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. 2010 Dec;61(12):1255-9.
doi: 10.1176/ps.2010.61.12.1255.

Association of general medical and psychiatric comorbidities with receipt of guideline-concordant care for depression

Susan L Ettner  1 , Francisca Azocar, Robert B Branstrom, Lisa S Meredith, Lily Zhang, Michael K Ong
Affiliations

Association of general medical and psychiatric comorbidities with receipt of guideline-concordant care for depression

Susan L Ettner et al. Psychiatr Serv. 2010 Dec.

Abstract

Objective: This study described the association of general medical and psychiatric comorbidities with receipt of guideline-concordant depression care.

Methods: Pharmacy, medical, and behavioral claims and enrollment data from OptumHealth in 2003-2006 were linked for 1,835 adults with a new depression diagnosis or a new antidepressant fill. Multiple logistic regression was used to estimate the association of comorbidities with receipt of guideline-concordant pharmacotherapy, guideline-concordant psychotherapy, and any guideline-concordant therapy.

Results: Eleven percent of patients received guideline-concordant psychotherapy; 23%, guideline-concordant pharmacotherapy; and 33%, any guideline-concordant therapy. Having a psychiatric but no medical comorbidity was associated with higher rates of guideline-concordant psychotherapy and overall guideline concordance; conversely, having a general medical but no psychiatric comorbidity was associated with lower rates of guideline-concordant psychotherapy. Comorbidities were associated with the probability of receiving any guideline-concordant therapy, but they were not associated with improved guideline concordance among patients already receiving therapy.

Conclusions: Patients with general medical comorbidities may not receive psychotherapy referrals, perhaps because of well-established relationships with their primary care providers.

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