Characteristics of patients with major depression who received care in general medical and specialty mental health settings

The purpose of this analysis was to compare depressed patients receiving care in the general medical setting with depressed patients receiving care in specialty mental health settings. The analysis was limited to 559 respondents from the NIMH Epidemiologic Catchment Area (ECA) study who met criteria for the diagnosis of major depression sometime in the year before the interview as defined by the Diagnostic Interview Schedule. Patients who received care in the general medical sector were more likely to be black, older than age 65, have a high school education or less, and to be women, and less likely to be in the highest socioeconomic quartile. A higher proportion of specialty mental health patients reported a lifetime history of delusions, met criteria for the diagnosis of panic disorder, obsessive-compulsive disorder, or schizophrenia, and had a lifetime history of psychiatric hospitalization. Depressed patients seen in the general medical sector had a lower chance of meeting criteria for major depression one year later than those seen in the specialty mental health sector. A multivariate analysis limited to an investigation of the relative importance of sociodemographic factors indicated that the following factors were significantly associated with receiving care in the specialty mental health care sector: Age groups 31-50 and 51-65, and single marital status. Black race was inversely correlated with use of specialty mental health care. These results suggest that data generated from the specialty mental health sector can be generalized to the general medical sector only after assessing demographic differences between the two groups. Demographic differences could be associated with differences in knowledge, attitudes, interpretation of symptoms, and treatment preferences related to depression.