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The Surgeon General's Report on Mental Health, issued by former Surgeon General David Satcher, MD, called the nation's attention to the importance of mental health in overall health. The report cited the commonality of mental illness and the fact that undertreatment of mental illness is an enormous problem fueled by stigma and barriers to access. Several demographic groups were identified as being at particularly high risk for having unmet mental health needs: children and youth, older adults, and members of medically underserved ethnic and racial groups. Because these groups rely largely on the primary care setting for their mental health needs, the report strongly recommended an expanded role for primary care physicians and allied health practitioners in providing mental health services.

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Depression is the leading cause of disability (lost years of healthy life) in Western countries at ages 15-44 years old. The estimated annual cost of depression in the US economy is $83 billion, including expenses related to care, absenteeism, reduced productivity on the job, and premature death and suicide. In the United States, the point prevalence and lifetime prevalence of depression are 6.6% and 16.6%, respectively. While depression may occur at any age, the typical age of onset of major depression is 27-35 years and the highest rate of depression exists in adults ages 40-59. Depression is twice as common among women as men. Recent data continue to support the Surgeon General's Report that blacks and Hispanics with a diagnosis of depression in the previous 12 months are less likely to receive mental health care than their white counterparts (58.9% and 51.8% vs 71.1%).

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Depression often coexists with other chronic medical illnesses, particularly in later life. Medical illness and disability —more common in the elderly—are risk factors for depression. Depression diminishes quality of life, leads to nonadherence with self-care (diet, exercise, taking medication as prescribed), increases use of other medical services, is a risk factor for suicide, and is associated with cognitive impairment in older adults. Additionally, major psychosocial risk factors for depression include bereavement, caregiver strain, social isolation, disability, role transitions, and severe medical problems.

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Depression is associated with abnormal functioning of the brain and often has a genetic basis. It often goes unrecognized and untreated and can therefore increase morbidity and mortality in populations such as the elderly and ethnically and racially diverse groups with high prevalence of chronic illness. However, depression is treatable and some interventions can significantly reduce its symptomatology and incidence. Depression is often a chronic illness, following a relapsing course. In order to prolong recovery and prevent recurrence, maintenance treatment beyond the acute treatment of the episode is usually medically appropriate, thus making the primary care setting an appropriate medical home for depression care. In addition, many people prefer to be treated in the general medical sector rather than being referred to specialty mental health care.

Agency for Healthcare Research and Quality (AHRQ), Department of Health and ...

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