[Factors associated with treatment adequacy of major depressive episodes in France]

Abstract

Introduction: Level of treatment inadequacy amongst people suffering from a major depressive episode (MDE) remains an important issue in the literature. Moreover, from a public health perspective, it's important to know how this situation can be improved.

Aim of the study: The objective of this study was to identify which factors are associated with adequate treatment for depression in France. A More specific objective was to investigate if being adequately treated is associated with the type of health care professionals consulted and, furthermore, to test the specific effect of providers taking sociodemographic and clinical variables into account.

Method: This study was carried out from the data of the Health Barometer 2005, a random survey on various health topics. Thirty thousand five hundred and fourteen individuals from 12 to 75 years old were interviewed by telephone from October 2004 to February 2005. Depressive disorders were assessed by a standardized tool (CIDI-SF) according to the classification of the DSM-IV (16,883 individuals had answered the questions of mental health: 60% of the individuals aged 15 or older).

Results: Levels of treatment adequacy are higher for women, more severe disorders, and for people living in Paris or Central Eastern regions. They are lower for students. Significant differences were found between types of professionals and levels of treatment adequacy. They are higher for psychiatrists than for psychologists and psychotherapists and higher than for general practitioners. Lowest levels of adequate treatment were found for depressed people who used services without considering this recourse being for "mental health reasons". There are also some significant differences in sociodemographic and clinical patient characteristics between health care professionals. The population of depressed people consulting without "mental health reasons" is older and less educated. The population of depressed people consulting a psychiatrist suffers from more severe disorders and is more educated than those consulting a general practitioner. The population of depressed people consulting a psychologist or a psychotherapist is younger and more educated. Taking sociodemographic and clinical variables into account, the probability of receiving an adequate treatment increases when using specialized care only, or conjointly with the primary care sector. To be retired and to be yet another "inactive" is associated with better treatment adequacy, as is living in Mediterranean, Paris or Central Eastern regions. Severe MDE also increases the probability of being adequately treated.

Discussion: Levels of treatment adequacy differ between health professionals, even when sociodemographic characteristics of their patients and the severity of their disorders are controlled; specialized care, in particular when associated with primary care use of services, is correlated with the highest rates of adequate treatments, and should therefore be recommended. Geographical areas are associated with adequation of treatments, but not with use of healthcare systems. This suggests that disparities in the organization of the healthcare systems and in the collaboration between professional might exist in the different areas.