Quality of Treatment and Disability Compensation in Depression : Comparison of 2 Nationally Representative Samples With a 10-Year Interval in Finland

• Published in: The journal of clinical psychiatry Vol. 68; no. 12; pp. 1886 - 1893
• Main Authors: HONKONEN, Teija I, ARO, Timo A, ISOMETSA, Erkki T, MARIANNA VIRTANEN, E, KATILA, Heikki O
• Format: Journal Article
• Language: English
• Published: Memphis, TN Physicians Postgraduate Press 01-12-2007
• Subjects: Adult and adolescent clinical studies; Antidepressive Agents - therapeutic use; Biological and medical sciences; Data Collection; Depression; Depressive Disorder - complications; Depressive Disorder - economics; Depressive Disorder - therapy; Disabled Persons - psychology; Electroconvulsive Therapy; Female; Finland; Humans; Insurance, Disability - statistics & numerical data; Male; Medical sciences; Middle Aged; Mood disorders; Practice Patterns, Physicians' - statistics & numerical data; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Quality of Health Care; Workers' Compensation - statistics & numerical data; Europe; Finland; Mood disorder; Disability; Depression; Treatment
• ISSN: 0160-6689; 1555-2101
• DOI: 10.4088/JCP.v68n1208

Depressive disorders cause substantial work impairment that can lead to disability compensation. The authors compared treatment received for depression preceding disability pension between 2 nationally representative samples with a 10-year interval.
The medical statements for 2 random samples drawn from the Finnish national disability pension registers, representing populations granted a disability pension for DSM-III-R major depression during a 12-month period from October 1993 through September 1994 (N = 277) and for ICD-10 depressive disorders (F32-F33) from October 2003 through September 2004 (N = 265) were examined. The proportions of persons receiving weekly psychotherapy, antidepressants, adequate antidepressant dosage, sequential antidepressant trials, lithium augmentation, and electroconvulsive therapy (ECT) were compared.
No significant differences emerged between the 2 samples, except for the adequacy of antidepressant dosage. Few subjects in either of the samples (8.7% for 1993-1994 vs. 10.6% for 2003-2004, p = .45) had received weekly psychotherapy. Most had received antidepressants (87.4% vs. 85.6%, p = .55) with increasingly adequate dosage (75.6% vs. 85.0%, p = .02), but only a minority had received sequential antidepressant trials (39.5% vs. 44.5%, p = .24). Lithium augmentation and ECT were rare (1.1% vs. 1.5%, p = .66 and 4.0% vs. 1.5%, p = .08, respectively). Even in 2003-2004, over half of the subjects were granted a disability pension without sequential antidepressant trials.
This nationally representative study indicates that, despite an increased antidepressant use and improved practice guidelines for depression, a considerable proportion of the people granted long-term compensation for depression seem to be suboptimally treated. Given the enormous costs of the disability, attention to the quality of treatment provided for depression is warranted before long-term disability compensations are granted.