The Quality of Care for Depressive and Anxiety Disorders in the United States

Abstract

DEPRESSIVE AND anxiety disorders are common and have a substantial impact on functioning and quality of life. National treatment guidelines for major depression document that effective treatments include antidepressant medications and cognitive-behavioral and interpersonal psychotherapies.^1-5 Research also supports the efficacy of these treatments for dysthymia, although the literature is less well developed.^5-9 In panic disorder, treatment guidelines strongly support the efficacy of cognitive-behavioral psychotherapies, some antidepressant medications, and benzodiazepines.^10,11 In generalized anxiety disorder (GAD), effective treatments include antidepressant medications, buspirone, benzodiazepines, cognitive-behavioral psychotherapies, and probably relaxation and unstructured therapy techniques.^12-15 Although these treatments are effective, patients frequently do not receive them.¹⁶ However, there have been few national studies of the quality of mental health care. Researchers have successfully characterized national quality of care for a variety of medical disorders,¹⁷ and it is important to know whether similar research in psychiatry can provide data to inform policy nationally. While the existing literature suggests that quality of care for common psychiatric disorders is moderate to poor across different types of treatment settings, national data are limited and not clinically detailed, and it is unclear which populations are at greatest risk for not receiving appropriate care.