Rates of Depression Treatment Rise

But 'we are still not investing enough in treatment,' one expert says.

This article was first published on Wednesday, April 24, 2019 in MedPage Today

By Elizabeth Hlavinka, Staff Writer, MedPage Today.  

From 1998 to 2015, an increasing number of patients with depression received outpatient treatment, and total spending on depression rose in the U.S., researchers found.

In a sample of almost 90,000 respondents with depression, the treatment rate increased from 2.36 (95% CI 2.12-2.61) per 100 in 1998 to 3.47 (95% CI 3.16-3.79) per 100 in 2015, a relative increase of 46.8%, reported Jason Hockenberry, PhD, of Emory University in Atlanta, Georgia, and colleagues.

From 1998 to 2007, the relative growth in prevalence was 21.8% and from 2007 to 2015, it was 20.6%, the authors wrote in JAMA Psychiatry.

Total spending on depression increased by around 2% per year, though this was below the annual growth rate in overall health spending during that time, they noted.

The authors also found that the rate of depression treatment observed in this study was lower than the overall rate of diagnosed depression, which is from 4.8% to 12.8% for varying age groups, according to the 2016 National Survey on Drug Use and Health.

Indeed, there are still many individuals who are not receiving treatment for their depression, said Sherry Glied, PhD, dean of the Robert F. Wagner Graduate School of Public Service at New York University in New York City. However, the findings here are "encouraging" because they demonstrate that efforts to increase Medicaid coverage and include mental health benefits in more private insurance plans have worked, she said.

"This is not the case where there have been new advances in treatment -- there really have not been," Glied, who was not involved in this study, told MedPage Today. "What we are doing is disseminating things we know how to do to people who can benefit from them, and we did that by expanding insurance coverage."

Amir Afkhami, MD, PhD, of George Washington University in Washington D.C., emphasized that although national policies like the Mental Health Parity and Addiction Equity Act or provisions in the Affordable Care Act may have expanded care for certain subgroups, many patients still lack access to affordable treatment, especially those residing in rural areas, young people, and women.

Stigmas and a psychiatrist shortage may also prevent individuals from receiving treatment, he added.

"We are still not investing enough in treatment, despite some of the recent promising advances," Afkhami, who was not involved in this study, told MedPage Today.

Hockenberry and colleagues examined data from the 1998, 2007, and 2015 Medical Expenditure Panel Surveys (MEPS), which comprised data from around 86,000 individuals. Respondents were classified as receiving depression treatment if they had outpatient visits or medication for major depressive disorder, but were excluded if they had bipolar depression.

Pharmacotherapy included antidepressants, antipsychotics, anxiolytics and hypnotics, stimulants, and mood stabilizers.

Respondents were a mean age of around 37. A little over half were women, about three-quarters were white, 28% were Hispanic, and 18% were black.

These trends in treatment were more pronounced among certain demographic groups from 2007 to 2015, with young people ages <18 reporting a 69.4% increase in treated prevalence, followed by a 48.0% increase among adults 18-34, and a 11% increase among adults 50-64.

The number of black respondents receiving treatment for depression increased from 1.00 (95% CI 0.58-1.42) per 100 in 1998 to 1.91 (95% CI 1.55-2.28) per 100 in 2015. Still, a "substantial gap" remains across races, as white patients still received treatment at more than double the rate of black individuals, with 4.00 (95% CI 3.58-4.43) per 100 receiving treatment in 2015, Hockenberry noted.

Psychotherapy use among patients with treated depression was 53.7% in 1998 and 50.4% in 2015, and the proportion using pharmacotherapy hovered around 80% across the time period. Although selective serotonin reuptake inhibitor (SSRI) use declined from 60.7% to 47.9%, it was still the most-used pharmacotherapy, the authors added.

Meanwhile, they found that annual per capita expenditures on depression visits were $1,074 in 1998 and $957 in 2015, with a mean number of visits of 7.38 and 6.79, respectively. Total expenditures on depression treatment rose from $12,430,000 in 1998 to $17,404,000 in 2015, while pharmaceutical spending on depression was $848 per year in 1998 and $603 per year in 2015.

"Despite recent concerns about drug costs, in the case of depression, spending on drugs has decreased since 2007, despite a notable increase in the prevalence of treated depression," the authors wrote. "This decrease was likely attributable in part to the multiple blockbuster antidepressants coming off patent in recent years and becoming available as low-cost generics."

This study was primarily limited because analyses on trends are subject to the policies and other extraneous factors that could influence responses, the authors reported. This survey also relies on self-reported healthcare visits, although these responses are supplemented with healthcare professional responses for verification. Lastly, the response rate to the 2015 version of the survey was low (47.7%), so it is possible the results were affected by nonresponse bias.

This study was partially supported by the Commonwealth Fund.

Hockenberry received grants from the Commonwealth Fund.

No other relevant disclosures were reported.