Factors associated with receipt of adequate antidepressant pharmacotherapy by VA patients with recurrent depression

Adequate treatment of depression improves the prognosis of depressed individuals. This study identified sociodemographic, medical, psychiatric, and health care utilization factors associated with receipt of adequate antidepressant pharmacotherapy by Veterans Health Administration (VHA) patients with recurrent depression.

National VHA electronic medical records were used to construct a cohort of depressed patients who were experiencing a recurrent episode of depression between 1999 and 2006. Multinomial logistic regression determined factors that were associated with no receipt of treatment and with three levels of treatment: some antidepressant pharmacotherapy, adequate acute-phase pharmacotherapy, and adequate continuation-phase pharmacotherapy.

A total of 26,770 patients aged 25 to 80 years, most of whom were male (84.5%), who were experiencing a recurrent episode of depression were identified. Female patients and those with substance abuse or dependence, nicotine dependence, or panic disorder were more likely to receive adequate acute-phase or continuation-phase treatment (or both) than to receive no treatment. Nonwhite race, being unmarried, having only VA benefits, having generalized anxiety disorder, and receiving treatment outside the mental health specialty sector were associated with a lower likelihood of receiving guideline-concordant care.

Factors associated with receipt of adequate treatment for recurrent depression were similar to those found in previous studies for patients with new episodes of depression. This study was one of the first to focus specifically on patients experiencing recurrent depression, rather than combining patients with new and recurrent episodes in one sample. Continued research is warranted on how to modify factors to increase receipt of adequate care.