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The Quality of Care for Depressive and Anxiety Disorders in the United States
Alexander S. Young, MD, MSHS;
Ruth Klap, PhD;
Cathy D. Sherbourne, PhD;
Kenneth B. Wells, MD, MPH
Arch Gen Psychiatry. 2001;58:55-61.
Background Depressive and anxiety disorders are prevalent and cause substantial
morbidity. While effective treatments exist, little is known about the quality
of care for these disorders nationally. We estimated the rate of appropriate
treatment among the US population with these disorders, and the effect of
insurance, provider type, and individual characteristics on receipt of appropriate
care.
Methods Data are from a cross-sectional telephone survey conducted during 1997
and 1998 with a national sample. Respondents consisted of 1636 adults with
a probable 12-month depressive or anxiety disorder as determined by brief
diagnostic interview. Appropriate treatment was defined as present if the
respondent had used medication or counseling that was consistent with treatment
guidelines.
Results During a 1-year period, 83% of adults with a probable depressive or
anxiety disorder saw a health care provider (95% confidence interval [CI],
81%-85%) and 30% received some appropriate treatment (95% CI, 28%-33%). Most
visited primary care providers only. Appropriate care was received by 19%
in this group (95% CI, 16%-23%) and by 90% of individuals visiting mental
health specialists (95% CI, 85%-94%). Appropriate treatment was less likely
for men and those who were black, less educated, or younger than 30 or older
than 59 years (range, 19-97 years). Insurance and income had no effect on
receipt of appropriate care.
Conclusions It is possible to evaluate mental health care quality on a national
basis. Most adults with a probable depressive or anxiety disorder do not receive
appropriate care for their disorder. While this holds across diverse groups,
appropriate care is less common in certain demographic subgroups.
From the Department of Veterans Affairs VISN 22 Mental Illness Research,
Education, and Clinical Center, West Los Angeles Veterans Healthcare Center,
Los Angeles, Calif (Dr Young); the Department of Psychiatry, University of
California, Los Angeles (Drs Young and Wells); the Health Services Research
Center, University of California, Los Angeles (Dr Klap); and RAND, Santa Monica,
Calif (Drs Young, Sherbourne, and Wells).
Reprints: Alexander S. Young, MD, MSHS, UCLA Neuropsychiatric Institute,
Health Services Research Center, 10920 Wilshire Blvd, Suite 300, Los Angeles,
CA 90024-6505
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