ORIGINAL PAPER Depression Diagnosis and Antidepressant Treatment among Depressed VA Primary Care Patients Chuan-Fen Liu Æ Duncan G. Campbell Æ Edmund F. Chaney Æ Yu-Fang Li Æ Mary McDonell Æ Stephan D. Fihn Published online: 5 May 2006 Ó Springer Science+Business Media, Inc. 2006 Abstract This study examined the extent to which 3559 VA primary care patients with depression symptomatol- ogy received depression diagnoses and/or antidepressant prescriptions. Symptomatology was classified as mild (13%), moderate (42%) or severe (45%) based on SCL-20 scores. Diagnosis and treatment was related to depression severity and other patient characteristics. Overall, 44% were neither diagnosed nor treated. Only 22% of those neither diagnosed nor treated for depression received treatment for other psychopathology. Depression treat- ment performance measures dependent on diagnoses and antidepressant prescriptions from administrative databases exclude undiagnosed patients with significant, treatable, symptomatology. Keywords Primary care patients Æ Veterans Æ Depression Æ Antidepressant treatment Æ Depression diagnosis Introduction Depression is prevalent in the general population and even more common in primary care settings, where 10–15% of patients evince significant depressive symptomatology (Katon & Schulberg, 1992; Ormel et al., 1994). Despite its prevalence, depression is underdetected and undertreated in primary care. Estimates of nondetection rates range from 30% to approximately 70% of depressed primary care patients (Coyne, Schwenk, & Fechner-Bates, 1995; Rost et al., 1998; Schulberg, Block, Madonia, Scott, Rodriguez, Imber et al., 1996; Simon, Goldberg, Tiemens, & Ustun, 1999). Adding to the problem of poor recognition, treatment of detected de- pressed patients is frequently inadequate. Less than half of detected primary care patients receive adequate depression care (Simon, VonKorff, Wagner, & Barlow, 1993). Whereas some suggest that undetected depression in primary care is mild and does not necessarily require intervention (Coyne et al., 1995; Coyne, Klinkman, Gallo, & Schwenk, 1997), others maintain that undetected pa- tients manifest serious symptomatology that persists over time (Rost et al., 1998). Findings that detected patients evince greater improvement in depression symptoms than undetected patients argue that increased detection repre- sents a necessary first step toward improvement of primary care depression treatment (Simon et al., 1999). To date, successful primary care depression management improve- ment efforts have had multiple components and have in- cluded increased screening for the illness, patient and provider education, and systems-level interventions de- signed to reorganize practice. C.-F. Liu (&) Æ D. G. Campbell Æ E. F. Chaney Æ Y.-F. Li Æ M. McDonell Æ S. D. Fihn Department of Veterans Affairs, Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA C.-F. Liu Æ D. G. Campbell Æ S. D. Fihn Department of Health Services, University of Washington, Seattle, WA, USA E. F. Chaney Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA Y.-F. Li Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA S. D. Fihn Department of Medicine, University of Washington, Seattle, WA, USA Adm Policy Ment Health & Ment Health Serv Res (2006) 33:331–341 DOI 10.1007/s10488-006-0043-5 123