Veterans With Depression Lack Access to Timely Follow-up Care

After screening positive for having depression, most veterans received at least minimal treatment but lacked access to timely follow-up care, according to new findings published in JAMA Network Open.

Lucinda B Leung, MD, PhD, Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, and colleagues confirmed these results with a cohort study that measured adherence to 2016 US Preventive Services Task Force recommendations for appropriate treatment and follow up for patients with depression.

Dr Leung and colleagues identified eligible veterans at 82 primary care Veterans Health Administration clinics in California, Arizona, and New Mexico between October 1, 2015, and September 30, 2019.

The final cohort included 607,730 veterans, of which 8% (82,998 of 997,185 person-years) screened positive for depression on the 2-item Patient Health Questionnaire. The majority of participants were men (89.9%), aged an average 59.4 years, and identified as nonHispanic White (55.9%).

“Clinicians identified fewer than half with depression (15,155 patients), of whom 32% (5034 of 15,650 person-years) met treatment guidelines for timely follow-up and 77% (12,026 of 15,650 person-years) completed at least minimal treatment,” explained Dr Leung and colleagues.

According to the findings, younger age, participants who identified as Black, and those with comorbid psychiatric diagnoses were all associated with timely follow up.
Authors noted individual quality metric components like medication or psychotherapy “were associated differently with overall quality results among patient groups, except for age.”

Overall, the majority of patients met guidelines completing minimal treatment but a minority received timely follow up.

“More research is needed to understand whether the discrepancy between patients who screened positive and patients identified as having depression reflects a gap in recognition of needed care,” concluded Dr Leung and colleagues.

Reference:
Leung LB, Chu K, Rose D, et al. Electronic Population-Based Depression Detection and Management Through Universal Screening in the Veterans Health Administration. JAMA Netw Open. 2022;5(3):e221875. doi:10.1001/jamanetworkopen.2022.1875