Persons with depressive symptoms and the treatments they receive: A comparison of primary care physicians and psychiatrists

Objective: To determine if demographic differences exist in patients with d epressive symptoms as the principal reason for visits to primary care physi cians (PCP) versus psychiatrists. To estimate the likelihood of these patie nts receiving a range of mental health services from each provider group. M ethods: Review and analysis of all outpatient visits made by patients with depressive symptoms using the National Ambulatory Medical Care Surveys (NAM CS) conducted in 1995 and 1996. Results: A significantly greater proportion of visits by persons with depressive symptoms as the principal reason for visit were made to psychiatrists than to primary care physicians (T = -3.56 , p = .000). However, men, African-Americans, other Non-White persons, and persons aged 65 to 74 and 75 years and over were proportionately more likel y to visit a PCP than a psychiatrist. Women, whites, and persons aged 45 to 64 were proportionately more likely to make a visit to a psychiatrist than to a PCP. The overall intensity of care delivered by PCPs for patients wit h depressive symptoms was significantly lower than that provided by psychia trists (t = -2.03, p = .02). Analysis of individual services also revealed significant differences in service provision. Conclusions: Demographic diff erences among the patient caseloads of these physician groups have implicat ions for mental health service delivery because of known distinctions in pr evalence rates, symptom presentation, and functionality among depressed pat ient subgroups.