In Brief

Only one in seven patients with depression and anxiety disorders received care consistent with evidence-based treatment recommendations, according to a recent Harvard Medical School study.

The study found that patients who lack coverage for mental health disorders were only 24 percent to 36 percent as likely to receive adequate care as patients with coverage.

"Our results indicate that unless insurance coverage for mental illness is broad, patients will have limited access to evidence-based treatments," says researcher Philip Wang, MD, DrPh, an instructor in medicine at Brigham and Women's Hospital and Harvard Medical School. "There is a need for parity between coverage for physical and mental disorders."

Evidence-based treatment is defined as either having eight visits with a psychologist, psychiatrist or other mental health specialist, or being prescribed medication for depression or anxiety and having four follow-up visits with a physician. The study, "Recent care of common mental disorders in the United States," suggests that insurance coverage is a significant barrier to receiving adequate mental health care.

In the study, Wang and his colleagues analyzed data from the Midlife Development in the United States Survey, a national telephone and mail survey conducted in 1996 by the John D. and Catherine T. MacArthur Foundation Network on Successful Midlife Development. More than 3,000 respondents were asked whether they sought help for mental health problems within the last 12 months and, if so, what types of professionals they saw and their total number of office visits. They were also asked about medication use.

The study shows that primary-care physicians are increasingly being asked to care for people with mental illness. Primary-care physicians treated nearly twice as many patients with depression, panic disorder and generalized anxiety disorder as mental health specialists.

However, the study found that mental health specialists were more likely to provide evidence-based treatments than primary-care physicians. About 43 percent of the patients treated by mental health specialists, including psychologists and psychiatrists, received adequate care, compared with 28 percent of the patients treated by primary-care physicians.

The study also found that African-Americans were only 10 percent as likely to receive evidence-based treatment as white patients. However, Wang says, further study is needed to determine if this difference is due to a bias among providers or if African-Americans prematurely leave treatment more often than other groups.

The study appears in the May 2000 Journal of General Internal Medicine (Vol. 15, No. 5).