Impact of Distance and Facility of Initial Diagnosis on Depression Treatment

Authors

  • Paul N. Pfeiffer,

    1. Department of Psychiatry, University of Michigan Medical School, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109
    2. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI
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    • Address correspondence to Paul N. Pfeiffer, M.D., Department of Psychiatry, University of Michigan Medical School, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109; e-mail: ppfeiffe@umich.edu. Paul N. Pfeiffer, Marcia Valenstein, M.D., John F. McCarthy, Ph.D., and Kara Zivin, Ph.D., are with the Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI. Joseph Glass, M.S.W., is with the Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, and the George Warren Brown School of Social Work, Washington University, St. Louis, MO. Karen Austin, M.S., is with the Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI.

  • Joseph Glass,

    1. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI
    2. George Warren Brown School of Social Work, Washington University, St. Louis, MO
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  • Karen Austin,

    1. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI
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  • Marcia Valenstein,

    1. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI
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  • John F. McCarthy,

    1. Department of Psychiatry, University of Michigan Medical School, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109
    2. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI
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  • Kara Zivin

    1. Department of Psychiatry, University of Michigan Medical School, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109
    2. Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI
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Abstract

Objective. To assess whether distance to services or diagnosis at a hospital-based medical center compared with a community clinic influences the receipt of psychotherapy versus pharmacotherapy for depression.

Data Source. Veterans Affairs (VA) administrative data for 132,329 depressed veterans between October 2003 and September 2004.

Study Design. Multivariable logistic and multinomial regression models were used to examine the relationship between distance to the nearest mental health facility and the facility of initial depression diagnosis on receipt of any and adequate psychotherapy and/or pharmacotherapy, adjusted for patient characteristics.

Principal Findings. Compared with those living within 30 miles of the nearest mental health treatment facility, depressed patients living between 30 and 60 miles away had a decreased likelihood of receiving psychotherapy (OR=0.71; 95 percent CI: 0.66, 0.76) and a greater likelihood of receiving antidepressant treatment (OR=1.27; 95 percent CI: 1.22, 1.33). Initial diagnosis at a small community clinic compared with a VA medical center was not associated with a difference in receipt of any psychotherapy (OR=0.95; 95 percent CI: 0.83, 1.09), but it was associated with decreased likelihood of receiving eight or more psychotherapy visits (OR=0.46; 95 percent CI: 0.35, 0.61) or any antidepressant treatment (OR=0.69; 95 percent CI: 0.63, 0.75).

Conclusions. The VA and similar health systems should make efforts to insure adequate psychotherapy is provided to patients who initiate treatment at small community clinics and provide psychotherapy alternatives that may be less sensitive to travel barriers for patients living remote distances from mental health treatment. Extending services to small community clinics that support antidepressant treatment should also be considered.

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