Researchers from the Johns Hopkins Bloomberg School of Public Health say that the number of Americans over-diagnosed and over-treated for depression is “staggering.” Their study examined adults with clinician-identified depression and individuals who experienced major depressive episodes within a 12-month period. It found that when assessed for major depressive episodes using a structured interview, only 38 percent of the subjects with clinician-identified depression met the 12-month criteria for depression.
“Over-diagnosis and over-treatment is common in the U.S. and frankly the numbers are staggering,” said Ramin J. Mojtabai, author of the study. “Among study participants who were 65 years old or older with clinician-identified depression, 6 out of every 7 did not meet the 12-month major-depressive-episodes criteria. While participants who did not meet the criteria used significantly fewer services and treatment contacts, the majority of both groups used prescription psychiatric medication.”
Using a sample of 5,639 participants from the 2009-2010 United States National Survey of Drug Use and Health, the researchers assessed clinician-identified depression based on questions about conditions that the participants were told they had by a clinician in the past 12 months. The study, published in Psychotherapy and Psychosomatics, found that even among participants without a lifetime history of depression, a majority reported having taken prescription psychiatric medications.
“A number of factors likely contribute to the high false-positive rate of depression diagnosis in community settings, including the relatively low prevalence of depression in these settings, clinicians’ uncertainty about the diagnostic criteria and the ambiguity regarding sub-threshold syndromes,” said Mojtabai. “Previous evidence has highlighted the under-diagnosis and under-treatment of major depression in community settings. The new data suggest that the under-diagnosis and under-treatment of many who are in need of treatment occurs in conjunction with the over-diagnosis and over-treatment of others who do not need such treatment. There is a need for improved targeting of diagnosis and treatment of depression and other mental disorders in these settings.”
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