Inequities in medical follow-up for depression: a population-based study in Montreal

Psychiatr Serv. 2010 Mar;61(3):258-63. doi: 10.1176/ps.2010.61.3.258.


Objectives: The aim of this study was to measure the quality of medical follow-up of depression in a universal-access health care system and identify its main correlates.

Methods: This retrospective cohort study of adult patients who received diagnoses of depression between April 2003 and March 2005 in Montreal used administrative data to measure the quality of medical follow-up within the first three months of diagnosis. Indicators of adequate follow-up care included having at least one outpatient visit to a family physician or a psychiatrist, the first follow-up visit within 30 days of diagnosis, more than half of follow-up visits with the same physician, and at least three follow-up visits.

Results: During the study period, 41,375 Montrealers aged 18 and older received a new diagnosis of depression. Among those, 90% (N=37,071) had at least one visit with a physician (family practitioner or psychiatrist) within the first three months of diagnosis, 59% (N=24,295) benefited from continuity with their usual provider, 50% (N=20,846) received a prompt follow-up visit, and 48% (N=19,819) had optimal contacts with practitioners. Medical follow-up was less adequate for older patients, male patients, patients living in very deprived neighborhoods, and patients with high morbidity levels. The quality of medical follow-up was better when both a family physician and a psychiatrist were involved.

Conclusions: The results suggest that universal access facilitates optimal practitioner contacts during the acute treatment phase of depression. However, despite universal access, the findings revealed that some inequities persist.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Continuity of Patient Care*
  • Depression / drug therapy*
  • Female
  • Healthcare Disparities*
  • Humans
  • Male
  • Middle Aged
  • Quebec
  • Retrospective Studies
  • Urban Population*
  • Young Adult