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Quality of Outpatient Depression Treatment in Patients With Comorbid Substance Use Disorder.
- Source :
-
American Journal of Psychiatry . May2021, Vol. 178 Issue 5, p414-423. 10p. - Publication Year :
- 2021
-
Abstract
- <bold>Objective: </bold>Clinical practice guidelines recommend concurrent treatment of co-occurring depression and substance use disorders; however, the degree to which patients with substance use disorders receive guideline-concordant treatment for depression is unknown. The authors investigated the provision of guideline-concordant depression treatment to patients with and without substance use disorders in a large integrated health care system.<bold>Methods: </bold>In a retrospective cohort study of 53,034 patients diagnosed with a depressive disorder in fiscal year 2017 in the U.S. Veterans Health Administration, the authors assessed the association of comorbid substance use disorders with guideline-concordant depression treatment, including both medication and psychotherapy, while adjusting for patient demographic and clinical characteristics.<bold>Results: </bold>Guideline-concordant depression treatment was lower across metrics for patients with co-occurring depression and substance use disorders compared to those without substance use disorders. Consistent findings emerged in covariate-adjusted models of antidepressant treatment, such that patients with substance use disorders had 21% lower odds of guideline-concordant acute treatment (adjusted odds ratio=0.79, 95% CI=0.73, 0.84) and 26% lower odds of continuation of treatment (adjusted odds ratio=0.74, 95% CI=0.69, 0.79). With regard to psychotherapy, patients with co-occurring depression and substance use disorders had 13% lower odds (adjusted odds ratio=0.87, 95% CI=0.82, 0.91) of adequate acute-phase treatment and 19% lower odds (adjusted odds ratio=0.81; 95% CI=0.73, 0.89) of psychotherapy continuation.<bold>Conclusions: </bold>Despite the availability of effective treatments for depression, patients with co-occurring substance use disorders are less likely to receive guideline-concordant depression treatment. Efforts to improve the provision of care to those with co-occurring substance use disorders should focus on clinician-based interventions and use of integrated care models to improve the quality of depression treatment. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 0002953X
- Volume :
- 178
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- American Journal of Psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 150289124
- Full Text :
- https://doi.org/10.1176/appi.ajp.2020.20040454