Depression Treatment Trends Before and After 1970, Essay Example

Comparing and Contrasting the Depression Treatment Trends before and after 1970 usingTwo peer reviewed Journals.

Introduction

Depression, according to Soni (2012) is a medical illness that causes persistent feelings of sadness and loss of interests in daily activities, with resulting symptoms requiring appropriate treatment as they seriously affects and interferes with the lifestyles of individuals that are so affected.

The growth and development as it the relate to the treatment of this disease can be better understood by comparing and contrasting the different trends before and after the 1970 period, when new government regulations and laws were introduced , patients were de-institutionalization  and clinical practices began to increase to improve the management and control.

Trend during the Post 1970 period

In a survey conducted to compare trends in outpatient treatment of depressive disorders in the United States between 1987 and 1997, Olson et al (2002), used data from the 1987 National Medical Expenditure Survey and the 1997 Medical Expenditure Panel Survey, which had sample sizes of N=34,459 and N=32,636 respectively, as well as a qualifying condition that participants must have made or reported at least one outpatient visit for depression.

Olson et al. (2002), found at the end of the survey that,(a) the rate of depression treatment had increased from 0.73 per 100 persons in 1987 to 2.33 per 100 persons in 1997, (b) the proportion of individuals that used antidepressant medication rose from 37.3% to 74.5%, (c) psychotherapeutic treatment declined from 71.1% down to 60.2%, (d) the number of depression treatment per visit per user was reduced from 12.6 to 8.7 per year, (e) physicians treatment for the condition rose 17.4 % and (f) the treatment cost mostly covered by third parties improved by approximately 16%.

The conclusion drawn from the trends from the survey observed by Olson et al. (2002) was that depressive disorders were highly prevalent in the United States in the period under review, in that there was marked increase in the size of the population that received treatment.

Thesetreatments according to Olfson et al. (2002) were characterized by greater involvement of physicians, greater use of psychotropic medications, expanding availability of third party payments and reductions in outpatients as well as psychotherapy treatments.

The Pre 1970 period

In an article entitled “How an Age of Anxiety became an Age of Depression”, Horowitz (2010) wrote that during the 1950’s and 1960’s, anxiety was the emblematic mental health problem in the United States, and depression was considered a rare condition.

Using statistical trends in diagnosis, drugs prescriptions, textual readings of diagnostic criteria, and secondary literature, Horowitz (2010), made three major findings, and these were; (a) the association of anxiety and amorphous conceptions of stress and neurosis evolved into incompatible situations that demanded diagnostic specificity from professionals in the discipline, (b) contrasting  nosologies  of anxiety and depression in the Diagnostic and Statistical Manual of Mental Disorders 111 extended major depressive disorders  to include  greater number of patients than any other disorder, and (c) antidepressant drugs at the time were not associated with the stigma  and allergic side effects of anxiolytic.

According to Selye (1968) contribution, the stress condition during the 1950’s and the 1960’s encompass a diffuse and multifaceted array of psychic, somatic and interpersonal problems that developed as a response to the daily strains of life. Horowitz (2010) then infer from his peer argument that the common psychological feature of those problems included a mélange of symptoms like headaches, sadness, fatigue, back pain, gastro enteritis complaints, and sleep and appetite difficulties which often accompany personal, financial, occupational  and health concerns.

Additionally, Shorter (1992), reported in the same study that the period before the 2oth century, professional and lay people were likely to regard this varied combinations of symptoms as problems associated with the nerves that were emphasizing the somatic aspects of  complaints.

Comparing and Contrasting

The studies conducted by both researchers covered ten year periods and involved the analysis of surveys from reliable sources like the Medical Expenditure Panel Survey, the National Medical Expenditure Survey, secondary literature, and medical treatment records from health institutions.

The depression trends observed during the pre-1970 period were less understood than during the post 1970 era, and were attributed to anxiety as a result of personal, financial, occupational and health concerns. In the post 1970 depression analysis, patients were subjected far more sophisticated and scientifically orientated treatment by different groups of specialized medical experts like psychiatrists and psychologists than in previous period.

In comparing and contrasting both studies, Horowitz (2010) was first to point out that various factors that evolve between 1970 and 1990 had transformed the conditions that had prevailed in the pre-1970 period, and have caused anxiety to be viewed as depression, but with the introduction of new interest in the 21^st century, a reemergence of anxiety as the signature mental health problem in the American society will occur.

It was also carefully noted that in the pre-1970 period the use of antidepressant drugs was almost non-existent, in comparison to the post period, where according to Olfson et al. (2002), there was a 37% increase in usage over the ten years.

Depression, Horowitz (2010) informed us was associated in the pre-1970 period with hospitalized patients, rather than with clients of general physicians or of outpatient psychiatrists. However, due to the de-institutionalization of these patients at the dawn of the 1970’s, depression has now dominated clinical practices and treatment and research in psychiatry the target for solution in the broader culture.

The role also played by DSM-1 to extending the major depressive disorders to include greater number of patients during the pre-1970 period, paved the way for studies like Olfson et al. (2002) and others to conduct surveys using participants that have to meet qualifying conditions, in order for behavioral trends to be accurately and scientifically captured.

In Horowitz (2010) studies, in comparison to Olfson et al (2002), no mention was made regardingthe cost of treating patients during the pre-1970 period, and this most likely was due to the fact that the majority of these patients were hospitalized or imprisoned while being treated.

During the era Olfson et al. 2002) however, the scenario changed with the development of more professionalism in the treatment of depression as a disease outside the confines of hospitals but within clinical practices widely spread across the country. This also led to changes in the payment patterns for these services, with third parties becoming involved in a greater way in providing the necessary financial coverage.

The trend that was developing in the 1970’s was also captured statistically by IMS America (1976), when it reported that treatment statistics indicated growing interest in depression, with the first half of the decade showing that the management of the disease became as common as that of anxiety.

Depression affected patients suffered more during the period of study conducted by Horowitz (2010), than with that of Olfson et al. (2002), due to the stigma that was attached to the disease as well as the fact that they were subjected to treatment in institutions like hospitals and places of incarceration. The stigma attached to the disease helped to significantly reduce the number of persons who would seek medical help for their persistent feeling of sadness and loss of interest in daily activities.

Conclusions

The conclusion drawn by Olson (2002) and Horowitz (2010) differs significantly in outlook, in that the former saw depression as a depressive condition that will increase as the population increases, while the latter is of the view that with renewed interests from researchers, anxiety will reemerge to occupy the position it had during the pre-1970 period. Whether the latter view materializes in the future remains to be seen.

Finally, the developments associated with the treatment of depression could be linked to assessments of the trends that were previously associated with anxiety, as well as those that occur in the post 1970 period, and as such both studies played a significant role in the improved quality of clinical treatment that are presently being delivered to persons affected by the disease in various clinical practices across the country.

Reference

Horowitz, A.V. (2010). How an Age of Anxiety became an Age of Depression TheMilbank Quarterly Vol.8 No.1 (2010) pp.112-138

IMS America (1997). National Disease and Therapeutic Index Ambler PA IMS America pp.125-126

Olson, M., Marcus, S.S., Druss, B., Elinson, L., Tanielian, T., Pincus, H.A., (2002). National Trends in Outpatient Treatment of Depression JAMA (2002) 287 (2) pp.203-209

Shorter, E. (1992).  From Paralysis to Fatigue: A History of Psychosomatic Illness in the modern era Free Press New York.

Selve, H. (1968). The Stress of Life McGraw-Hill New York

Soni, A. (2012). Trends in use and Expenditures for Depression among US Adults age 18 and older, Civilian Non-Institutionalized Population 1999 and 2009

Statistical Brief #377 Medical Expenditure Panel Survey www.meps.ahrq.gov/meps/web/data_files/publication/st.377.pdf , 10/15