The proposed research concerns the, process by which individuals become identified as suffering from depression and make their way along the path from the community to mental health care services. It focuses on the role of age and gender in influencing individuals' use of general and specialty outpatient mental health care, in prompting providers to identify patients as depressed, and in affecting the nature of the treatment provided. It will probe this issue by examining the manner in which patients' age, gender, and self-reports of depressive symptoms interact, in the presence of other factors, to affect outcomes that are indicators of progress along the path to mental health care for depression, such as use of general outpatient medical care, being diagnosed as depressed by a regular primary care provider, being referred to specialty mental health providers for care of depression, and receiving specialty mental health care for depression. Patient characteristics to be taken into account in the analysis include health status, socioeconomic traits, and prior utilization patterns. Some characteristics of the patient's regular primary care provider will also be studied, including age, sex, specialty, measures of workload and accessibility, and attitudes toward the treatment of depression. The setting is Kaiser Permanente, Northwest Region (KPNW), a large group practice HMO. Financial constraints do not limit patients' access to primary care or providers' choice of most treatment options. The study focuses on outpatient care, and will rely largely on existing databases. The study addresses the well-recognized discrepancy between the prevalence of depression in the population and its recognition and treatment by primary care providers. It is motivated by previous research findings that raise the possibility of age/sex differentials in the diagnosis and treatment of depression that are not related to severity of depressive symptoms and need for treatment. It will provide information that should be useful in developing strategies for improving the treatment of depression by primary care providers.
