Toward an effective design of behavioral health care delivery: An empirical analysis of care for depression

A criticism of behavioral health care delivery is that it has largely missed the social determinants of behavioral health disorders and their diagnosis. Toward addressing this criticism, this study evaluates the delivery of behavioral health care as a part of primary care operations. Focusing on the treatment of depression, the study results show that: (i) primary care clinics operating in communities with superior social environment characteristics are associated with improved depression outcomes in the short term, and (ii) psychosocial resources (social and emotional support) and the built environment (man-made resources and infrastructure to support human activity) of primary care clinics are associated with sustaining the improvement in depression outcome in the long term. Centering our attention on IT-enabled, evidence-based, and affordable primary care as mechanisms that can enable the integration of behavioral and medical care delivery, the results suggest that IT-enabled and evidence-based primary care are associated with improvements in depression outcomes. We also find that the effect of improving the affordability of behavioral health care delivery depends on the community's socioeconomic status. Primary care clinics in socioeconomically disadvantaged communities practicing cost-containment are associated with improvements in depression outcomes, and, therefore, can contribute toward reducing disparities in behavioral health care delivery. Counter to our original expectations, we find that the effect of evidence-based care on improvements on depression outcomes increases as the availability of medically trained behavioral health care specialists practicing in a community increases lending support to concerns that primary care clinics in resource-rich communities obtain greater benefit from quality improvement interventions.