I was surprised to learn that Mental Health Awareness Month was started in 1949, nearly seven decades ago. But have we made any progress since then? I would argue that although there is a general awareness in the United States that mental health conditions exist, we remain deficient in some extremely important aspects of the problem, including treatment utilization, prevention (yes that is a thing), and the removal of stigma. With regard to treatment utilization, I have been analyzing antidepressant and psychotherapy utilization for patients with a new major depressive disorder (MDD) diagnosis. To say the least, the results are disturbing.
In a population of 12,091 patients, the majority (53.9%) of patients were not receiving any treatment five months after their initial MDD diagnosis. These individuals were not filling prescriptions for antidepressants nor attending any kind of psychotherapy. You can see a rapid rise in the lack of treatment utilization as time elapses from the initial MDD diagnosis (Figure 1): In the first month, 89% of individuals received some form of treatment, but only 33% were still receiving treatment at 12 months. The only slightly encouraging statistic is that antidepressant adherence did not significantly decline, but stayed relatively constant from the first month (17%) to one-year post-diagnosis (12%).
Given these results, it is clear that there is tremendous room for improvement in healthcare utilization and treatment adherence in patients with MDD. As the number one cause of worldwide disability,1 it has been estimated that scaling up the effective treatment of depression and anxiety disorders by $147 billion between 2016 and 2030 would return $310 billion from that investment.2 This means that we can improve people’s lives while saving money! One approach that has been found to improve treatment quality for patients with depression is utilizing collaborative care, which is a multidisciplinary approach that includes primary care physicians, occupational clinicians, nurses, and administrators.3 And in an effort to help patients in new ways, fresh research is beginning to shed light on other potential solutions.
Whatever the approach, having a basic awareness of mental health disorders is only the beginning — we now need to take action by investing in our collective mental health. Whether this is a personal investment, like spending more time exercising, or a societal investment, like ramping up affordable access to mental health services for those who need it, I think that the only mistake is doing nothing. It is time to make some more progress.
Figure 1. Antidepressant and psychotherapy treatment utilization the first year after first depression diagnosis by depression severity. “AD Adherence” is defined as proportion of days covered (PDC) ≥0.8 during the two-week span. “Regular Psych” is defined as having at least two psychotherapy visits per month. “Irregular treatment” indicates a patient received either antidepressants or psychotherapy, but at PDC <0.8 and less than two psychotherapy visits per month.
- World Health Organization. Depression and other common mental disorders: global health estimates. World Heal Organ. 2017:1-24. doi:CC BY-NC-SA 3.0 IGO
- Chisholm D, Sweeny K, Sheehan P, et al. Scaling-up treatment of depression and anxiety: A global return on investment analysis. The Lancet Psychiatry. 2016;3(5):415-424. doi:10.1016/S2215-0366(16)30024-4
- Katon WJ, Seelig M. Population-based care of depression: Team care approaches to improving outcomes. J Occup Environ Med. 2008;50(4):459-467. doi:10.1097/JOM.0b013e318168efb7