) and comprehensiveness of (5/5 measures) care, but not with coordination (0/1 measure) and continuity (0/1 measure). In contrast, persons with depression who received specialty treatment had more difficulties in coordination (1/1 measure) and continuity (1/1 measure) of primary care. Persons treated for depression in primary care reported the least difficulties in any of the four domains of primary care (0/10 measures).ConclusionsMajor depression was associated with significant challenges in receipt of primary care; however, these problems varied based on whether and where depression treatment is received.