EMBARGOED FOR RELEASE: 3 p.m. (CT) TUESDAY, JANUARY 21, 1997 Media Advisory: To contact Robert M.A. Hirschfeld, M.D.,
call Alana Mikkelsen at 409/772-2618.
DEPRESSION SERIOUSLY UNDERTREATED Society and individuals pay high cost for undertreatment
CHICAGO--Individuals with depression are being seriously undertreated, even though effective treatments have been available for more than 35 years, according to an article in this week's issue of The Journal of the American Medical Association (JAMA).
Robert M.A. Hirschfeld, M.D., from the Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, chaired a consensus panel on the undertreatment of depression which was organized by the National Depressive and Manic Depressive Association (NDMDA).
The panel writes; "In light of the prevalence and perniciousness of depression, the economic cost of the illness, its treatability, and previous public and professional educational efforts, why are so many people with depression receiving inadequate treatment or getting no treatment at all?"
The panel also writes: "There is still an enormous gap between our knowledge about the correct diagnosis and treatment of depression and the actual treatment that is being received in this country. Reasons for the gap have been attributed to patient, provider and health system factors."
Panel members continue: "Patient-based reasons include: failure to recognize the symptoms, under-estimating the severity of depression, limited access to treatment, reluctance to see a mental health care specialist due to stigma, non-compliance with prescribed medical regimens, and lack of adequate insurance reimbursement.
Reasons that rest with physicians include: Failure of medical schools in providing sufficient education about psychiatric diagnosis, limited provider training in interpersonal skills, belief in the myth that psychiatric disorders are not 'real' illnesses, inadequate time to evaluate and treat depression, failure to consider psychotherapeutic approaches, avoidance of treating patients with depression because of poor insurance coverage, poor collaboration among providers, prescribing inadequate doses of antidepressant medication for inadequate durations, and the fact that psychiatric disorders may take more time to diagnose and treat than many other medical conditions."
The panel adds: "Some primary care physicians are reluctant to use the mental health care system because of financial constraints, a lack of qualified providers to refer to, or a fear of offending the patient. Finally, many managed health care systems create barriers to prescribing the best antidepressant medication, discourage the proper monitoring of patients, and do not allow for the proper recognition of the chronic and recurrent nature of depression. Too many patients with depression are treated for very brief periods of time and then lost to the health care system."
Depression is one of the most frequent of all medical illnesses. It is a pernicious illness associated with long duration of episodes, high rates of chronicity, relapse, and recurrence, psychosocial and physical impairment, and mortality and morbidity--with a 15 percent risk of death from suicide in patients who have ever been hospitalized for depression. Despite these facts, the vast majority of patients with chronic depression are misdiagnosed, receive inappropriate or inadequate treatment, or are given no treatment at all, according to information cited in the study.
The panel proposes the following strategies to improve the quality of services to depressed patients:
1. Educate patients to act as informed consumers and advocates. 2. Develop performance standards for behavioral health care. 3. Remove barriers to provider recognition, diagnosis, and screening through educational programs. 4. Collaboration among primary care physicians, psychiatrists, and other mental health professionals. 5. Conduct research on the development and testing of new treatments. Editors note: The conference was supported by an unrestricted educational grant from Bristol-Myers Squibb. None of the participants (including consensus panel members and expert presenters) received an honorarium. Only travel and lodging expenses were supported.
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For more information:
contact the AMA's Amy Fox at 312/464-4843.
email: [email protected]
AMA web site: http://www.ama-assn.org
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