What is the association between quality of treatment for depression and patient outcomes? A cohort study of adults consulting in primary care

J Affect Disord. 2013 Oct;151(1):265-74. doi: 10.1016/j.jad.2013.05.097. Epub 2013 Jul 20.


Background: The association between adequate treatment for a Major Depressive Episode (MDE) and improvements in depressive symptoms is not well established in naturalistic practice conditions. The main objective of this study was to examine the association between receiving at least one minimally adequate treatment for MDE (i.e. according to clinical guidelines) in the previous 12 months and evolution of depressive symptoms at 6- and 12-months. Associations with receiving pharmacotherapy and/or psychotherapy and the role of severity of depression were examined.

Methods: This cohort study included 908 adults meeting criteria for previous-year MDE and consulting at one of 65 primary care clinics in Quebec, Canada. Multilevel analyses were performed.

Results: Results show that (i) receiving at least one minimally adequate treatment for depression was associated with greater improvements in depression symptoms at 6 and at 12 months; (ii) adequate pharmacotherapy and adequate psychotherapy were both associated with greater improvements in depression symptoms, and (iii) the association between adequate treatment and improvement in depression symptoms varied as a function of severity of symptoms at the time of inclusion in the cohort with worse symptoms at the time of inclusion being associated with greater reductions at 6 and 12 months.

Limitations: Measures are self-reported. Participants were recruited at different stages over the course of their MDE.

Conclusions: This study shows that adequate treatment for depression is associated with improvements in depressive symptoms in naturalistic primary care practice conditions, but that those with more severe depressive symptoms are more likely to receive adequate treatment and improve across time.

Keywords: Adequacy of treatment; Major depressive episode; Multilevel analysis; Quality indicator; Quality of care.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antidepressive Agents / therapeutic use
  • Cohort Studies
  • Combined Modality Therapy
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Primary Health Care / standards*
  • Psychotherapy / standards
  • Quality Indicators, Health Care / standards
  • Quality of Health Care* / statistics & numerical data
  • Severity of Illness Index
  • Young Adult


  • Antidepressive Agents