Diagnosis and treatment of depression and anxiety in rural and nonrural primary care: National survey results

Objective: Data from the 2006 National Ambulatory Medical Care Survey were examined for differences in the diagnosis and treatment of depressive and anxiety disorders in rural and nonrural primary care settings. Methods: A sample of 11,658 patient visits to primary care providers was examined. ICD-9-CM codes were used to identify prevalence rates of depressive and anxiety disorder diagnoses. Treatments also were examined with criteria from American Psychiatric Association practice guidelines. Results: No ruralnonrural differences were found in diagnosis rates for depression (about 3%) or anxiety disorders (about 1.5%). Approximately 67% of individuals with a depressive disorder and 36% of those with an anxiety disorder received a recommended treatment during the visit, with no rural-nonrural differences. Conclusions: Although few differences were found between rural and nonrural primary care visits, these data support the notion that anxiety and depression are underdiagnosed in primary care. Moreover, recognition and diagnosis often do not translate into adequate treatment in both rural and nonrural primary care settings.