Poster #123 - Psychotherapy and Antidepressant Use after U.S. Preventive Services Task Force Recommendation for Universal Adult Depression Screening

• In Event: Friday Poster Reception

Abstract

Introduction
Depression is one of the leading causes of disability, yet fewer than a third of adults with depression receive any treatment. Barriers to depression treatment include stigma, cost, provider availability, and differential provision of diagnoses and treatment. In January 2016, the U.S. Preventive Services Task force (USPSTF) issued a Grade B recommendation for universal adult depression screening to advance accurate diagnosis and appropriate treatment. My objective was to evaluate changes in psychotherapy and antidepressant use, individually and in combination, among U.S. adults following the recommendation.

Data
I analyzed publicly available Medical Expenditure Panel Survey (MEPS) data from 2008-2023 and applied MEPS person-level weights to derive nationally representative estimates.  

Study Design
I used an interrupted time series design and estimated Logit regression models to assess changes in the likelihood of psychotherapy and antidepressant use associated with the USPSTF recommendation immediately (level change) and over time (post-USPSTF trend). I conducted stratified analysis to assess changes by race/ethnicity, health insurance, education, and family income and sensitivity analysis to account for the 2020 onset of the COVID-19 pandemic. 

Population
The analytic sample included 372,962 noninstitutionalized adults aged ≥18 years and older. This corresponded to a nationally representative sample of 244,316,623 adults.   

Principal Findings
Results that remained robust to COVID sensitivity analysis indicated significant post-USPSTF trend increases in the likelihood of psychotherapy only among adults overall (odds ratio [OR]=1.08; 95% CI, 1.04-1.11), and among Non-Hispanic (NH) White (OR=1.08; 95% CI, 1.04-1.12), any private insurance (OR=1.11; 95% CI, 1.06-1.15), high school diploma/ GED (OR=1.07; 95% CI, 1.02-1.13), and family income ≥400% Federal Poverty Level (FPL) (OR=1.13; 95% CI, 1.07-1.19) subgroups. Results indicated significant level-decreases at the USPSTF recommendation in the likelihood of antidepressant use only among adults overall (OR=0.88; 95% CI, 0.82-0.94), and among NH White (OR=0.86; 95% CI, 0.79-0.93), any private insurance (OR=0.85; 95% CI, 0.78-0.92), and high school diploma/ GED (OR=0.80; 95% CI, 0.73-0.88) subgroups. There were significant post-USPSTF trend decreases in the likelihood of antidepressant use only among uninsured (OR=0.89; 95% CI, 0.82-0.97) and family income <125% FPL (OR=0.97; 95% CI, 0.93-1.0) subgroups. In contrast, results indicated a level-increase in the likelihood of antidepressant use only among adults with 0-12 years of education (OR=1.25; 95% CI, 1.05-1.48). There were no statistically significant changes in the likelihood of combined psychotherapy and antidepressant treatment overall, however, the post-USPSTF trend significantly increased among adults with any private insurance (OR=1.07; 95% CI, 1.02-1.12) and family income ≥400% FPL (OR=1.07; 95% CI, 1.00-1.14). 

Conclusions
The USPSTF recommendation for universal adult depression screening was associated with an overall increase in the likelihood of psychotherapy only among U.S. adults and decrease in the likelihood of antidepressant use only. Significant changes, however, were not experienced universally across sociodemographic subgroups.

Implications
Healthcare organizations should ensure adequate systems are in place to provide treatment for all patients who screen positive for depression. Additionally, healthcare organizations should coordinate mental health care between prescribing and non-prescribing providers to ensure clinical guidelines recommending use of psychotherapy and pharmacotherapy for depression treatment are implemented appropriately.

Author

• Sonia M Tetlow, Georgia Budget & Policy Institute
  Presenting Author