Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In their nationally representative
US survey, Dr Kessler and colleagues reported that of individuals who reported
depression, 64.3% seen in the specialty mental health sector had received
adequate care, but that only 41.9% of individuals seen in primary care had
received care at this level.1 Although these
percentages may seem to imply that the mental health sector provides better
care for patients with depression,2 there
are significant differences between patients with depression who seek care
from their primary physicians vs those who are treated by mental health specialists.
Patients with depression seen in the specialty mental health sector receive
more care and would not be there if they did not accept that they needed such
care. They also are probably more likely to adhere to treatment. The situation
in primary care is different, where patients with depression typically present
with somatic symptoms such as fatigue, may not accept a diagnosis of depression
if suggested, and may not be willing to obtain mental health treatment even
if it is offered.
Dietrich AJ, Oxman TE, Williams, Jr JW. Treatment of Depression by Mental Health Specialists and Primary Care Physicians—Reply. JAMA. 2003;290(15):1991–1993. doi:10.1001/jama.290.15.1991-a