Comorbid Chronic Illness and the Diagnosis and Treatment of Depression in Safety Net Primary Care Settings

Objective: To estimate the impact of chronic medical conditions on depression diagnosis, treatment, and follow-up care in primary care settings. Design: This was a cross-sectional study that used interviewer-administered surveys and medical record reviews. Three hundred fifteen participants were recruited from 3 public primary care clinics. Depression diagnosis, guideline-concordant treatment, and follow-up care were the primary outcomes examined in individuals with depression alone compared with individuals with depression and chronic medical conditions measured using the Charlson Comorbidity Index (CCI). Results: Physician diagnosis of depression (32.6%), guideline-concordant depression treatment (32.7%), and guideline-concordant follow-up care (16.3%) were all low. Logistic regression analysis showed no significant difference in the likelihood of depression diagnosis, guideline-concordant treatment, or follow-up care in individuals with depression alone compared with those with both depression and chronic medical conditions. Participants with severe depression were, however, twice as likely to receive a diagnosis of depression as participants with moderate depression. In addition, participants with moderately severe and severe depression received much less appropriate follow-up care than participants with moderate depression. Among participants receiving a depression diagnosis, 74% received guideline-concordant treatment. Conclusion: Physician depression care in primary care settings is not influenced by competing demands for care for other comorbid medical conditions. (J Am Board Fam Med 2009; 22: 123-135.)