Racial Disparities in Depression Treatment

Racial minorities in the United States are significantly less likely to receive treatment for depression or adequate care when treatment is available, a new study suggests.

Investigators at Harvard Medical School, in Boston, Massachusetts, found that, among individuals with any depressive disorder within the past 12 months, 63.7% of Latinos, 68.7% of Asians, and 58.8% of African Americans did not access any mental health treatment, compared with 40.2% of non-Latino whites.

Further, the study revealed that among those who did receive treatment for depression, members of ethnic minorities were significantly less likely than whites to receive adequate care in the past year — 12% of African Americans, 13% of Asians, and 22% of Latinos compared with 33% of whites.

"Depression is one of the leading illnesses in terms of disease burden. The fact that depression treatment for the general population, but in particular for ethnic and racial minorities, is so inadequate leads one to believe that a major public health effort is sorely needed. Rethinking what we offer and how we offer it is salient, since we need to shift what we are currently doing," principal investigator Margarita Alegria, PhD, told Medscape Psychiatry.

The study included 8762 individuals. Access to mental healthcare was assessed by past-year receipt of any mental health treatment. Adequate treatment for acute depression was defined as 4 or more specialty or general health provider visits in the past year plus antidepressant use for 30 days or more or 8 or more specialty mental health provider visits lasting at least 30 minutes with no antidepressant use.

On average, the authors report, "Latinos, Asians, and African Americans with depression were 9 to 23 percentage points less likely to access mental health treatment and receive adequate depression treatment than non-Latino whites with similar observed characteristics."

The study findings show that even after adjustment for social class–related variables such as poverty, insurance coverage, and education, ethnicity and race still had an independent effect on access to depression treatment. However, the authors also point out that regardless of race or ethnicity, the majority of individuals who accessed depression treatment received inadequate care.

"We did not expect to find such low levels of adequate depression care, given all the effort that has been put into improving it," said Dr. Alegria.

"It's possible," she added, "that that low use of depression treatment is partly due to the correct anticipation by minorities that they are more likely to receive inadequate care. As a result, individuals might decide that there is a low payoff to seeking depression care."

The researchers cite several potential factors that may contribute to disparities in access to depression care and adequate treatment, including:

• Symptom presentation for mental health disorders varies across racial and ethnic groups, potentially resulting in misdiagnosis.
• Losing pay from work or the stigma that surrounds mental illness may constrain service utilization in racial- and ethnic-minority communities.
• Members of racial/ethnic minorities often mistrust healthcare providers.
• Minority families may be less likely to recognize depression or feel they can provide care without formal providers.
• Insufficient funding for mental health services in safety-net settings for uninsured, Medicaid, and other vulnerable patients.

"Our findings shift the debate to developing policy, practice, and community solutions to address the barriers that generate these disparities. Simply relying on current systems, without considering the unique barriers to high-quality care that apply for underserved ethnic- and racial-minority populations, is unlikely to affect the pattern of disparity we observed," the researchers write.

-Adapted from: “Minorities With Depression Have Limited Access to Care, Receive Inadequate Treatment”, Medscape Psychiatry, November 04, 2008 at http://www.medscape.com/viewarticle/582818?src=mp&spon=12&uac=21416FZ re: Psychiatric Services 2008;59:1264-1272.

 

11/08