General medical and specialty mental health service use for major depression.


Journal Article

OBJECTIVE: While major depression is common, many depressed persons receive, at best, inadequate treatment. A first step in remedying inadequate detection and treatment of major depression requires understanding the pathways into treatment-from situations of no care, to disease recognition, to referral and appropriate treatment-as well as identifying factors associated with movement between these several stages. METHODS: Using the Epidemiologic Catchment Area sample, we identified factors associated with treatment in the general medical or mental health specialist section, or no treatment in a subsample of individuals with current major depression. RESULTS: Strikingly, one-fourth of the sample received no services, over half received care in the general medical sector, and only one-fifth accessed a mental health specialist. Among those receiving any health services (general or mental), men and respondents reporting suicidal symptoms were at risk of receiving no care, while perceived poor health and a cluster of core depressive symptoms were associated with increased odds of service use (general or mental). Among respondents receiving general medical services, perceived poor health, core depressive symptoms, a history of depression, and comorbid mental conditions increased the odds of treatment in the specialty mental health sector. CONCLUSIONS: The findings emphasize the need for public health initiatives to 1) improve detection and movement into treatment among those at risk of receiving no care; and 2) insure that, once within the health care system, the processes of primary care treatment and specialty referrals conform to evidence-based treatment guidelines.

Full Text

Duke Authors

Cited Authors

  • Burns, BJ; Ryan Wagner, H; Gaynes, BN; Wells, KB; Schulberg, HC

Published Date

  • 2000

Published In

Volume / Issue

  • 30 / 2

Start / End Page

  • 127 - 143

PubMed ID

  • 11001277

Pubmed Central ID

  • 11001277

International Standard Serial Number (ISSN)

  • 0091-2174

Digital Object Identifier (DOI)

  • 10.2190/TLXJ-YXLX-F4YA-6PHA


  • eng

Conference Location

  • United States