PHS6 - Racial/Ethnic Differences in the Treatment of Adolescent Major Depressive Disorders (MDD) Across Healthcare Providers Participating in the Medicaid Program

Abstract

The objective of this research study was to examine whether racial/ethnic differences in receipt of MDD treatment could be explained by the specialty of provider diagnosing the adolescent. In this retrospective cohort study, adolescents (10-20 years-old) with ≥2 MDD diagnoses were identified using 2005–2007 Medicaid data from Texas. Patients were categorized based on the types of provider who gave the initial MDD diagnosis (psychiatrist (PSY-I), social worker/psychologist (SWP-I), and primary care physician (PCP-I)). Within the sub-cohorts identified by each type of provider, patients were further divided by racial/ethnic groups. A general linear multi-level model (MLM) was used to examine whether being first identified by a psychiatrist is associated with higher treatment rate and reduced variation in treatment utilization across racial/ethnic groups. Of the 13,234-new pediatric MDD cases diagnosed during the study period, 61% were SWP-I, 33% by PSY-I and 6% by PCP-I. Results of the adjusted analysis showed that being first diagnosed by a psychiatrist is associated with higher chance of receiving MDD related treatment (PCP-I vs. PSY-I (OR: 0.54, 95%CI: 0.4-0.7) and SWP-I vs. PSY-I (OR: 0.17, 95%CI: 0.1-0.2)). Specifically regarding the receipt of pharmacotherapy, a significant interaction effect was detected between types of identifying providers and patients’ race/ethnicity. The analysis stratified by race/ethnicity found Whites received comparable treatment regardless receiving initial diagnosis from PCPs or PSYs, while for Hispanics, being first identified by a PCP is associated with lower likelihood of receiving treatment as compared to being first identified by a psychiatrist. Further analysis stratified by provider types showed that a significant racial/ethnic variation in medication utilization was observed in PCP-I, reduced in SWP-I, and disappeared in PSY-I. For adolescents with MDD, being first diagnosed by a psychiatrist is associated with higher treatment rate and reduced racial/ethnic variation in the utilization of pharmacotherapy.