Social Psychiatry and Psychiatric Epidemiology

, Volume 42, Issue 9, pp 740–746

Who is treated, and how, for depression?

An analysis of statutory health insurance data in Germany
  • Anke Bramesfeld
  • Thomas Grobe
  • Friedrich Wilhelm Schwartz
ORIGINAL PAPER

Abstract

Background

Studies on the treatment of depression using epidemiological survey methods suggest a high level of under-treatment. Little is known about the characteristics of those people receiving treatment and indeed what kind of treatment they are likely to receive.

Method

Analysis of the data of a statutory health insurance company in Germany.

Results

In middle-aged groups, about 50% of those diagnosed as being depressed in outpatient care are prescribed antidepressants and/or psychotherapy in the course of a year. There is more pharmacologic treatment provided in rural areas and more psychotherapy in cities, suggesting that treatment is dependent upon service availability rather than evidence-based treatment decisions. Treatment rates are considerably lower in the very young and the very old and show gender bias. Young females receive less pharmacologic treatment than young males, and elderly men are, in general, treated less than women, suggesting under-treatment at least for these groups.

Conclusions

The low treatment rates following the diagnosis of depression in the young and the old require attention, in particular with respect to gender aspect.

Key words

treatment of depression sociodemographic characteristics health insurance data epidemiology health service research 

References

  1. 1.
    Alonso J, Angermeyer M, Bernert S, Bruffaerts R, Brugha T, Bryson H, de Giralamo G, de Graaf R, Demyttenaere K, Gasquet I, Haro J, Katz S, Kessler R, Kovess V, Lepine J, Ormel J, Polidori G, Rousso J, Vilagut G (2004) Psychotropic drug utilization in Europe: results from the European study of the epistemology of mental disorders (ESEMeD) project. Acta Psychiatr Scand 109(Suppl 420):55–64Google Scholar
  2. 2.
    Alonso J, Angermeyer M, Bernert S, Bruffaerts R, Brugha T, Bryson H, de Giralamo G, de Graaf R, Demyttenaere K, Gasquet I, Haro J, Katz S, Kessler R, Kovess V, Lepine J, Ormel J, Polidori G, Rousso J, Vilagut G (2004) Use of mental health services in Europe: results from the European study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand 109(Suppl 420):47–54Google Scholar
  3. 3.
    Andrews G, Sanderson K, Corry J, Lapsley H (2000) Using epidemiological data to model efficiency in reducing the burden of depression. J Ment Health Policy Econ 3:175–186PubMedCrossRefGoogle Scholar
  4. 4.
    Bramesfeld A, Grobe T, Schwartz F (2007) Who is diagnosed as suffering from depression in the German statutory health care system? An analysis of health insurance data. Euro J Epidemiology DOI 10.1007/s10654-007-9128-zGoogle Scholar
  5. 5.
    Busch S, Leslie D, Rosenheck R (2004) Measuring quality of psychopharmacotherapy for depression in a national health care system. Med Care 42:532–542PubMedCrossRefGoogle Scholar
  6. 6.
    Busse R, Riesberg A (2004) Health care systems in transition: Germany. Copenhagen WHO regional office for Europe on behalf of the European observatory on health systems and policiesGoogle Scholar
  7. 7.
    Fegert J, Kölch M, Zito J, Glaeske G, Janhsen K (2006) Antidepressants use in children and adolescents in Germany. J Clin Child Adolesc Psychopharmacol 16:197–206CrossRefGoogle Scholar
  8. 8.
    Fernández A, Haro J, Martinez-alonso K, Demyttenaere K, Brugha T, Autonell G, de Giralamo G, Bernert S, Lépine J, Alonso J (2007) Treatment adequacy for anxiety and depressive disorders in six European countries. Br J Psychiatry 190:172–173PubMedCrossRefGoogle Scholar
  9. 9.
    Fiedler G (2005) Suizide, Suizidversuche und Suizidalität in Deutschland. Daten und Fakten 2003. http://www.uke.uni-hamburg.de/extern/tzs/online-text/daten.pdf
  10. 10.
    Freudenstein U, Jagger C, Arthur A, Donner-Banzhoff N (2001) Treatment for late life depression in primary care—a systematic review. Fam Pract 18:321–327PubMedCrossRefGoogle Scholar
  11. 11.
    Friemel S, Bernert S, Angermeyer M, König H (2005) Die direkten Kosten von depressiven Erkrankungen in Deutschland. Ergebnisse aus dem European study of the epidemiology of mental disorders (ESEMeD) Projekt. Psych Prax 32:113–121CrossRefGoogle Scholar
  12. 12.
    Grobe T, Bramesfeld A, Schwartz F (2006) Versorgungsgeschehen. Analyse von Krankenhausdaten. In: Stoppe G, Bramesfeld A, Schwartz F (eds) Volkskrankheit Depression? Bestandsaufnahme und Perspektiven. Springer, Berlin, Heidelberg, pp 39–98Google Scholar
  13. 13.
    Grobe T, Dörning H, Schwartz F (2004) GEK-Gesundheitsreport 2004. Schwerpunktthema: Gesundheitsstörungen durch Alkohol. St. Augustin Asgard-VerlagGoogle Scholar
  14. 14.
    Harrington R, Whittaker J, Shoebridge P, Campbell F (1998) Systematic review of efficacy of cognitive behavior therapy in childhood and adolescent depressive disorder. BMJ 23:1559–1563Google Scholar
  15. 15.
    Hazell P, O’Connell D, Heathcote D, Henry D (2004) Trizyclic drugs for depression in children and adolescents. The Cochrane LibraryGoogle Scholar
  16. 16.
    Hunkeler E, Katon W, Tang L, Williams J, Kroenke K, Lin E, Harpole L, Arean P, Levine S, Grypma L, Hargreaves W, Unützer J (2006) Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ 332:259–263PubMedCrossRefGoogle Scholar
  17. 17.
    Kessler R, Demler O, Frank R, Olfson M, Pincus H, Walters E, Wang P, Wells K, Zaslavsky A (2005) Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 352: 2515–2523PubMedCrossRefGoogle Scholar
  18. 18.
    Murray C, Lopez A (1997) Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study. Lancet 349:1498–1504PubMedCrossRefGoogle Scholar
  19. 19.
    Oldehinkel A, Wittchen H-U, Schuster P (1999) Prevalence, 20-month incidence and outcome of unipolar depressive disorders in a community sample of adolescents. Psychol Med 29:655–668PubMedCrossRefGoogle Scholar
  20. 20.
    Ostler K, Thompson C, Kinmonth A-L, Peveler R, Stevens L, Stevens A (2001) Influence of socio-economic deprivation on the prevalence and outcome of depression in primary care. The Hampshire depression project. Br J Psychiatry 178:12–17PubMedCrossRefGoogle Scholar
  21. 21.
    Palsson S, Östling S, Skoog I (2001) The incidence of first-onset depression in a population followed from the age 70 to 85. Psychol Med 31:1159–1168PubMedCrossRefGoogle Scholar
  22. 22.
    Parikh S, Lesage A, Kennedy S, Goering P (1999) Depression in Ontario: under-treatment and factors related to antidepressant use. J Affect Dis 67–76Google Scholar
  23. 23.
    Regier D, Farmer M, Rae D, Myers J, Kramer M, Robins L, George L, Karno M, Locke B (1993) One-month prevalence of mental disorders in the United States and sociodemographic characteristics: the epidemiologic catchment area study. Acta Psychiatr Scand 88:35–47PubMedGoogle Scholar
  24. 24.
    Sachverständigenrat für die Konzertierte Aktion im Gesundheitswesen (2001) Depressive Störungen. In: Gutachten 2000/2001: Bedarfsgerechtigkeit und Wirtschaftlichkeit, Ausführliche Zusammenfassung. Sachverständigenrat für die Konzertierte Aktion im Gesundheitswesen, pp 169–177Google Scholar
  25. 25.
    Stordal E, Mykletun A, Dahl A (2003) The association between age and depression in the general population: a multivariate examination. Acta Psychiatr Scand 107:132–142PubMedCrossRefGoogle Scholar
  26. 26.
    Whittington C, Kendall T, Fonagy P, Cotrell D, Cotgrove A, Boddington E (2004) Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 363:11341–11345CrossRefGoogle Scholar
  27. 27.
    Wittchen H-U, Hofler M, Meister W (2001) Prevalence and recognition of depressive syndromes in German primary care settings: poorly recognized and treated? Int Clin Psychopharmacol 16:121–135CrossRefGoogle Scholar
  28. 28.
    Wittchen H-U, Jacobi F (2006) Epidemiologie. In: Stoppe G, Bramesfeld A, Schwartz F (eds) Volkskrankheit Depression? Bestandsaufnahme und Perspektiven. Springer, Berlin, Heidelberg, pp 15–37Google Scholar
  29. 29.
    Wittchen H-U, Müller N, Pfisterer H, Winter S, Schmidtkurz B (1999) Affektive, somatoforme und Angsstörungen in Deutschland—Erste Ergebnisse des bundesweiten Zusatzsurveys “Psychische Störungen”. Gesundheitswesen 61:216–222Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Anke Bramesfeld
    • 1
  • Thomas Grobe
    • 2
  • Friedrich Wilhelm Schwartz
    • 1
  1. 1.Dept. for EpidemiologySocial Medicine, and Health System Research, Medical School Hannover, OE 5410HannoverGermany
  2. 2.Institute for Social Medicine, Epidemiology and Health System Research (ISEG)HannoverGermany

Personalised recommendations