Quality of Treatment and Disability Compensation in Depression: Comparison of 2 Nationally Representative Samples With a 10-Year Interval in Finland

Teija I. Honkonen, M.D., Ph.D.; Timo A. Aro, M.D., Ph.D.; Erkki T. Isometsä, M.D., Ph.D.; E. Marianna Virtanen, Ph.D.; and Heikki O. Katila, M.D., Ph.D.

Objective: Depressive disorders cause substantial work impairment that can lead to disability compensation. The authors compared treatment received for depression preceding disability pension between 2 nationally representative samples with a 10-year interval.

Method: The medical statements for 2 random samples drawn from the Finnish national disability pension registers, representing populations granted a disability pension for DSM-III-R major depression during a 12-month period from October 1993 through September 1994 (N = 277) and for ICD-10 depressive disorders (F32-F33) from October 2003 through September 2004 (N = 265) were examined. The proportions of persons receiving weekly psychotherapy, antidepressants, adequate antidepressant dosage, sequential antidepressant trials, lithium augmentation, and electroconvulsive therapy (ECT) were compared.

Results: No significant differences emerged between the 2 samples, except for the adequacy of antidepressant dosage. Few subjects in either of the samples (8.7% for 1993-1994 vs. 10.6% for 2003-2004, p = .45) had received weekly psychotherapy. Most had received antidepressants (87.4% vs. 85.6%, p = .55) with increasingly adequate dosage (75.6% vs. 85.0%, p = .02), but only a minority had received sequential antidepressant trials (39.5% vs. 44.5%, p = .24). Lithium augmentation and ECT were rare (1.1% vs. 1.5%, p = .66 and 4.0% vs. 1.5%, p = .08, respectively). Even in 2003-2004, over half of the subjects were granted a disability pension without sequential antidepressant trials.

Conclusion: This nationally representative study indicates that, despite an increased antidepressant use and improved practice guidelines for depression, a considerable proportion of the people granted long-term compensation for depression seem to be suboptimally treated. Given the enormous costs of the disability, attention to the quality of treatment provided for depression is warranted before long-term disability compensations are granted.

(J Clin Psychiatry 2007;68:1886-1893)

Received Jan. 3, 2007; accepted Mar. 12, 2007. From the Finnish Institute of Occupational Health (Drs. Honkonen and Virtanen); Ilmarinen Mutual Pension Insurance Co. (Drs. Aro and Katila); the Department of Mental Health and Alcohol Research, National Public Health Institute (Dr. Isometsä); and the Department of Psychiatry, Helsinki University Central Hospital (Drs. Isometsä and Katila), Helsinki, Finland.

Supported financially by Special Governmental Grants for Health Sciences Research in the Helsinki University Central Hospital and by the Ilmarinen Mutual Pension Insurance Co., Helsinki, Finland.

The authors thank Ms. Anna-Maarit Penttilä, Department of Psychiatry, Helsinki University Central Hospital, for the data collection and the Finnish Center for Pensions, the Social Insurance Institution of Finland, and all the participating insurance institutions for their cooperation in the data collection.

Dr. Isometsä has received honoraria from Eli Lilly, H. Lundbeck, GlaxoSmithKline, and Pfizer for speaking in educational symposia in Finland. Dr. Aro is employed full-time and Dr. Katila is employed part-time by the Ilmarinen Mutual Pension Insurance Co. Drs. Honkonen and Isometsä have received financial support for this research from the Ilmarinen Mutual Pension Insurance Co.

Corresponding author and reprints: Teija I. Honkonen, M.D., Finnish Institute of Occupational Health, Topeliuksenkatu 41aA, FI-00250 Helsinki, Finland (e-mail: teija.honkonen@ttl.fi).