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Psychotherapy and pharmacotherapy in depression
Regina H Powers1, Thomas J Kniesner, Thomas W Croghan
1Office of Applied Studies, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, 16-105, Rockville, MD 20857, USA. RPowers@samhsa.gov
The Journal of Mental Health Policy and Economics
|October 28, 2003
Summary
Choosing a psychiatrist for depression treatment, rather than other providers, significantly reduces treatment failure, independent of therapy intensity. Case management, however, increases treatment failure risk despite higher medication use.
Area of Science:
- Psychiatry and Mental Health
- Health Services Research
Background:
- Depression treatment involves pharmacotherapy and psychotherapy, with unclear relative roles and differing guidelines.
- Evidence on factors influencing combined treatment in real-world practice is limited.
Purpose of the Study:
- To identify key factors associated with combined pharmacotherapy and psychotherapy for depression.
- To examine the influence of provider choice, health plan characteristics, and patient factors.
Main Methods:
- Retrospective analysis of claims data from 1,023 individuals treated for depression.
- Examined provider type, insurance benefits, psychotherapy intensity, pharmacotherapy intensity, and treatment failure rates.
- Used regression models to control for diagnosis, comorbidity, and demographics.
Main Results:
- Psychiatrist-led care doubled psychotherapy use and slightly increased pharmacotherapy compared to other providers.
- Antidepressant prescriptions reduced treatment failure by 5%, but psychotherapy intensity did not.
- Patients seeing psychiatrists had half the likelihood of treatment failure, irrespective of psychotherapy.
- Case management increased pharmacotherapy and treatment failure likelihood.
Conclusions:
- Psychiatrist choice is linked to reduced depression treatment failure, suggesting care coordination benefits.
- Psychotherapy intensity did not impact treatment failure in this study.
- Managed care strategies like case management may increase treatment failure risk.