Depressive and anxiety disorders are common and cause substantial disability. Medications and psychotherapies are effective, but many patients do not receive adequate treatment. Young and colleagues reviewed data from the National Comorbidity Survey (1997-1998) to estimate the rate of appropriate treatment of anxiety and depressive disorders in the U.S. population, along with the effects of insurance, provider type, and demographic characteristics.

During a 1-year period, 83% (CI, 81% to 85%) of 1636 adults with a depressive or anxiety disorder saw a health care provider, and 30% (CI, 28% to 33%) received appropriate treatment. Most saw only their primary care physician, and 19% (CI, 16% to 23%) of those patients received appropriate care. Ninety percent (CI, 85% to 94%) of the 320 patients who saw a mental health professional received appropriate care. Insurance status affected whether the individual saw a provider but had no effect on appropriateness of care. Appropriate treatment was less likely for men, black persons, less educated persons, and those younger than 30 or older than 59 years of age. When psychiatric medications were used, the dose and duration of therapy were appropriate for about 75% of the patients. Among patients seeing primary care physicians, those who received poor-quality care were less likely to report that their mental health problems were evaluated (35.6% vs. 65.3%; P < 0.001), that psychiatric drugs were recommended (11.4% vs. 55.7%; P < 0.001), or that referral to a mental health specialist was made (4.1% vs. 23.5%; P < 0.001) compared with those who received appropriate care. Patients who received poor-quality care were less likely than patients who had appropriate care to view themselves as needing mental health care (31.4% vs. 70%; P < 0.001).

These results indicate that most adults in the community with depressive or anxiety disorders do not receive appropriate treatment, even though the great majority did see a health care professional. In the past, most patients with depressive disorders treated in primary care settings did not receive adequate doses of medication for an adequate duration. This more recent study shows that prescribed psychiatric medications were usually given at an appropriate dose and duration. Thus, the current barriers to appropriate treatment of depression and anxiety disorders lie in recognition, diagnosis, referral, and acceptance by patients.

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