Association of functional disability and treatment modalities with perceived effectiveness of treatment among adults with depression: a cross-sectional study

Approximately 17.3 million US adults had at least one major depressive episode (MDE) in 2017. Of those, about two-thirds received mental health services from health professionals. Persons with disabilities (PWD) have higher risks of depression and may face more challenges in seeking treatment.

Examined whether the presence of disabilities affected the perceived effectiveness of treatment for people with MDE who received outpatient mental health care.

We obtained MDE status, functional disability, modality of treatment (i.e., medication only, counseling only, medication plus counseling), self-reported effectiveness of treatment, and covariates from a nationally representative sample of US adults aged ≥18 years in the 2015-2019 National Survey on Drug Use and Health. We used multivariable logistic regression models with recommended survey weighting to examine associations between disability and perceived effectiveness of treatment.

The study population comprised 9992 respondents, representing 9.53 million US adults who had MDE and received outpatient mental health care in the past year. Overall, 58.9% had at least one functional limitation. A higher proportion of PWDs received medication plus counseling treatment compared to persons without disabilities (79.2% vs. 67.9%, P < .001). PWDs were significantly less likely to rate treatment as effective (OR = 0.77; 95% CI: 0.66-0.91). Odds ratios decreased as the number of limitations increased, and this association was moderated by treatment modality.

PWDs have poorer perceived outcomes of outpatient mental health care for depression, especially for treatment modalities involving counseling. These findings call for focused attention to depression treatment efforts for PWD that accommodate their needs.