As many as one in every six Americans experience major depression at some point in their lives, but the vast majority never obtain adequate treatment, according to a study published today in the Journal of the American Medical Association.
As many as one in every six Americans experience major depression at some point in their lives, but the vast majority never obtain adequate treatment, according to a study published today in the Journal of the American Medical Association. While researchers found some 33 million or more Americans suffer from the debilitating condition, in line with past estimates, only 22 percent of those surveyed with major depression in the past year were receiving sufficient care. The study used trained research clinicians to diagnose patients, answering critics who maintain past figures were inflated by a large proportion of mild cases and unreliable diagnostic procedures. The clinicians classified 90 percent of patients as moderate to extremely severe cases. The findings carry both health and economic implications, suggest experts. “Persons with a major depressive disorder were taken out of their productive role for an average of 35 days,” noted Dr. Joshua Straus, director of consultation-liaison psychiatry at the Stone Institute of Psychiatry in Chicago. “The plain fact is that depression is highly disabling.” Straus also cited the ripple effect on other aspects of health: “Having major depression is associated with increased death due to heart disease and stroke.” In addition, patients who are not adequately treated tend to use inpatient hospital care excessively, driving up overall health-care costs. Treatment Not ForthcomingThe study found that almost half of the subjects did not receive any care at all. And some doctors believe the numbers may be even worse. Dr. Paul Appelbaum, chair of the department of psychiatry at the University of Massachusetts Medical School in Worcester, Mass, and past president of the American Psychiatric Association, said that the study’s definition of “adequate treatment” a 30-day drug or psychotherapy regimen was too lenient. “It’s likely that an even smaller percentage of persons than the 22 percent figure given really had their depression treated adequately,” he added. “If anything, the study overstates the degree of treatment in the community,” concurred Dr. Alec Bodkin, chief of the clinical psychopharmacology research program at McLean Hospital in Belmont, Mass. “[Their] definition of adequacy may include some energetic but ineffective treatment.” Physicians pointed to ignorance, social stigma, and lack of insurance coverage as the primary causes of inadequate treatment. Dr. William McKinney, director of the Asher Center for the Study and Treatment of Depressive Disorders in Chicago, emphasized the need for people to be proactive. “Depression is clearly underdiagnosed and therefore many people will not get the treatment they need. The public needs to be aware and seek treatment or recommend evaluation [for others].” How Doctors Are RespondingAppelbaum called for increased efforts to dispel the social stigma of mental disorders with “public education that emphasizes that depression is an illness like other illnesses.” He also stressed the importance of increased health coverage for mental illnesses, noting the disparity between the United States and other nations. “Most other major industrialized countries have national health insurance programs & [in which] psychiatric illnesses tend to be treated as other illnesses,” said Appelbaum. “[In America], most health insurance policies currently discriminate against mental disorders by limiting coverage.” Insurance companies counter that expanding coverage could increase health insurance costs by hundreds of millions of dollars, causing many to lose their insurance completely. Nevertheless, many doctors continue to work to break down these barriers to mental-health treatment. Appelbaum highlighted the effectiveness of adequate treatment in helping patients as one reason, noting that roughly 60 percent of patients respond to the first medication taken. Added Appelbaum, “Patients who respond to the medication can in the course of several weeks see a complete recovery.” Bodkin summed up the growing sentiment that there is an urgent need to deal with the problem of major depression. “The symptoms of depression substantially impair the quality of life and capacity for role function. The predominant lack of effective treatment for people suffering from depressive illnesses should not be tolerated by our society.”(Source: Journal of the American Medical Association: ABC News: 17th June 2003)