How Are Patients With Depression Chosen for Appropriate Mental Health Services?

young teen girl talking to therapist
young teen girl talking to therapist
The probability of having a severe mental illness was associated with higher odds of a participant receiving both medication and counseling.

In patients with depression, the pathway to care, severity of symptoms, age, race/ethnicity, and place of residence have an effect on the specific type of mental health services they receive, according to a study published in Psychiatric Services in Advance.1 Having an understanding of how health and socioeconomic characteristics influence selection into various types of services and treatment modalities might help to enhance psychiatric services, thus decreasing the burden associated with untreated depression.

The investigators sought to identify sociodemographic and health characteristics related to the use of different mental health services, including counseling, medication, or both, among adults who experienced a major depressive episode in the prior year and had received professional outpatient mental health services. A total of 4169 adults comprised the analytic sample.

Data were derived from the 2015 and 2016 samples of the National Survey on Drug User and Health, an annual multistage area-probability sample survey that estimates the rate of substance use, mental health issues, and use of mental health services among the noninstitutionalized civilian population in the United States.2 Factors associated with the relative odds of receiving each modality of mental health services were compiled using multinomial logistic regression analyses.

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Overall, 69% of the participants received both prescription medication and counseling (ie, consulting with a healthcare professional about their depression; 2786 of 4169), 24% received counseling only (1012 of 4169), and 9% received prescription medication only (371 of 4169). Being ordered into mental health care was associated with a higher likelihood of receiving both medication and counseling. Furthermore, the probability of having a severe mental illness was associated with higher odds of a participant receiving both medication and counseling.

The investigators concluded that the ways in which individuals with depression enter mental health care and are chosen for various mental health service modalities might be an indicator of a person’s access to care. Findings from the current study imply that such dynamics as how patients enter into care (ie, independently or via coercion) are associated with the kinds of services they ultimately receive. Additional research is warranted, focusing on the connection among selection into mental health services, patient-reported outcomes, and treatment efficacy.


1. Alang S, McAlpine D, McCreedy E. Selection into mental health services among persons with depression [published online Mar 2, 2020]. Psychiatr Serv. doi:10.1176/

2. Results From the 2015 National Survey On Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016. Accessed M