Depression Treatment Utilization Low in Symptomatic Patients

Woman with depression
Sitting woman with depression
Treatment rates for patients with major depressive disorder with an elevated PHQ-9 score were characterized in this study.

The following article is a part of conference coverage from Psych Congress 2020 Virtual Experience, held virtually from September 10 to 13, 2020. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the Psych Congress 2020.


Although patients with severe depression were more likely to use antidepressants and psychotherapy than patients with mild depression, treatment utilization was low in both groups, according to study data presented at Psych Congress 2020, held virtually from September 10 to 13, 2020.

This retrospective cohort study enrolled patients with major depressive disorder and commercial or Medicare insurance. Patient information was obtained from integrated medical and pharmacy claims and Electronic Health Records from the years 2014 to 2018.

The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression symptom severity. Patients with a PHQ-9 score ≥5 were included. Study entry occurred when an index score of PHQ-9 ≥5 was first observed. The study period covered the 6 months before and 12 months after the index date. The primary outcome was the use of antidepressant therapy and/or psychotherapy.

The study cohort comprised 29,236 adults with major depressive disorder. According to PHQ-9 scores, the distribution of depression severity was as follows: 41.8% mild (PHQ-9 score: 5-9), 27.6% moderate (10-14), 18.8% moderately severe (15-19), and 11.9% severe (20-27). In the 6 months preceding elevated PHQ-9 score, 33.1% of patients had used antidepressant therapy and 7.3% had used psychotherapy. In the 12 months after the index date, these percentages increased to 43.6 and 14.7%, respectively. In patients who had not received depression treatment in the 6 months before the index date, 20.6% and 10.7% began antidepressant therapy and psychotherapy, respectively, during follow-up. The percentage of patients who initiated treatment during the follow-up period increased with increasing depression severity. However, even in patients with severe depression, 61% remained untreated during follow-up.

Although treatment rates increased in the year after elevated PHQ-9 score, many patients still did not receive care for depression. “Novel interventions may be needed to reduce symptom severity and increase use of treatments for [major depressive disorder],” investigators wrote.

Disclosure: This study was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. Please see the original reference for a full list of authors’ disclosures.

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Ruetsch C, Liberman JN, Rui A, Forma F. Antidepressant and psychotherapy treatment among patients with major depressive disorder and an elevated PHQ-9 score. Presented at: Psych Congress 2020 Virtual Experience; September 10-13, 2020. Poster 109.