Disparities In Depression Treatment Research Articles

The Relationship of Chronic Disease Burden and Racial-Ethnic Disparities in Depression Treatment.

Chronic disease and depression are closely related, and depression, if left untreated, can worsen physical disease symptoms. Furthermore, treating depression can improve patient outcomes. Generally, treatment for depression is lower in minority groups. The aim of this study was to determine the relationship between chronic disease burden and depression treatment and whether that relationship differs between white to non-white patient visits to primary care physicians. We conducted a quantitative secondary data analysis using data from 2014-2019 National Ambulatory Medical Care Survey (NAMCS). Visits by adults with depression to primary care physicians (n = 3832). Logistic regressions estimated the odds of medication treatment, mental health counseling treatment, and any treatment. Visits by patients with 3 or more chronic conditions had 1.39 times the odds of receiving medication treatment (p-value = 0.06). However, when examining treatment by race, visits by white patients with 1-2 chronic conditions had 3.04 times the odds of receiving mental health treatment (p-value = 0.09) compared to visits by non-white patients and 2.09 times the odds of receiving any treatment (p-value = 0.08) compared to visits by non-white patients. Although not significant at the p < .05 level, the results suggest that the odds of depression treatment is greater during visits by patients with multiple co-occurring chronic conditions compared to visits by people without chronic conditions. It appears that this effect is larger for visits by white patients compared to visits by non-white patients. Further research is needed to confirm these findings and determine how this association impacts minorities distinctly and what could be the reason behind the disparity. These findings could help physicians be aware of ongoing disparities in depression treatment and provide more equitable depression treatment.

Racial/Ethnic Disparities in Depression Treatment for Caregivers Investigated by the US Child Welfare System.

To determine whether there are racial/ethnic differences in depression treatment for caregivers investigated by the US child welfare system. This cross-sectional study used baseline data from the Second National Survey of Child and Adolescent Well-being, a nationally representative sample of children and caregivers investigated by US child welfare agencies (February 2008-April 2009). We included permanent caregivers who met criteria for major depression and had available covariate data (n=908). In multivariable logistic regression models, we estimated the associations between caregiver race/ethnicity and past-year receipt of: any depression treatment, minimally adequate depression treatment, and depression treatment from 4 sectors (general medical, psychiatry, nonpsychiatry mental health, and human services). We controlled for clinical need and access variables according to the Institute of Medicine's definition of health care disparities. Black caregivers had the lowest rates of treatment receipt of any racial/ethnic group, with 42.2% receiving any depression treatment and 17.2% receiving minimally adequate depression treatment in the past year. In multivariable analyses controlling for clinical need and access variables, Black caregivers were less likely than White caregivers to receive any depression treatment (odds ratio [OR]=0.49 [95% CI: 0.24-0.97]), minimally adequate depression treatment (OR=0.37 [95% CI: 0.16-0.85]), and depression treatment from the general medical sector (OR=0.40 [95% CI: 0.18-0.89]) in the past year (all P< .05). Future research should examine the underlying mechanisms of Black-White disparities in depression treatment for caregivers involved with the US child welfare system and develop targeted interventions to promote equitable mental health care for this highly vulnerable population.

Primary Care Physician Recognition and Documentation of Depressive Symptoms Among Chinese and Latinx Patients During Routine Visits: A Cross-Sectional Study

Purpose: Asian and Latinx individuals have a high burden of untreated depression. Under-recognition of depressive symptoms may contribute to existing disparities in depression treatment. The objective of this cross-sectional study was to determine whether physicians recognize and treat depressive symptoms for Chinese and Latinx patients during routine primary care visits.Methods: We analyzed data from 1171 Chinese and Latinx patients who were interviewed within 1 week after a primary care visit in a large academic practice, which had not yet implemented universal depression screening. We included participants with depressive symptoms (defined as a Patient Health Questionaire-2 score ≥3) and no prior history of depression (N=118). We investigated whether patients perceived having a mental health need in the prior year and conducted chart reviews to assess provider recognition of depressive symptoms, defined as documentation of symptoms, antidepressant initiation, or mental health referral within 30 days of the visit. We further examined differences by race/ethnicity and language preference.Results: Among the 118 patients with depressive symptoms and no prior depression diagnosis (mean age 68), 71 (61%) reported a mental health need in the prior 12 months; however, providers recognized depressive symptoms in only 8/118 patients (7%). The number of patients with recognized symptoms was small across race/ethnicity and language preference groups and we found no significant differences.Conclusion: Physicians recognized and documented depressive symptoms for 1 in 10 Chinese and Latinx patients during routine primary care visits. Targeted efforts are needed to address under-recognition of symptoms and improve depression care for these populations.

Perception of Unmet Need after Seeking Treatment for a Past Year Major Depressive Episode: Results from the 2018 National Survey of Drug Use and Health.

Depression, a leading cause of disability and mortality world-wide that one in five U.S. adults are estimated to experience in their lifetime, presents special complications in treatment. While it is well-recognized that there are several barriers to even obtaining treatment for depression, once an individual obtains treatment they may not receive the type of care that they need. In order to examine common factors of those who experienced an unmet treatment need for depression despite seeking mental health treatment, we examined data from the 2018 National Survey of Drug Use and Health (NSDUH). We cross-sectionally compared two groups of individuals who both met criteria for a past year Major Depressive Episode (MDE) and sought mental health treatment, however one group reported an unmet treatment need and the other did not. Results indicate a variety of personal identity and social factors associated with perceiving an unmet treatment need, including age, race/ethnicity, sexual attraction, marital status, poverty level, health insurance, substance misuse, global health, and role impairment. This study contributes to the literature by providing further support for disparities in depression treatment at the consumer, provider, and systemic levels that have downstream effects for health equity policy and public health promotion.

Protocol for studying racial/ethnic disparities in depression care using joint information from participant surveys and administrative claims databases: an observational cohort study

IntroductionCurrent evidence indicates that older racial/ethnic minorities encounter disparities in depression care. Because late-life depression is common and confers major adverse health consequences, it is imperative to reduce disparities in...

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults: Guideline V. Assessment of Cultural Factors.

(Excerpted from "The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition." Copyright © 2016, American Psychiatric Association. Reprinted with permission.).

Cultural Factors, Depressive and Somatic Symptoms Among Chinese American and European American College Students

This study seeks to fill a gap in the existing empirical literature about the relationship between somatic and depressive symptoms and their associations with cultural factors among Chinese American and European American college students. In particular, the study examined how three culturally relevant psychological constructs, self-construal, loss of face, and emotion regulation, associate with depressive and somatic symptoms among Chinese American and European American college students and if they can explain possible group differences in depressive symptoms. The sample consisted of 204 Chinese American and 315 European American college students who completed an online survey. Based on multiple regression analyses, European American students reported higher levels of somatic symptoms on the Patient Health Questionnaire–15 (PHQ-15) than Chinese Americans. There was no initial group difference in depressive symptoms based on Center for Epidemiologic Studies–Depression Scale (CES-D) scores. Correlations between depressive and somatic symptoms, independent and interdependent self-construal, and cognitive reappraisal and independent self-construal were stronger for European Americans than Chinese Americans. Somatic symptoms, loss of face, and expressive suppression were positively associated with depressive symptoms, whereas independent self-construal and cognitive reappraisal were negatively associated with depressive symptoms for both groups. When controlling for gender and somatic symptoms, being Chinese American and male was significantly and positively associated with depressive symptoms measured with the CES-D. These ethnic and gender differences in depressive symptoms were explained by independent self-construal, loss of face, cognitive reappraisal, and expressive suppression. Clinical implications include the incorporation of specific culturally relevant constructs and avoidance of race-, ethnicity-, and gender-based stereotypes to reduce health disparities in depression treatment.

Depression Treatment Among Elderly Medicare Beneficiaries With Incident Cases of Cancer and Newly Diagnosed Depression.

Depression treatment can improve the health outcomes of elderly cancer survivors. There is a paucity of studies on the extent to which depression is treated among elderly cancer survivors. Therefore, this study estimated the rates of depression treatment among elderly cancer survivors and identified the factors affecting depression treatment. A retrospective cohort study design was adopted, and data were obtained from the linked Surveillance, Epidemiology and End Results (SEER) and Medicare database. Elderly individuals (≥ 66 years) with incident cases of breast, colorectal, or prostate cancer and newly diagnosed depression (N=1,673) were followed for six months after the depression diagnosis to identify depression treatment (antidepressants only, psychotherapy only, combined treatment with both antidepressants and psychotherapy, and no depression treatment). Chi-square tests and multinomial logistic regressions were used to analyze the factors associated with depression treatment. In this study population, 46% received antidepressants only, 27% received no treatment, 18% received combined therapy, and 9% received psychotherapy only. Factors associated with depression treatment included anxiety, the percentage of psychologists at the county level, the number of visits to primary care physicians, ongoing cancer treatment, the presence of other chronic conditions, and race-ethnicity. The study findings indicate that two-thirds of cancer survivors received depression treatment in the first six months after depression diagnosis. Our study findings indicate that racial-ethnic disparities in depression treatment persist and competing demands for cancer treatment may take priority over depression care. Also, the availability of psychologists may influence receipt of psychotherapy among cancer survivors.

Development of a Faith-Based Mental Health Literacy Program to Improve Treatment Engagement Among Caribbean Latinos in the Northeastern United States of America.

Depression is one of the leading causes of years lived with disability (YLDs) worldwide. Although depression can be successfully treated, 75% of Americans do not receive care. Treatment rates among Latinos immigrants are significantly lower than non-immigrant Latinos and non-Hispanic Whites. Known factors for mental health-care disparities such as poverty, insurance coverage, language barriers, and access to specialty mental health services in Latino neighborhoods do not fully explain the differences in treatment rates. Significant, but poorly understood factors influencing depression treatment among Latinos in the United States are lack of culturally congruent care, low mental health literacy, and stigma. Even though churches are a major source of health information, social and spiritual support for Latinos, the conceptualization of culturally congruent care rarely addresses religious beliefs. Therefore, one strategy to reduce disparities in depression treatment is to partner with churches to address faith-based stigma. Community-based participatory research is recognized as a methodology particularly well suited for creating successful culturally targeted interventions. The purpose of this article is to describe the process of creating a faith-based mental health literacy intervention in the Caribbean Latino community using the principles of community-based participatory research.

Uptake of depression treatment recommendations among Latino primary care patients.

Primary care providers (PCP) are the entry point for public sector depression treatment for many Latino patients. However, many Latino patients do not initiate their PCPs' recommended treatment, which likely contributes to ethnic disparities in depression treatment. This study examined factors related to Latino patients' uptake of their PCPs' recommendations for depression treatment. Ninety Latino primary care patients who received a depression treatment recommendation from their PCP participated in a telephone interview. Patients rated their working alliance with their PCP and their PCP's cultural competence. They also reported their treatment preference, the type of recommendation, and their intended and actual uptake of the recommendation. Patients were contacted at two time points (Time 1: M = 14 days after PCP appointment; Time 2: M = 84 days after PCP appointment) to report their uptake status. At Time 1, 23% of patients had initiated uptake of the treatment recommendation, increasing to 53% at Time 2. Patients who received a medication recommendation were more likely to have followed though on the recommendation, compared with patients who received a psychotherapy recommendation. The working alliance was positively associated with intention to follow up on a treatment recommendation, and also mediated the relationship between cultural competence and intention of following up on the recommendation. PCP's treatment recommendation and the PCP-patient alliance play a role in Latino primary care patients intention to follow a treatment recommendation for depression. An improved understanding of this role could enhance efforts to improve depression treatment uptake.

Ministers’ Perceptions of Church-Based Programs to Provide Depression Care for African Americans

African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers' perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. From August 2011 to March 2012, data were collected from three focus groups conducted with adult ministers (n = 21) from a black mega-church in New York City. Using consensual qualitative research to analyze data, eight main domains emerged: definition of depression, identification of depression, causal factors, perceived responsibilities, limitations, assessment, group interpersonal psychotherapy, and stigma. A major finding was that ministers described depression within a context of vast suffering due to socioeconomic inequalities (e.g., financial strain and unstable housing) in many African American communities. Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants' confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment.

PMS7 Depression Treatment Patterns among Individuals with Arthritis

To examine the patterns of depression treatment among individuals with arthritis and depression by demographic, socioeconomic, access to care, health status and lifestyle risk factors. We used a cross-sectional design. Our data source was the 2008 annual release of Medical Expenditures Panel Survey (MEPS). Individuals with self-reported arthritis were identified from medical conditions and household files. Presence of depression was captured from medical conditions file. The study sample consisted of 947 adults with arthritis and depression. Unadjusted group differences in depression treatment patterns among individuals with arthritis and depression were analyzed using Chi-square tests. Multinomial logistic regressions were used to examine the relationship between depression treatment and demographic, socioeconomic, access to care, health status and lifestyle risk factors. All analysis accounted for complex survey design of MEPS. Overall, 20% of individuals with arthritis and depression had no depression treatment, 56% used antidepressants only and 24% used psychotherapy with or without antidepressants. After controlling for all other independent variables, we found that compared to whites, African Americans (AOR=0.37) and Latinos (AOR=0.28) were significantly less likely to use antidepressants only. Individuals with middle income (AOR=0.32) were significantly less likely to receive psychotherapy with or without antidepressants, than individuals with high income. One in every five individuals with both arthritis and depression did not have any treatment for depression. Racial and socio-economic disparities in depression treatment were found. Further research is required to explore that whether lack of depression treatment results in poor health outcomes related to arthritis among individuals with arthritis and depression.

Ethical Dimensions of Disparities in Depression Research and Treatment in the Pharmacogenomic Era

Disparities in access to, and utilization of, treatment for depression among African-American and Caucasian elderly adults have been well-documented. Less fully explored are the multidimensional factors responsible for these disparities. The intersection of cultural constructs, socioeconomic factors, multiple levels of racism, and stigma attending both mental health issues and older age may help to explain disparities in the treatment of the depressed elderly. Personalized medicine with its promise of developing interventions tailored to an individual's health needs and genetically related response to treatment might seem a promising antidote to the documented underutilization of standard depression treatments by African Americans. However, this paper examines the multidimensional factors associated with disparities in effective treatment of depression among African-American and Caucasian elderly adults and argues the scientific and ethical importance of pursuing various paths to address multiple levels and sources of stigma and mistrust if pharmacogenomics is to help, rather than exacerbate, disparities in depression treatment. Seven recommendations are offered to increase the likelihood that developments in pharmacogenomics will reduce disparities in depression treatment.

Racial-Ethnic Composition of Provider Practices and Disparities in Treatment of Depression and Anxiety, 2003–2007

Objectives: This study explored whether racial and ethnic disparities in the treatment of depression and anxiety are associated with provider-level factors. Methods: This study analyzed 58,826 office-based adult outpatient visits to primary care physicians and psychiatrists. Data were from the National Ambulatory Medical Care Survey, 2003–2007. Outcomes included counseling and referral for counseling, antidepressant prescription, and any care for depression or anxiety. The analyses of treatment outcomes were not limited to visits with a depression or anxiety diagnosis. Results: Compared with visits to primary care physicians by whites, such visits by blacks and Hispanics were less likely to result in antidepressant prescription or in any care for depression or anxiety; primary care visits by Hispanics were also less likely to result in counseling. Compared with visits to psychiatrists by whites, such visits by blacks were less likely to result in an antidepressant prescription. The majority of visits to both primary care physicians and psychiatrists by blacks and Hispanics were to practices serving a high percentage of nonwhite patients. However, racial and ethnic disparities in care that were especially evident in primary care settings persisted after the analyses controlled for whether visits were to settings with a high or low percentage of nonwhite patients. Conclusions: Disparities in care for depression and anxiety in primary care continue and are not fully accounted for by less care being provided in settings that nonwhites frequent. Physician bias, resource issues, and patient factors may all play a role in the diagnosis and treatment of depression and anxiety. (Psychiatric Services 62:1019–1025, 2011)

Racial-ethnic composition of provider practices and disparities in treatment of depression and anxiety, 2003-2007.

This study explored whether racial and ethnic disparities in the treatment of depression and anxiety are associated with provider-level factors. This study analyzed 58,826 office-based adult outpatient visits to primary care physicians and psychiatrists. Data were from the National Ambulatory Medical Care Survey, 2003-2007. Outcomes included counseling and referral for counseling, antidepressant prescription, and any care for depression or anxiety. The analyses of treatment outcomes were not limited to visits with a depression or anxiety diagnosis. Compared with visits to primary care physicians by whites, such visits by blacks and Hispanics were less likely to result in antidepressant prescription or in any care for depression or anxiety; primary care visits by Hispanics were also less likely to result in counseling. Compared with visits to psychiatrists by whites, such visits by blacks were less likely to result in an antidepressant prescription. The majority of visits to both primary care physicians and psychiatrists by blacks and Hispanics were to practices serving a high percentage of nonwhite patients. However, racial and ethnic disparities in care that were especially evident in primary care settings persisted after the analyses controlled for whether visits were to settings with a high or low percentage of nonwhite patients. Disparities in care for depression and anxiety in primary care continue and are not fully accounted for by less care being provided in settings that nonwhites frequent. Physician bias, resource issues, and patient factors may all play a role in the diagnosis and treatment of depression and anxiety.

Collaborative Depression Care Management and Disparities in Depression Treatment and Outcomes

Collaborative depression care management (DCM), by addressing barriers disproportionately affecting patients of racial/ethnic minority and low education, may reduce disparities in depression treatment and outcomes. To examine the effects of DCM on treatment disparities by education and race/ethnicity in older depressed primary care patients. Analysis of data from the randomized controlled trial Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT). Twenty primary care practices. A total of 396 individuals 60 years or older with major depression. We conducted model-based analysis to estimate potentially differential intervention effects by education, independent of those by race/ethnicity (and vice versa). Algorithm-based recommendations to physicians and care management by care managers. Antidepressant use, depressive symptoms, and intensity of DCM over 2 years. The PROSPECT intervention had a larger and more lasting effect in less-educated patients. At month 12, the intervention increased the rate of adequate antidepressant use by 14.2 percentage points (pps) (95% confidence interval [CI], 1.7 to 26.4 pps) in the no-college group compared with a null effect in the college-educated group (-9.2 pps [95% CI, -25.0 to 2.7 pps]); at month 24, the intervention reduced depressive symptoms by 2.6 pps on the Hamilton Depression Rating Scale (95% CI, -4.6 to -0.4 pps) in no-college patients, 3.8 pps (95% CI, -6.8 to -0.4) more than in the college group. The intervention benefitted non-Hispanic white patients more than minority patients. Intensity of DCM received by minorities was 60% to 70% of that received by white patients after the initial phase but did not differ by education. The PROSPECT intervention substantially reduced disparities by patient education but did not mitigate racial/ethnic disparities in depression treatment and outcomes. Incorporation of culturally tailored strategies in DCM models may be needed to extend their benefits to minorities. clinicaltrials.gov Identifier for NCT00279682.

Differences in Treatment Attitudes Between Depressed African-American and Caucasian Veterans in Primary Care

Depressive disorders are common, and it is important to understand the factors that contribute to racial disparities in depression treatment. This primary care study of veterans with subsyndromal depression examined two hypotheses: that African Americans would be less likely than Caucasians to believe that medication is beneficial in depression treatment and would be more likely to believe that counseling or psychotherapy is beneficial. Primary care patients with subsyndromal depression were referred to the Philadelphia Department of Veterans Affairs Behavioral Health Laboratory and asked about past experiences and attitudes toward depression treatment. Among 111 African-American and 95 Caucasian participants, logistic regression analyses determined that African Americans were less likely to view medication as beneficial (odds ratio=.44). No racial differences were found in participants' attitude toward counseling or psychotherapy. The findings support the premise that clinicians treating patients with subsyndromal depressive syndromes should take into account racial differences in attitudes toward treatment.

Differences in Treatment Attitudes Between Depressed African-American and Caucasian Veterans in Primary Care

Objectives: Depressive disorders are common, and it is important to understand the factors that contribute to racial disparities in depression treatment. This primary care study of veterans with subsyndromal depression examined two hypotheses: that African Americans would be less likely than Caucasians to believe that medication is beneficial in depression treatment and would be more likely to believe that counseling or psychotherapy is beneficial. Methods: Primary care patients with subsyndromal depression were referred to the Philadelphia Department of Veterans Affairs Behavioral Health Laboratory and asked about past experiences and attitudes toward depression treatment. Results: Among 111 African-American and 95 Caucasian participants, logistic regression analyses determined that African Americans were less likely to view medication as beneficial (odds ratio=.44). No racial differences were found in participants' attitude toward counseling or psychotherapy. Conclusions: The findings support the premise that clinicians treating patients with subsyndromal depressive syndromes should take into account racial differences in attitudes toward treatment. (Psychiatric Services 62:426–429, 2011)

Retention in depression treatment among ethnic and racial minority groups in the United States

Premature discontinuation of psychiatric treatment among ethnic-racial minorities is a persistent concern. Previous research on identifying factors associated with ethnic-racial disparities in depression treatment has been limited by the scarcity of national samples with adequate representation of minority groups and especially non-English speakers. In this article, we aim to identify variations in the likelihood of retention in depression treatment among ethnic-racial minority groups in the United States as compared to non-Latino whites. Second, we aim to identify the factors that are related to treatment retention. We use data from the Collaborative Psychiatric Epidemiology Surveys to examine differences and correlates of depression treatment retention among a representative sample (n=564) of non-Latino whites, Latinos, African-American, and Asian respondents with last 12-month depressive disorder and who report receiving formal mental health treatment in the last year. We define retention as attending at least four visits or remaining in treatment during a 12-month period. Being seen by a mental health specialist as opposed to being seen by a generalist and having received medication are correlates of treatment retention for the entire sample. However, after adjusting for demographics, clinical factors including number of co-occurring psychiatric disorders and level of disability, African-Americans are significantly less likely to be retained in depression treatment as compared to non-Latino whites. Availability of specialized mental health services or comparable treatment within primary care could improve treatment retention. Low retention suggests persistent problems in the delivery of depression treatment for African-Americans.

Disparity in depression treatment among racial and ethnic minority populations in the United States.

Prior research on racial and ethnic disparities in depression treatment has been limited by the scarcity of national samples that include an array of diagnostic and quality indicators and substantial numbers of non-English-speaking individuals from minority groups. Using nationally representative data for 8,762 persons, the authors evaluated differences in access to and quality of depression treatments between patients in racial-ethnic minority groups and non-Latino white patients. Access to mental health care was assessed by past-year receipt of any mental health treatment. Adequate treatment for acute depression was defined as four or more specialty or general health provider visits in the past year plus antidepressant use for 30 days or more or eight or more specialty mental health provider visits lasting at least 30 minutes, with no antidepressant use. For persons with past-year depressive disorder, 63.7% of Latinos, 68.7% of Asians, and 58.8% of African Americans, compared with 40.2% of non-Latino whites, did not access any past-year mental health treatment (significantly different at p<.001). Disparities in the likelihood of both having access to and receiving adequate care for depression were significantly different for Asians and African Americans in contrast to non-Latino whites. Simply relying on present health care systems without consideration of the unique barriers to quality care that ethnic and racial minority populations face is unlikely to affect the pattern of disparities observed. Populations reluctant to visit a clinic for depression care may have correctly anticipated the limited quality of usual care.