Author Reply

Excerpt

To the Editor:—Ms. Kinkead raises some excellent points regarding the treatment of depression in rural areas and the associated access and stigma problems that present barriers to quality health care. More research is needed to clearly measure and understand disparities in treatment between rural and urban areas. We believe that quality care for depression includes evidence-based psychotherapies, but access to such treatment is clearly constrained in most rural areas. However, this does not mean that residents of rural areas in need of depression care should be resigned to alternative treatments. Instead, redress of the access and stigma problems in rural communities must be pursued through carefully targeted policies and interventions. Although some treatment options exist for primary care providers practicing in rural areas, viable interventions for improving quality of depression care in rural areas are still in need of development. For example, more primary care providers should be trained to provide the brief primary-care versions of psychotherapies, which have been shown to be effective, such as Problem solving therapy1 or Interpersonal counseling.2 Because of the high prevalence of depression and its adverse impact on quality of life, costs, morbidity, and functioning, and in light of the evidence that psychosocial therapies may be more efficacious than medications for the relatively milder depressive conditions often found in primary care settings,3 the availability of such psychotherapies is a critical component of quality health care. …