Patients with co-occurring depression and substance use issues are significantly less most likely to obtain sufficient depression therapy, researchers located in a retrospective cohort study published in the American Journal of Psychiatry In Advance involving 53,034 patients who had been diagnosed in the United States Veterans Health Administration (VHA) in fiscal year 2017.
Past investigation has indicated that correctly treating co-occurring depression and substance use issues includes treating each issues simultaneously (depression with pharmacotherapy, psychotherapy or each) and that only about half of sufferers with each diagnoses obtain therapy for depression, the researchers mentioned. Thus, investigators wanted to ascertain whether or not people with each issues obtain a related level of care in outpatient depression therapy as these people who have depression but not substance use issues.
The researchers integrated 53,034 patients of the VHA who experienced a new episode of depression in fiscal year 2017, 30 days just before or right after getting a depression diagnosis that indicated active depression (Patient Health Questionnaire (PHQ-2 higher than 2 or PHQ-9 higher than 9) and excluded sufferers who had currently received a depression diagnosis or therapy (psychotherapy or prescription) for depression in the year just before the index diagnosis date. The researchers also excluded sufferers who had bipolar disorder, character issues or developmental issues. The cohort integrated 7516 sufferers who had received a substance use disorder diagnosis in the year just before getting the depressive disorder diagnosis.
To figure out conformance with the sufficient acute-phase therapy and the sufficient continuation-phase therapy measures of the Healthcare Effectiveness Data and Information Set (HEDIS), the researchers investigated whether or not the patients received a prescription inside the 90 days following the depression diagnosis for an antidepressant for at least 84 of the 114 days following the initial prescription and continuing antidepressant medication for 180 of the initial 231 days following the initial prescription. They also investigated whether or not the patients received a psychotherapy session for depression inside 90 days of the index depression diagnosis and at least 3 psychotherapy sessions in the 12 weeks following the initial therapy session.
They produced 4 logistic regression models to figure out whether or not there was an association among substance use disorder diagnosis, sufficient acute- and continuation-phase antidepressant or psychotherapy, adjusted for covariates and evaluated with every person substance use disorder.
The researchers located that 28,081 of the 53,034 patients in the cohort received any antidepressant therapy and 18,484 sufferers received any psychotherapy for depression inside 90 days following their diagnosis. The 7,516 patients with substance use issues had reduced odds of getting acute or continuation phases of antidepressants (acute phase, adjusted odds ratio (AOR)=.79, 95% CI=.73, .84, P <.001 continuation phase, AOR=.74, 95% CI=.69, .79, P <.001) or psychotherapy (acute phase, AOR=.87, 95% CI=.82, .91, P <.001 continuation phase, AOR=.81, 95% CI=.73, .89, P <.001) that met the suggestions.
Without adjusting for covariates, the researchers located that 59.4% of the 7,516 sufferers who had each a depressive disorder diagnosis and a substance use disorder diagnosis received acute-phase antidepressant therapy even though 66.2% of the sufferers with no substance use issues received that therapy. The distinction in price of therapy for continuation-phase antidepressant therapy was higher: 36.3% of sufferers with co-occurring substance use issues received therapy even though the price rose to 44.8% for sufferers with no each issues.
Psychotherapy was much more regularly supplied in each acute and continuation types to these with no substance use issues (35.4%, 32.2% respectively) than to these with each issues (31.6%, 26.8%).
Of the patients with substance use issues who received therapy, 1,117 received psychotherapy and 2,390 received antidepressant therapy in mental well being clinics, 1,014 received psychotherapy and 1,287 received antidepressants in principal care/principal care mental well being integration clinics, 83 received psychotherapy and 102 received antidepressants in substance use disorder specialty clinics, and 163 received psychotherapy and 265 received antidepressants in other clinics.
“By assessing both antidepressant medications and psychotherapy for depression, we found that psychotherapy does not account for the lower utilization of medication-based interventions among patients with comorbid substance use. Indeed, receipt of guideline-concordant antidepressant and psychotherapy treatments is consistently lower across depression care metrics among those with comorbid substance use disorders,” the researchers mentioned.
Limitations of the study included the sole inclusion of veterans in care inside the VHA program, the exclusion of solutions received outside the VHA program and the emphasis on solely the indicators of sufficient acute and continuation phases of care to the exclusion of other facets of higher-good quality care.
“Although the magnitude of difference (approximately 20% lower odds) may seem modest, both depression and substance use disorders are highly prevalent, such that even modest differences amount to large numbers of individuals. These findings highlight the opportunity for increased depression treatment across both treatment modalities for those with substance use disorders to achieve guideline-concordant care.”
Reference
Coughlin LN, Pfeiffer P, Ganoczy D, Lin LA. Quality of outpatient depression treatment in patients with comorbid substance use disorder (published on line October 29, 2020). AJP in Advance. doi: 10.1176/appi.ajp.2020.20040454
