Health Service Patterns Indicate Potential Benefit of Supported Self-Management for Depression in Primary Care

Objective: To examine health service delivery in a Canadian province (British Columbia) toconsider how Canadian health care services might be developed to best address the large numberof individuals with mildly to moderately severe depressive illnesses.Method: We used provincial administrative data to describe patterns of medical servicesprovided to individuals suffering from depression during 3 different time periods (1991–1992,1995–1996, and 2000–2001) and to determine the frequency with which depression patientsreceive treatment from primary care physicians and psychiatrists. We then used these findings toconsider the feasibility and potential applicability of the various approaches that have beendescribed to decrease the burden of disease related to depression.Results: In the fiscal year 1991–1992, the “treated prevalence” rate was 7.7%; in 1995–1996, itwas 8.7%; and in 2000–2001, it was 9.5%. In each cohort over the 10-year period, theproportion of individuals who received a diagnosis of depression and who were then treated byprimary care physicians alone (no psychiatric services were provided) remained constant at 92%.Conclusions: Supported self-management is identified as a promising intervention that could beintegrated into primary health care within the context of the Canadian health care system. Itconstitutes a feasible and practical approach to enhance the role of family physicians in thedelivery of services to individuals with milder forms of depression and promotes the activeengagement of individuals in their recovery and in prevention of future episodes.