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Guideline concordance of treatment for depressive disorders in Canada

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Abstract

Background

Depression is one of the most prevalent mental health problems worldwide with considerable social and economic burdens. While practice guidelines exist, their adherence is inconsistent in clinical practice.

Objective

To provide up-to-date national estimates of the adequacy of treatment received by Canadians having suffered a major depressive disorder (MDD) and examine factors associated with this adequacy. To evaluate the impact of different definitions of guideline-concordant treatment on the results.

Subjects

Data were drawn from the Canadian Community Health Survey, cycle 1.2: Mental Health and Well-Being (CCHS 1.2), a nationally representative survey conducted in 2002 and targetting persons aged 15 years or older living in private dwellings. In order to calculate the prevalence of treatment adequacy, we used a sample of 1,563 individuals meeting the criteria for MDD in the 12 months preceding the survey. A subset of 831 subjects who reported having used health services for mental health purposes at least once during that time served to identify the factors associated with treatment adequacy.

Measurements

Four definitions of minimally adequate treatment were considered and covariates were selected according to a well-known behavioral model. The analyses consisted of prevalence estimates and logistic regression models.

Results

Among selected subjects, 55% received guideline-concordant treatment according to the Canadian guidelines. Inadequacy was more prevalent in rural settings, for less complex cases, and in the general medical sector. Depending on the definition, prevalence of guideline-concordant treatment ranged between 48 and 71%, and factors associated with guideline-concordant treatment were mainly need factors and sector of care.

Conclusions

A large proportion of people with a depressive disorder do not receive minimally adequate treatment. Improved access to and quality of treatment is required, especially in primary care settings.

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Acknowledgments

This study was supported by grants from the Quebec Inter-University Center for Social Statistics, from the Department of Social and Preventive Medicine, University of Montreal, and from the Faculté des études Supérieures, University of Montreal. The research and analyses are based on data produced by Statistics Canada; the opinions expressed do not represent the views of Statistics Canada. Conflict of interest: The authors report no conflicts of interest relevant to the subject matter in this article.

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Authors and Affiliations

  1. Dept. of Social and Preventive Medicine, Faculty of medicine, University of Montreal, Montreal, QC, Canada

    Arnaud Duhoux, Louise Fournier PhD, Cat Tuong Nguyen PhD, Pasquale Roberge & Rachelle Beveridge

  2. Institut national de Santé Publique du Québec, 190 Crémazie blvd. East, Montreal, QC, H2P 1E2, Canada

    Arnaud Duhoux, Louise Fournier PhD, Cat Tuong Nguyen PhD & Pasquale Roberge

  3. Groupe de Recherche Interdisciplinaire en Santé, Montreal, QC, Canada

    Arnaud Duhoux, Louise Fournier PhD, Cat Tuong Nguyen PhD & Pasquale Roberge

  4. Groupe de recherche sur l’équité d’accès et l’organisation des services de santé de première ligne (GREAS1), Montreal, QC, Canada

    Arnaud Duhoux & Louise Fournier PhD

Authors
  1. Arnaud Duhoux
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  2. Louise Fournier PhD
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  3. Cat Tuong Nguyen PhD
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  4. Pasquale Roberge
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Correspondence to Arnaud Duhoux.

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Duhoux, A., Fournier, L., Nguyen, C.T. et al. Guideline concordance of treatment for depressive disorders in Canada. Soc Psychiat Epidemiol 44, 385–392 (2009). https://doi.org/10.1007/s00127-008-0444-8

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  • DOI: https://doi.org/10.1007/s00127-008-0444-8

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