Psychiatric practice variations in the diagnosis and treatment of major depression

Practice variations in the diagnosis, treatment, and outcomes of patients with major depression were examined within six psychiatric practices participating in a national outcomes-management project.

Six of 20 psychiatric clinics met selection criteria for this study and provided a database of 5, 106 patients. Patients completed the BASIS-32, the Short-Form-36 Health Survey, and a Beginning Services Survey. Treatment information was also obtained directly from the clinician or through a medical record review.

Although 73.1 to 77 percent of patients screened positive for a depressive disorder, only 18.5 to 36.8 percent were diagnosed with major depression (p<.001). Between 39 and 72 percent of patients received psychotropic medications, a significant difference across sites (p<.001). In addition, the number of psychotherapy sessions was significantly different across sites (p<.001).

Patient care varies considerably across psychiatric practices, a finding that is particularly relevant for developers of performance indicators and risk-adjustment strategies for mental health.