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Are Psychiatrists' Characteristics Related to How They Care for Depression in the Medically Ill?

Results From a National Case-Vignette Survey

Received March 30, 2001; revised July 30, 2001; accepted August 6, 2001. From the Department of Psychiatry, Georgetown University Medical Center, Washington, DC; the National Institute of Mental Health, Bethesda, MD; the Duke University Medical Center, Durham, NC; the University of Maryland, College Park, MD; Bowling Green State University, Bowling Green, OH; and the Henry Ford Health Sciences Center, Detroit, MI. Address correspondence and reprint requests to Dr. Epstein, Department of Psychiatry, Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007. E-mail: epsteins{at}gunet.georgetown.edu

The authors' goal was to examine the relationship between psychiatrists' characteristics and their decisions regarding depression care. A national sampling of 278 psychiatrists answered diagnosis and treatment questions for one of four case vignettes with depression and various degrees of medical comorbidity. They also responded to a questionnaire assessing practice and demographic characteristics. Tendency to diagnose major depression was significantly associated with being board certified, being in practice for less time, having a greater percentage of patients with managed care, and having a greater percentage of patients on psychotropic medications. Tendency to recommend an antidepressant was significantly associated with the psychiatrist being male, being less satisfied with practice, and having a greater percentage of patients on psychotropic medications. These findings remained significant even after controlling for case characteristics. Diagnostic and prescribing tendencies of psychiatrists appear to be associated with specific physician characteristics and not simply case characteristics. These findings have implications for further studies of predictors of quality of care.

Key Words: Depression • General Topics in Psychiatry • Medical Making

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