Quality of Depression Care and Its Impact on Health Service Use and Mortality Among Veterans

Objective: Little is known about the effects of quality of depression care on patient outcomes other than depression status. This study examined Veterans Health Administration (VHA) data over a six-year period to determine whether quality of depression care was related to patients' health service use and mortality. Methods: Using a national VHA database, the authors identified 205,165 veterans with a new-onset depressive disorder and at least one filled prescription for an antidepressant medication between October 1, 1999, and September 30, 2005. Quality of depression care was assessed with antidepressant medication possession ratios and adequacy of follow-up care (three or more depression-related visits during the 84 days after a depression diagnosis). Logistic regression modeling was used to predict inpatient service use and all-cause mortality. Results: Of the cohort 48% received an adequate supply of antidepressant medication and 31% had three or more follow-up visits during the 84-day profiling period. Rates of adequate medication supply did not change over the six-year period, but there were improvements in adequate follow-up care over the study period (p=.03). Adequate follow-up depression care was associated with increased health service use and decreased likelihood of 12-month all-cause mortality. Conclusions: According to the quality indicators, less than half of patients with newly diagnosed depression received high-quality care. Notably, adequate follow-up care for depression was significantly related to reduction in odds of patient mortality at the 12-month follow-up. These findings suggest that quality of depression care may significantly affect patient outcomes, including mortality, and that further efforts to improve quality appear warranted. (Psychiatric Services 59: 1399-1405, 2008)