NEW YORK, Jan 21 (Reuters) -- Many people with depression are going undiagnosed and untreated, say a panel of mental health experts.
"In light of the prevalence and perniciousness of depression, the economic cost of the illness, its treatability, and previous public and professional educational efforts, why are so many people with depression receiving inadequate treatment or getting no treatment at all?" ask the experts in this week's issue of The Journal of the American Medical Association.
The panel, organized by the National Depressive and Manic Depressive Association (NDMDA) in Chicago, places blame on both the public and the medical community, and calls for better consumer education and training of doctors.
According to panel chairperson Dr. Robert Hirschfield of the University of Texas Medical Branch in Galveston, effective treatments for depression have been available for more than 35 years.
"There is still an enormous gap between our knowledge about the correct diagnosis and treatment of depression, and the actual treatment that is being received in this country," he and his colleagues assert.
That conclusion is consistent with other studies reported recently by Health e-Line, including one showing that depression goes largely undiagnosed and untreated in adolescents who seek emergency room care for nonspecific physical problems.
During a recent two-day meeting, more than a dozen panel members drawn from the health professions, consumer groups, and the general public listened to presentations from experts on the diagnosis of depression, treatment, and treatment costs.
Included in the presentations were "sobering" findings that the range of people who receive adequate treatment for their depression runs from a low of 5% to a high of 26.8%. Such treatment was defined as receiving an antidepressant for four consecutive weeks.
Panel members then discussed all material presented to them before reaching their consensus on the key issues and proposing strategies to remedy the situation.
According to their report, "patient-based" reasons for the undertreatment of depression include: failure to recognize the symptoms of depression; underestimating its severity; having limited access to treatment; reluctance to see a mental health specialist due to fear of being stigmatized; not complying with doctors' treatment prescriptions; and lack of adequate insurance coverage.
Among the reasons for undertreatment among physicians are: failure of medical schools to provide proper education about diagnosis and treatment of depression; inadequate time taken to evaluate and treat depression; failure to consider psychotherapy approaches; and avoidance of treating patients with poor insurance coverage.
The panel also noted that many managed care health systems (which closely scrutinize treatment plans before agreeing to pay) place barriers in the way of the management of depression, including the prescribing of antidepressant drugs, proper monitoring of patients, and reimbursing treatment for depression treatment.
To remedy the situation, the panel proposes the following strategies:
-- educate patients to act as informed consumers and advocates (of better care);
-- develop performance standards for providers of behavioral health care;
-- remove barriers to the recognition of depression, and to the diagnosis of the disorder through educational programs for practicing physicians;
-- and improve collaboration among physicians and other mental health professionals.
"The time is ripe to apply lessons learned from other areas of public health to behavioral health services in order to improve the quality of services to all patients with depression," the panel report states.
A nationwide study of psychiatric illness conducted in 1980 found that only 1 in 10 people with depression received adequate treatment. Depression is estimated to affect 15% of men and 24% of women at some point during their lifetimes. And the panel cited recent evidence that the age of onset of depression has fallen, "therefore, the public health significance of depressive disorders has increased."
SOURCE: The Journal of the American Medical Association (1997;277:333-340)
