Depression in Ontario: under-treatment and factors related to antidepressant use

Our study examines how depression is treated in Ontario, with particular ex amination of the correlates of antidepressant utilization using a broad mod el of individual (clinical), demographic, and health system determinants of treatment. From a community epidemiologic survey, a sample of 333 individu als with major depression in the past year was identified. More than half r eceived no treatment (untreated n = 170, 51.1%), while 74 (22.2%) received treatment without medication, 29 (8.7%) received treatment mainly with anxi olytics, and only 60 (18.0%) were treated with antidepressants. All four gr oups had similar rates of alcohol and substance abuse. Disability and comor bid anxiety were common, with the least in the untreated group and the most in the antidepressant group. Increased use of antidepressants was associat ed with psychiatrist contact, while family physicians treated a substantial minority primarily with anxiolytics. Under a universal health care system, no differential access to antidepressants was found in terms of demographi c characteristics. Clinical severity and contact with a psychiatrist correl ate with antidepressant treatment of depression. (C) 1999 Elsevier Science B.V. All nights reserved.