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October 15, 2003

Treatment of Depression by Mental Health Specialists and Primary Care Physicians—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(15):1991-1993. doi:10.1001/jama.290.15.1991-a

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.

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