Predictors of poor response to depression treatment in primary care

Abstract

Objective: Depression is pervasive and costly, and the majorit of depression is treated in primary care. The objectiv of this study was to identify patient characteristics predictiv of poor depression outcomes in primary care clinics Methods: This observational study followed 792 patient receiving usual care for depression in 83 clinics acros Minnesota for at least six months between 2008 and 2010 The primary outcome was an ordinal outcome of remissio or response without remission ("response") six months afte the start of treatment. The outcome was assessed via telephon administration of the Patient Health Questionnaire-9 Associations of patient characteristics with the primary outcom were assessed by using ordinal logistic regression Results: Themajority of patientswere female, Caucasian, an employed, and most had some college education and good very good, or excellent self-rated health. At baseline, 32% ha mild depression, 40% moderate depression, 20% moderatel severe depression, and 8% severe depression. One-Third o patients had psychotherapy or psychiatric care in addition t antidepressant medications. At six months, only 47% of patient obtained depression remission or response. Patient were significantly less likely to experience remission or respons if they rated their health as poor or fair or if they wer unemployed and were more likely to achieve remission o response if they were younger or had mild depression Conclusions: Patients with poor or fair health or who wer unemployed were less likely to respond to usual depressio care and may be good candidates for limited, but potentiall more effective, intensive treatment resources for depression.