Though effective treatments
are available for individuals suffering from chronic depression and anxiety, very little is known about how often these treatments are used or how prevalent these conditions are among the
nation's general population.
But in a first-of-its-kind
study, UCLA researchers have developed estimates for both the prevalence of chronic psychiatric illness in the general population
and how often individuals suffering from such illnesses receive appropriate treatment.
In the study, published
in the December issue of the peer-reviewed journal Psychiatric Services and currently available online, researchers found that approximately 4.7%
of the nation's population suffers from persistent depression or anxiety disorders, with a minority of those afflicted receiving adequate medication or counseling.
"From a policy perspective,
this study indicates that we have to do much better in terms of helping people in the population and clinicians in primary
care," said lead author Dr. Alexander S. Young, a UCLA professor of psychiatry and director of health services for
the Department of Veterans Affairs Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC). "We need
to understand that psychiatric disorders are treatable with psychotherapy and/or medication. Patients would benefit if we
improved linkages between primary care and specialty mental health care so that patients are referred and accept referrals
to mental health specialists, especially when they are chronically ill.
"Also, we have to improve
insurance arrangements so that they encourage more intensive treatment in people who remain ill," he said.
The study was based on data
from Healthcare for Communities, a nationally representative household survey of adults in the United States. The researchers
analyzed responses from 1,642 adults with major depression or anxiety disorders. These surveys, conducted in 1997 and 1998, with follow-ups approximately 2 1/2 years later, assessed
diagnosis, quality of life, treatment satisfaction, medical conditions, suicidal thoughts, insurance, and the use of medications
and counseling.
At follow-up, the researchers
found that 59% of the individuals no longer met the criteria for having a psychiatric disorder. But to their surprise, they
found that among those who remained ill, there were only modest increases in medication use and no statistically significant
increase in the use of counseling for their disorders - measures that are known to significantly improve outcomes, especially
when used in combination.
Among this subgroup:
- 87% had a chronic, co-morbid medical disorder.
- In the prior year, 88% had seen a primary care practitioner, but only 22% had consulted a mental health specialist.
- In the 2 1/2 years between baseline and follow-up, use of medication rose from 21% to 29%, and use of counseling fell from 23% to 19%.
- Only 12% with persistent illness were getting both medication and counseling (the appropriate treatment in this situation).
- 51% had suicidal thoughts at follow-up.
- Men and those with less education received less treatment.
"Persistent depressive and anxiety disorders are remarkably common in the U.S. population and are associated with substantial morbidity. There are significant problems
with the quality of care received by this population, and these problems persist over time," the researchers concluded. "In
the population with persistent depressive and anxiety disorders, increasing the rate of appropriate care from its current low level could result in substantial improvement in individuals'
lives."
In addition to Young, study
authors included Ruth Klap, Ph.D., of the Health Services Research Center at UCLA; Rebecca Shoai, M.P.H., M.S.W., affiliated
with MIRECC; and Kenneth B. Wells, M.D., M.P.H., of the UCLA Department of Psychiatry and the RAND Corp.
The Robert Wood Johnson
Foundation funded the study, with additional support from the National Institute of Mental Health and the U.S. Department
of Veterans Affairs.
The UCLA Department of Psychiatry and Biobehavioral Sciences within the David Geffen School of Medicine is home
to faculty who are experts in the origins of and treatments for disorders of complex human behavior. The department is
part of the Semel Institute for Neuroscience and Human Behavior at UCLA, a world-leading interdisciplinary research and education
institute devoted to the understanding of complex human behavior and the causes and consequences of neuropsychiatric disorders.
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