Study Identifies Characteristics of Depression Care in Primary Care Clinics

Depression, a significant cause of disability in the United States, is largely managed by primary care providers; therefore, understanding how these clinicians manage depression is an important step toward identifying opportunities for improvement.

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.


Health resource utilization was found to be greater in patients with a diagnosis of major depressive disorder (MDD) compared with patients with non-MDD depression, according to study data presented at Psych Congress 2020 Virtual Experience, held virtually from September 10 to 13, 2020. However, both cohorts had low rates of specialized mental health care use. Instead, the majority of patients with depression were managed exclusively by primary care providers (PCPs).

This retrospective cohort study extracted electronic health record data from primary care clinics across the United States for the years 2013 to 2017. Depression was identified using the relevant International Classification of Disease (ICD) codes from the 9th (ICD-9) and 10th (ICD-10) revisions. Patients with an ICD-9/ICD-10 code for MDD were compared with patients with an ICD-9/ICD-10 code for any non-MDD form of depression. Features of care utilization were compared between the MDD and non-MDD cohorts.

The study cohort comprised 7760 patients with non-MDD depression and 22,970 patients with MDD. Overall, 26.3% of patients with MDD had undergone depression screening with the Patient Health Questionnaire-9 (PHQ-9) compared with 16.1% of patients with non-MDD depression. A significantly greater proportion of patients with MDD vs those with non-MDD depression had used antidepressants (70.7% vs 42.6%; P <.05). Patients with MDD vs those with non-MDD depression were more likely to have had a follow-up visit with a mental health specialist after diagnosis at their primary care clinic (7.4% vs 4.0%; P <.05) and were less likely to receive care exclusively from their PCP after diagnosis (84.7% vs 88.4%; P <.05). Patients with MDD were also more likely than patients with non-MDD depression to visit urgent care (16.8% vs 15.0%) or emergency departments (8.8%, 5.7%) and to have inpatient admissions (3.7% vs 1.9%).

These data suggest that depression screening with PHQ-9 may be underutilized in primary care. Overall healthcare utilization was higher among patients with MDD compared with patients with non-MDD depression. However, mental health specialist visits were low in both cohorts. Further study of depression management in primary care settings is crucial for improving mental health care uptake.   

Disclosure: The study was supported by Takeda Pharmaceuticals USA and Lundbeck LLC, and some study investigators are employees of these companies.  Please see the original reference for a full list of authors’ disclosures.

Visit Psychiatry Advisor’s meetings section for complete coverage of Psych Congress 2020.



Azar KMJ, Pressman A, Vaidya S, et al. Characterizing management of depression in a primary care setting. Presented at: Psych Congress 2020 Virtual Experience; September 10-13, 2020. Poster 121.