Multiple national policies designed to expand insurance coverage for mental health services in the United States likely contributed to modest increases in treatment for depression, according to an analysis of three national medical expenditure surveys.
for their depression,” wrote Jason M. Hockenberry, PhD, of Emory University in Atlanta and his associates. The study was published in JAMA Psychiatry.
To examine trends in depression treatment and spending, especially after the passage of the Mental Health Parity and Addiction Equity Act in 2008 and the Affordable Care Act in 2010, the authors analyzed responses to the 1998, 2007, and 2015 Medical Expenditure Panel Surveys (MEPSs). The final analysis included 86,216 individuals who were a mean (SD) age of 37.2 years.
From 1998 to 2015, rates of outpatient treatment for depression increased from 2.36 (95% confidence interval, 2.12-2.61) per 100 to 3.47 (95% CI, 3.16-3.79) per 100. The treated prevalence among white survey respondents was more than double that of black respondents in 2015, at 4.00 (95% CI, 3.58-4.43) per 100, compared with 1.91 (95% CI, 1.55-2.28) per 100. Though psychotherapy use declined from 1998 to 2007 and then increased slightly in 2015, the proportion of patients treated using pharmacotherapy stayed relatively constant at 81.9% (95% CI, 77.9%-85.9%) in 1998 and 80.8% (95% CI, 77.9%-83.7%) in 2015.
Total spending on outpatient depression treatment increased from $12,430,000 in 1998 to $15,554,000 in 2007, and $17,404,000 in 2015. The percentage of spending that came from self-pay decreased from 32% in 1998 to 20% in 2015. At the same time, the percentage of spending covered by Medicaid increased, from 19% in 1998 to 36% in 2015.
Dr. Hockenberry and his coauthors acknowledged the limitations of their study, including the pitfalls of relying on national surveys over long periods of time. Specifically, the MEPSs depended in part on inexact measures, such as memory of health care visits; the 2015 survey also had a response rate of only 47.7%. That said, they reinforced their findings by citing how additional surveys that assess major depression – including the 2016 National Survey on Drug Use and Health – “have found similar proportions of treated depression to what we find in the 2015 MEPS.”
The study was supported in part by the Commonwealth Fund, and Dr. Hockenberry also reported receiving grants from the Commonwealth Fund. No other conflicts of interest were reported.
SOURCE: Hockenberry JM et al. JAMA Psychiatry. 2019 Apr 24. doi: 10.1001/jamapsychiatry.2019.0633.