Slow Growth in Utilization of Depression Care Despite More Insurance Coverage

Despite expanding insurance coverage for mental health conditions, rates of depression treatment have been lower than expected, indicating other non-financial barriers to care, according to a study published in JAMA Psychiatry

The study authors examined the trends in prevalence of depression and spending for treatment among the US population from 1998 to 2007 and 2007 to 2015. To do this, they analyzed health service and spending data from the 1997, 2007, and 2015 Medical Expenditure Panel Surveys, which included responses of 86,216 individuals. The authors aimed to determine whether utilization of depression treatments in the United States mirrored an increase in mental health coverage policies and the emergence of newly available therapy options. 

Of the 86,216 individuals included in the analysis, rates of outpatient depression treatment increased from 2.36 per 100 population in 1998 to 3.47 per 100 population in 2015. The proportion of respondents who were treated for depression using psychotherapy decreased from 53.7% in 1998 to 43.2% in 2007, and then increased to 50.4% in 2015. However, the proportion of individuals receiving pharmacotherapy remained steady at 81.9%, 82.4%, and 80.8%, respectively.

Despite the growing prevalence of treated depression and coverage by insurance, overall spending on depression-related care showed only a gradual increase from 1998 to 2015, the authors noted. Additionally, the rate of treatment for depression remains lower than the reported rate of incidence. 

For outpatient treatment of depression, national expenditures increased from approximately $12.4 million in 1997 to $15.6 million in 2007 and then to $17.4 million in 2015. This is consistent with a slowing growth in spend for depression, the authors indicated. The proportion of spending that came from uninsured individuals decreased during this time from 32% in 1998 to 20% in 2015, which can be largely attributed to increasing Medicaid coverage, according to the study.

“Despite historic expansions of insurance coverage for individuals with mental health conditions, it appears that in this case the growth in use and cost has been more modest than some might have expected,” lead study author Jason Hockenberry, PhD, associate professor at the Emory Rollins School of Public Health, said in a press release. “The main shift has been that Medicaid expenditures for this condition have increased markedly, with a concomitant decrease among those that do not have insurance.”

In addition, the lower-than-expected rate of treatment indicates that substantial barriers remain to individuals with depression, the authors concluded.

Reference 

Hockenberry J, Joski P, Yarbrough C, et al. Trends in treatment and spending for patients receiving outpatient treatment of depression in the United States, 1998-2015. JAMA Network. Doi: 10.1001/jamapsychiatry.2019.0633