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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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