Receipt of pharmacotherapy and psychotherapy among a nationally representative US sample of privately insured adults with depression: associations with insurance plan arrangements and provider specialty

ObjectivesThe use of combination therapy (psychotherapy + pharmacotherapy) to treat depression still offers fewer relapse episodes and higher odds of adherence to proper treatment. Little is known however, about the utilization rates of the various pharmacologic options available for depression across physician specialties and insurance arrangements in the private sector. The purpose of this study was to quantify provider, patient, insurance and geographic factors associated with the use of pharmacologic options. MethodsA 2010-2011 retrospective cohort of new antidepressant users aged from 18 to 64 were included and using data from medical and pharmacy commercial claims from Health Analytics Marketscan Database, a nationally representative sample of privately insured individuals with depression, adjusted multiple logistic regression models calculated individual estimates. Key findingsFourteen per cent of adults with depression received at least one monotherapy medication; only 1.1% received combination therapy (medication + psychotherapy). Almost 80% of patients were treated by generalists. Adjusted estimates reported that being treated by a primary care provider, having a fee-for-service insurance arrangement, living in the South and younger age (18-44) were associated factors with lower utilization rates of combination therapy. Bupropion, second-generation antipsychotics and tricyclic antidepressants were more often used by mental health specialists. ConclusionsLess than one-fifth of patients received pharmacotherapy or psychotherapy regimes. After controlling for severity and complexity of depression, data suggest large differences about treatment choices among specialists and generalists, even though the latter remains as de facto mental health service system' in the USA. Recommendations to increase consistent evidence-based practice are discussed.