Improving Primary Care Treatment for Depression Helps Cut Mental Health Treatment Disparities Among Men

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Wednesday
November 24, 2004

Improving care for depression in primary care medical practices may help narrow the gender gap that now leaves a greater proportion of depressed men untreated compared with women, according to a RAND Corporation study issued today.

Both men and women treated in medical practices that used a depression treatment improvement program were more likely to receive care for their depression than peers treated in medical practices that provided usual care, according to the study in the December edition of the journal Medical Care.

But some of the treatment approaches studied increased the rate of receiving appropriate care more among men than women. The findings suggest that quality improvement programs may help reduce the treatment disparity seen among the estimated 6 million depressed men in the United States, according to researchers from RAND Health.

“Interventions to improve the quality of treatment for depression in primary care settings can help both men and women,” said Cathy Sherbourne, a RAND senior behavioral scientist and lead author of the study. “But it is important to keep the interventions flexible so patients are offered a choice of treatments.”

Past research has shown that men are less likely than women to recognize, acknowledge, and seek treatment for their depression. In addition, their loved ones and even their physicians are less likely to detect depressive symptoms in men than women. Little is known about the reason for the disparity, although some researchers suggested it may be related to the fact that women are 1 to 3 times more likely to suffer from depression than men.

Last year, the National Institute of Mental Health began a public education campaign titled “Real Men. Real Depression” in an effort to boost treatment among depressed men. It's the first public health education campaign targeted to men with depression.

RAND researchers wanted to know whether men and women respond differently to efforts to improve treatment for mental health problems. So they examined the issue by analyzing results from Partners in Care, a pioneering depression treatment improvement program designed and tested by researchers from RAND and the UCLA School of Medicine in the late 1990s.

The study assigned 46 primary care practices across different sites in the United States to either their usual care for depression or to programs that provided education for providers and patients about depression treatments. Partners in Care provided resources to make it easier to get the treatments — either medication or cognitive-behavioral psychotherapy — if necessary. About 1,300 patients participated in the study and were followed for up to five years after treatment.

Sherbourne and her colleagues found that the treatment improvement effort increased the number of both men and women who receive care for depression in the short term, although women continued to receive more care than men even after the interventions were begun.

However, the two treatment improvement interventions had different effects on men's and women's care. In addition, men showed more improvement than women on some outcomes.

Men who received the intervention that provided medication management had a greater reduction in unmet mental health needs 12 and 18 months after treatment began. In addition, men who received treatment that facilitated psychotherapy had more improvement than women in both their quality of life and in their employment outlook 6-18 months after the treatment began. On the other hand, the intervention that provided medication management improved quality of life and employment for women at 6-12 months.

Findings suggest that to reach both men and women, quality improvement programs for depression should be flexible enough to provide basic quality improvement services and offer either facilitated access to therapy or nurse specialist support for ongoing management.

The Partners in Care depression treatment improvement program has been widely distributed to medical practices across the country and the materials are available free on the RAND Web site. In addition, researchers published a book for the lay public that provides education about depression and summarizes the principles in the intervention (“Beating Depression: The Journey to Hope,” McGraw-Hill, 2002, Jackson-Triche, Wells, and Minnium).

The latest RAND study was funded by the National Institute of Mental Health, the federal Agency for Healthcare Quality and Research, and the John D. and Catherine T. MacArthur Foundation. The study is titled “Do the Effects of Quality Improvement for Depression Care Differ for Men and Women? Results of a Group-Level Randomized Controlled Trial.”

Other authors of the study are Robert Weiss of the UCLA School of Public Health, Naihua Duan of the David Geffen UCLA School of Medicine, Chloe Bird of RAND, and Dr. Kenneth Wells of RAND and the David Geffen UCLA School of Medicine.

RAND Health is the nation's largest independent health policy research organization, with a broad research portfolio that focuses on health care quality, costs, and delivery, among other topics.

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