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More People Treated for Depression, But Few Receive Adequate Care, JAMA Study Finds

More Americans than ever are receiving treatment for serious depression but only about 20% are adequately treated, according to a study in the current issue of the Journal of the American Medical Association, which focuses on depression, the Wall Street Journal reports (Windham, Wall Street Journal, 6/18). Researchers led by Ronald Kessler of Harvard Medical School interviewed 9,090 U.S. residents over age 18 in person between February 2001 and December 2002 as part of the National Comorbidity Survey (Kessler et al., JAMA, 6/18). The survey found that about 52% of patients with depression were receiving treatment, but just 47% of those getting treatment were receiving adequate treatment. Researchers defined adequate care as either four visits to a doctor that resulted in use of an antidepressant or mood stabilizer for at least 30 days or at least eight professional psychotherapy sessions lasting at least 30 minutes each (Wall Street Journal, 6/18). Researchers found that overall, just 21.7% of patients with depression received enough care over 12 months to be considered treated (JAMA, 6/18). The study found that about 13 million to 14 million Americans, or about 6.6% of the population, experience major depression each year, and as many as 33 million to 35 million people, or 16.2% of adults, have experienced major depression in their lifetime (Wall Street Journal, 6/18). The survey also found that women who have at least one episode of depression outnumbered men 1.7 to 1; African Americans are 40% less likely to experience depression than Hispanic or white people; people living in poverty are about four times as likely to experience depression as those who are not; and three times as many people ages 18 to 29 years experienced depression during a one-year period as people ages 60 and older.

Reasons for Inadequate Care

The researchers noted that some people do not receive adequate care because doctors often do not treat depression aggressively enough (Duenwald, New York Times, 6/18). According to researchers, erroneous dosing of antidepressants often creates a barrier to treatment (Wall Street Journal, 6/18). In some cases, researchers found that patients with depression were given just five milligrams of an antidepressant, instead of the standard 20 milligram dose (New York Times, 6/18). In addition, patients often become impatient with slow-acting antidepressant treatments or their side effects (Wall Street Journal, 6/18). Kessler said, "That's the most disturbing thing of all. After all these years of trying to [treat patients with depression] ... we've screwed up" (Washington Post, 6/18). The complete study is available online.

Cost Study

Depression among employees costs U.S. employers about $31 billion per year in lost productivity, according to a separate study in today's JAMA, the Atlanta Journal-Constitution reports. Researchers participating in the Annual Productivity Audit, a study funded by drug maker Eli Lilly, found that many Americans with major depression still showed up to work but experienced a loss of productivity, or "presenteeism" (Guthrie, Atlanta Journal-Constitution, 6/18). The researchers also found the average person diagnosed with clinical depression is incapable of performing work or "normal activities" for five weeks per year, compared to about 15 days for people with diabetes or hypertension. In addition, employees with depression lose approximately eight hours of productivity per week because they are unable to concentrate, they work slowly or they are fatigued (Elias, USA Today, 6/18). That reduced performance at work accounts for 80% of the total lost productivity, researchers said. Dr. Ben Druss, the Rosalynn Carter Chair in Mental Health at Emory University's Rollins School of Public Health, said putting an economic figure on depression could encourage companies to begin dealing with the illness. "Employers have a specific interest as to what they see as their return on investment of getting employees back on track," Druss said (Atlanta Journal-Constitution, 6/18). The complete study is available online.

Doctors Affected

Doctors as a group are "highly vulnerable" to depression, according to another article in today's JAMA, the San Francisco Chronicle reports. The article, a "consensus statement" written by doctors in a suicide prevention forum, said that although doctors face lower death rates from cancer and heart disease than the general population, they face a greater risk of death from suicide. According to the article, about 33% of doctors do not have a regular source of health care, and doctors' use of mental health services "appears low," although there is little data on actual usage. Medical students in the forum said that lack of time and confidentiality, stigma, cost and fear of documentation all presented barriers to receiving mental health care (Seligman, San Francisco Chronicle, 6/18). The consensus statement is available online.

Broadcast Coverage

The following broadcast programs reported on the JAMA depression issue:

  • ABCNews' "World News Tonight": The segment includes comments from Dr. Thomas Insel of the National Institute of Mental Health (McKenzie, "World News Tonight," ABCNews, 6/17). The ABCNews report on the study is available online.

  • NBC News' "Nightly News": The segment includes comments from Kessler and Andrew Solomon, author of The Noonday Demon: An Atlas of Depression (Bazell, "Nightly News," NBC, 6/17). The full segment is available in Windows Media online.

  • NPR's "Morning Edition": The segment includes comments from Kessler (Que, "Morning Edition," NPR, 6/18). The full segment is available in RealPlayer online.

  • NPR's "Morning Edition": The segment reports on the correlation between depression and susceptibility to heart attacks (Silberner, "Morning Edition," NPR, 6/18). The full segment is available in RealPlayer online.
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