Can someone who is smart explain what in the world the take-home points and utility of this study is? It has been on my reading list since October and I've been putting it off. The conclusion is somewhat mind-boggling to me:
Most US adults who screen positive for depression did not receive treatment for depression, whereas most who were treated did not screen positive. (JAMA Psychiatry 2016)
So what the heck are the authors trying to assert? That depression is both undertreated and overdiagnosed?
I am an internal medicine resident, so I am interested in what if anything this study really means for primary care medicine.
There's a few things I gleaned from this study which the Conclusion section alone didn't adequately cover.
1. For primary care physicians who don't use guidelines to regularly assess for depression severity, there is a significantly higher rate of false positive diagnoses as well as inappropriate prescribing of antidepressants (pg 1486, second paragraph of discussion). This is further supported by their finding that for some reason patients with severe distress were actually less likely to be treated with antidepressants than those who were only in mild distress (pg 1484, second paragraph of "treatment modalities" section; Also table 2).
2. There is a significant discrepancy in demographics in the sense that the groups with the highest rates of positive screens also receive less treatment (minorities, low income, low education, and elderly) (see tables). Additionally, those with less education are less likely to be treated by a psychiatrist and more likely to only receive care from a general medical practitioner vs. those with higher levels of education (pg 1485, last paragraph).
3. Use of treatment modalities other than antidepressants (particularly psychotherapy) may be underutilized by patients being seen only by general medical practitioners, especially older patients (Pg 1489, second paragraph). Additionally, the availability of other mental health professionals is significantly lower to those with severe symptoms on public insurance than those on private insurance (last table).
In terms of what it means for primary care, what I'm getting is that PC docs tend to over-prescribe antidepressants for patients with mild depressive symptoms and don't use alternative treatment or utilize other mental health professionals as frequently as psychiatrists. Additionally, access to mental health professionals is lower for patients who fall into certain disadvantaged demographics, and these patients also receive significantly less treatment than those with better living conditions.
That's my take on the article, but I'd love to know what some of the residents and attendings are getting out of it as well as if they feel the conclusions are congruent with what they are seeing in actual practice.
