Research report Treatment adequacy of anxiety and depressive disorders: Primary versus specialised care in Spain Anna Fernández a, ⁎ , Josep Maria Haro a , Miquel Codony b , Gemma Vilagut b , Montserrat Martínez-Alonso b , Jaume Autonell a , Luis Salvador-Carulla c , José Luis Ayuso-Mateos d , Miquel Angel Fullana a,e , Jordi Alonso b,e a Sant Joan de Déu-SSM, Fundació Sant Joan de Déu. Sant Boi de Llobregat, Barcelona, Spain b Health Services Research Unit, Institut Municipal d´Investigació Mèdica (IMIM), Barcelona, Spain c Psicost Association, Cadiz, Spain d Department of Psychiatry, Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Spain e Universitat Autónoma de Barcelona, Barcelona, Spain Received 16 November 2005; received in revised form 9 May 2006; accepted 10 May 2006 Available online 21 June 2006 Abstract Background: Literature suggests that a high proportion of the population with mental disorders remains either untreated or poorly treated. This study aimed to describe the adequacy of treatment for Anxiety and Depressive disorders in Spain, how this differs between providers (primary versus specialised care) and which factors are associated with appropriate care. Method: Data were derived from the Spanish sample (N = 5473) of the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross sectional study in a representative sample of adults. The subsample analyzed was composed by the 133 subjects with a mental disorder in the year prior to the interview who received treatment. Treatment adequacy was evaluated in two different ways: (1) considering definitions of minimally adequate treatment evidence based guidelines and criteria used in other epidemiological studies; (2) considering experts rating of treatment appropriateness based on the information contained in the case vignettes created from the CIDI answers. Generalised Estimating Equation (GEE) models and simple logistic regression were conducted to assess the correlates of adequate treatment. Results: Similar proportions of patients in specialty and general medical treatment received a minimally adequate treatment (31.8% and 30.5%, respectively). Associated factors to appropriateness were living in a large city, having a high educational level, and having a good self rated health state. Limitations: Treatment adequacy was based on simple information and criteria. Conclusions: Only one third of the mental health treatment in Spain met minimal adequacy criteria. More research is needed in order to find out reasons for these low rates. © 2006 Elsevier B.V. All rights reserved. Keywords: Treatment adequacy; Clinical guidelines; Primary care; Specialized mental health care Journal of Affective Disorders 96 (2006) 9 – 20 www.elsevier.com/locate/jad ⁎ Corresponding author. Sant Joan de Déu-Mental Health Services, Fundació Sant Joan de Déu, Carrer del Doctor Pujades, 42 08830 Sant Boi de Llobregat, Barcelona, Spain. Tel.: +34 93 640 63 50x2373. E-mail address: afernandez@sjd-ssm.com (A. Fernández). 0165-0327/$ - see front matter © 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2006.05.005