Quality of depression care for people with coincident chronic medical conditions.

OBJECTIVE

Depression is common and associated with poor outcomes for people with chronic medical conditions (CMCs). The goals of this study were (1) to determine the effect of CMCs on the use and quality of depression care and (2) to understand whether the patient-provider relationship mediates the relationship between CMCs and depression care quality.

METHOD

With the use of data from the 1997-1998 National Survey of Alcohol, Drug, and Mental Health Problems (Healthcare for Communities), the relationships between CMCs, depression recognition, receipt of minimally adequate depression care and the patient-provider relationship were assessed with multivariate linear and logistic regression models for 1309 adults who met criteria for major depressive disorder.

RESULTS

Depressed patients with a CMC were more likely to have their depression recognized by a provider (OR=2.10; 95% CI=1.32-3.35) and to take antidepressant medications (32% vs. 19%, P=.02) than those without a CMC. However, having a CMC was not associated with receiving minimally adequate depression care or patient satisfaction. Depression recognition was associated with number of medical visits (OR=1.12; 95% CI=1.09-1.15), having a usual source of care (OR=3.57; 95% CI=2.26-5.63), and provider trust (OR=1.07; 95% CI=1.04-1.11).

CONCLUSION

Depressed people with a comorbid CMC are more likely to have their depression recognized than those without a CMC, though were no more likely to receive minimally adequate depression care. Aspects of the patient-provider relationship, including trust and continuity of care, may help to explain the increased rate of depression recognition among patients with severe CMCs.