Quality of treatment and disability compensation in depression:: Comparison of 2 nationally representative samples with a 10-year interval in Finland

Objective: 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. Method: 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. Results: 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. Conclusion: 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.