Trends in Treatment and Spending for Patients Receiving Outpatient Treatment of Depression in the United States, 1998-2015

This analysis of national Medical Expenditure Panel Survey data examines trends in outpatient treatment of depression in the United States from 1998 to 2015. Key PointsQuestionHow did the trends in the prevalence of depression and spending for treatment in the US population shift from 1998 to 2007 and from 2007 to 2015? FindingsIn this analysis of 86216 individuals from the 1998, 2007, and 2015 Medical Expenditure Panel Surveys, an absolute increase occurred in the prevalence of treated depression from 2.88 per 100 in 2007 to 3.47 per 100 in 2015, and an increasing proportion of this treatment was covered by insurance, particularly Medicaid (increase from 19% to 36%). MeaningThese trends appear to be consistent with policies that were intended to increase insurance coverage of depression treatment. ContextAfter marked increases from 1987 to 1997, trends in depression treatment in the United States increased modestly from 1998 to 2007. However, multiple policy changes that expanded insurance coverage for mental health conditions may have shifted these trends again since 2007. ObjectiveTo examine national trends in outpatient treatment of depression from 1998 to 2015, with particular focus on 2007 to 2015. Design, Setting, and ParticipantsThis analysis of the use of health services and spending for treatment of depression in the United States assessed data from the 1998 (n=22 953), 2007 (n=29 370), and 2015 (n=33 893) Medical Expenditure Panel Surveys (MEPSs). Participants included respondent households to the nationally representative survey. Data were analyzed from June 15 through December 18, 2018. Main Outcomes and MeasuresRates of outpatient and pharmaceutical treatment of depression; counts of outpatient visits, psychotherapy visits, and prescriptions; and expenditures. ResultsThe analysis included 86216 individuals from the 1998, 2007, and 2015 MEPSs. Respondents' mean (SD) age was 37.2 (22.7) years; 45086 (52.3%) were female, 24312 (28.2%) were Hispanic, 15463 (17.9%) were black, and 62926 (72.9%) were white. Rates of outpatient treatment of depression increased from 2.36 (95% CI, 2.12-2.61) per 100 population in 1998 to 3.47 (95% CI, 3.16-3.79) per 100 population in 2015. The proportion of respondents who were treated for depression using psychotherapy decreased from 53.7% (95% CI, 48.3%-59.1%) in 1998 to 43.2% (95% CI, 39.0%-47.4%) in 2007 and then increased to 50.4% (95% CI, 46.0%-54.9%) in 2015, whereas the proportion receiving pharmacotherapy remained steady at 81.9% (95% CI, 77.9%-85.9%) in 1998, 82.4% (95% CI, 79.3%-85.4%) in 2007, and 80.8% (95% CI, 77.9%-83.7%) in 2015. After adjusting for inflation using 2015 US dollars, prescription expenditures for these individuals decreased from $848 (95% CI, $713-$984) per year in 1998 to $603 (95% CI, $484-$722) per year in 2015, whereas the mean number of prescriptions decreased from 7.64 (95% CI, 6.61-8.67) in 1998 to 7.03 (95% CI, 6.51-7.56) in 2015. National expenditures for outpatient treatment of depression increased from $12 430 000 000 in 1997 to $15 554 000 000 in 2007 and then to $17 404 000 000 in 2015, consistent with a slowing growth in national outpatient expenditures for depression. The percentage of this spending that came from self-pay (uninsured) individuals decreased from 32% in 1998 to 29% in 2007 and then to 20% in 2015. This decrease was largely associated with increasing Medicaid coverage, because the percentage of this spending covered was 19% in 1998, 15% in 2007, and 36% in 2015. Conclusions and RelevanceRecent policy changes that increased insurance coverage for depression may be associated with reduced uninsured burden and with modest increases in the prevalence of and overall spending for outpatient treatment of depression. The lower-than-expected rate of treatment suggests that substantial barriers remain to individuals receiving treatment for their depression.