Medication management of depression - The impact of comorbid chronic medical conditions

Objective: This paper addresses the following question: Does quality of care for depression differ between depressed persons with and without chronic medical conditions (CMCs)? Methods: We used a population-based mental health survey to identify respondents aged 18 to 64 with the diagnosis of major depression in the past year (N=278). In our model, the dependent variable was guideline-level medication management of depression. Determinants for guideline-level care were modeled using multivariate logistic regression. Results: Depressed persons with CMCs were significantly more likely to receive guideline-level care for depression than were the depressed persons without CMCs (OR= 1.46; 95% C.I. = 1.12-1.90). This increased likelihood did not persist when the sample excluded persons seeing physicians at more than eight visits per year (OR= 0.81; 95% Cl = 0.35 - 1.90). Previous psychiatric hospitalization was the only other significant determinant of guideline-level care. Conclusion: Depressed persons with comorbid CMCs are more likely to receive guideline-level care for depression than are depressed persons without comorbid CMCs. However, the association did not persist once we excluded respondents who were high utilizers. This finding implies that further understanding of the interaction between depression care and comorbid CMCs will require a longitudinal focus on repeated physician-patient interactions. (C) 2004 Elsevier Inc. All rights reserved.