The Depression Treatment Cascade in Primary Care: A Public Health Perspective
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Major depressive disorder (MDD) is common and costly. Primary care remains a major access point for depression treatment, yet the successful clinical resolution of depression in primary care is uncommon. The clinical response to depression suffers from a “treatment cascade”: the affected individual must access health care, be recognized clinically, initiate treatment, receive adequate treatment, and respond to treatment. Major gaps currently exist in primary care at each step along this treatment continuum. We estimate that 12.5% of primary care patients have had MDD in the past year; of those with MDD, 47% are recognized clinically, 24% receive any treatment, 9% receive adequate treatment, and 6% achieve remission. Simulations suggest that only by targeting multiple steps along the depression treatment continuum (e.g. routine screening combined with collaborative care models to support initiation and maintenance of evidence-based depression treatment) can overall remission rates for primary care patients be substantially improved.
KeywordsMajor depressive disorder Depression treatment cascade Recognition Treatment Remission Primary care Public health
BWP and BNG’s contribution to this paper was supported by grant R01MH086362 of the National Institute of Mental Health and the National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA. BWP is an investigator with the Implementation Research Institute (IRI), at the George Warren Brown School of Social Work, Washington University in St Louis; through an award from the National Institute of Mental Health (R25 MH080916-01A2) and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative (QUERI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the NIH.
Dr. Pence has received research support from the National Institute of Mental Health (NIMH) and received honoraria and research support from the National Institutes of Health (NIH).
Dr. O’Donnell reported no potential conflicts of interest relevant to this article.
Dr. Gaynes has received research support from the Agency for Healthcare Research and Quality (AHRC), the NIMH, and the NIH; has served as a consultant for Bristol-Myers Squibb; and has received payment for development of educational presentations from MedScape.
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