Abstract
ObjectiveTo examine the association of geographic access to providers with racial/ethnic variations in treatment quality among youth with depression. MethodsThe geographic access to providers who initiated the depression treatment was measured using the travel distance estimated based on Google Maps® and the provider density within a 5-mile radius of each patient residence. Depression treatment quality was measured as treatment engagement, defined as having ≥2 prescriptions or psychotherapy with 2-month following a new depression diagnosis, and treatment completion defined as having ≥8 sessions of psychotherapy within 12 weeks or received ≥84 days of continuous treatment with antidepressants within 114 days following the treatment initiation. ResultsThe results of multivariate logistic regression analysis have demonstrated that the travel distance to provider was only negatively associated with the treatment engagement of Hispanics (5.0 - 14.9 vs ≤ 4.9 miles: OR=0.74, 95% CI [0.54–0.88]; ≥15 vs ≤ 4.9 miles: OR=0.82, 95% CI [0.56–0.97]), while a higher mental health specialist density was only positively associated with the treatment engagement of Blacks (1.00–1.99 vs < 1.00: OR=1.63, 95% CI [1.03–4.51]; 2.00–4.99 vs < 1.0: OR=2.28, 95% CI [1.21–7.11]). Among those who have engaged in the treatment, travel distance was associated with a lower likelihood of treatment completion in all racial/ethnic groups. LimitationsThe study did not account for types of transportation used by patients. ConclusionGeographic access barriers had a negative association with treatment quality of pediatric depression. Minority children were more sensitive to the barriers than Whites.
Published Version
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