Primary Care Physicians' Selection of Low-Intensity Treatments for Patients With Depression

Most outpatient treatment for depression is delivered by primary care physicians (PCPs), yet little is known about which patient variables affect PCPs' selection of high-intensity interventions, namely antidepressant medications or psychotherapy, as opposed to less-intensive treatment regimens (eg, watchful waiting, exercise). Our objective was to ascertain whether the patient's symptom severity, presenting psychosocial stress, and lifestyle habits influenced treatment recommendations.

Forty-two PCPs from six Northeastern US primary care practices provided recommendations in response to vignettes depicting patients with major depressive disorder who varied in symptom severity, psychosocial stressors, and lifestyle habits.

Low-intensity-only interventions were recommended less than 25% of the time. Lower symptom severity and higher psychosocial stressors were associated with a greater likelihood of "low-intensity interventions only" recommendations. Less-intensive treatments were rarely recommended without more intensive treatments when the vignettes featured severe depression, whereas they were recommended 39% of the time with vignettes featuring mild/moderate symptoms. In response to the mild/moderate vignettes, the presence of psychosocial stressors led to a decreased likelihood of low-intensity-only recommendations.

Although vignettes depicting depressed patients with mild/moderate symptoms were more likely to elicit low-intensity treatment recommendations, the frequency was still low. Given the evidence that antidepressants and psychotherapy for mild/moderate depression may be no more effective, and likely less cost-effective, than low-intensity treatments, the findings suggest a need to disseminate knowledge of less intensive treatment options to primary care physicians.