Mental Health Specialist Care for Depression: The Effect on Guideline-Concordant Depression Care of Adults with Co-Occurring Major Depressive Disorders and Diabetes

OBJECTIVES. Mental health specialists and primary care providers are the two major types of provider for depression care. Whether mental health specialist care provides better quality of depression treatment has long been a debate and a major interest of research, with the evidence even less clear in population with co-occurring physical conditions. The objectives of this study is to determine the effect of mental health specialist care on receiving guideline-concordant depression care among adults with co-occurring major depressive disorders (MDD) and diabetes.

METHODS. This study analyzed claims data from North Carolina Medicaid Analytic Extracts (MAX) during 2006-2011.Person-level fixed effect and instrumental variable estimation were implemented to examine the effect of having any mental health specialist visit during the acute phase of a MDD episode on receiving depression care (N=43,822).

FINDINGS On average, 43% of episodes had guideline-concordant depression care with either adequate antidepressant use or adequate psychotherapy use. Preferred instrumental variable specifications showed that mental health specialist care increased the probabilities of adequate pharmacotherapy, adequate psychotherapy, and guideline-concordant depression care by 19.4%, 15.4%, and 26.5%. Overall, mental health specialist care is found to increase the likelihood of receiving guideline-concordant care among those with co-occurring diabetes.

IMPACT. Despite the increased ease of use of depression treatments in primary care, seeing a mental health specialist still resulted in substantial increases in the quality of depression care received in adult Medicaid beneficiaries with complex healthcare needs.