Utilization of antidepressants, antipsychotics, and psychotherapy among privately insured individuals with depression: association with guideline concordance, regional variation and insurance architecture

Abstract

Depressive disorders, more specifically major depressive disorder and dysthymia are serious, disabling illnesses. Approximately one in five persons is affected by a mood disorder at some point. My thesis examines the utilization rates of several pharmacologic and non-pharmacologic options of treatment for depression in a privately insured population in the US. The purpose of this study is to increase knowledge related to utilization patterns of pharmaceuticals or psychotherapy and yield recommendations to increase primary care capacity to deal with mental illnesses and acknowledge the variability of treatment in terms of geographical location and insurance type. Results indicate that large proportions of depressed children, adolescents and adults are not receiving any treatment or are receiving treatments unsupported or equivocally supported by empirical evidence. For insurance variation, managed care is more likely to utilize more established medication therapy with more robust evidence supporting their effectiveness. Finally, this study found large geographical variation that couldn't be explained on the basis of illness severity, guideline-concordance, or subject's characteristics. The extent to which this variation reflects system inefficiencies or inappropriate care is discussed.