Psychiatric Practice Variations in the Diagnosis and Treatment of Major Depression

• Published in: Psychiatric services (Washington, D.C.) Vol. 51; no. 3; pp. 336 - 340
• Main Authors: Kramer, Teresa L., Daniels, Allen S., Zieman, Gayle L., Williams, Carla, Dewan, Naakesh A.
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01.03.2000; American Psychiatric Association
• Subjects: Adult; Biological and medical sciences; Catchment Area (Health); Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - therapy; Female; Humans; Institution therapy. Inpatient treatment; Male; Medical sciences; Mental Health Services - organization & administration; Middle Aged; Outcome Assessment (Health Care); Patient Compliance; Practice Patterns, Physicians; Psychiatry - trends; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy - methods; Psychotropic Drugs - therapeutic use; Surveys and Questionnaires; Treatment Outcome; Treatments; United States; United States; North America; America; Mood disorder; Social environment; Human; Psychiatric hospital; Evaluation; Mental health; Depression; Geographical division; Treatment; Professional practice; Diagnosis; Comparative study; Public health; Geographical variation
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.51.3.336

OBJECTIVE: Practice variations in the diagnosis, treatment, and outcomes of patients with major depression were examined within six psychiatric practices participating in a national outcomes-management project. METHODS: Six of 20 psychiatric clinics met selection criteria for this study and provided a database of 5,106 patients. Patients completed the BASIS-32, the Short-Form-36 Health Survey, and a Beginning Services Survey. Treatment information was also obtained directly from the clinician or through a medical record review. RESULTS: Although 73.1 to 77 percent of patients screened positive for a depressive disorder, only 18.5 to 36.8 percent were diagnosed with major depression (p<.001). Between 39 and 72 percent of patients received psychotropic medications, a significant difference across sites (p<.001). In addition, the number of psychotherapy sessions was significantly different across sites (p<.001). CONCLUSIONS: Patient care varies considerably across psychiatric practices, a finding that is particularly relevant for developers of performance indicators and risk-adjustment strategies for mental health.