Ethnic Differences in Depression Treatment for Cardiac Patients

Coronary heart disease (CHD) is the leading cause of mortality in the United States, with an excess of mortality in African Americans. Traditional risk factors occur more frequently among African Americans, but do not fully account for this increased risk. Elevated depressive symptoms have been shown to be associated with higher morbidity and mortality in patients with CHD. A recent study of 864 patients (727 whites, 137 African Americans) found there the prevalence of elevated depressive symptoms was similar for African Americans (35%) and whites (27%). However, the rate of antidepressant use was 21% for whites but only 11.7% for African Americans. This difference was especially evident in men compared to women, with only 22% of moderately to severely depressed African American men on antidepressants compared to 43% of their white counterparts.

The authors concluded that African Americans with CHD are less likely to be treated with antidepressant medications compared with whites despite having similar levels of depression.

The authors were unable to determine if the differential rates of antidepressant treatment in African Americans is a result of underdiagnosis of depression or undertreatment by physicians, or if it is an expression of reluctance of African American patients to discuss their symptoms and request or accept pharmacological treatment. The ethnic differences in the psychopharmacological management of depression suggests that more careful assessment of depression, especially in African Americans, is necessary to optimize care of patients with CHD.

-Adapted from: “Ethnic Differences in the Treatment of Depression in Patients With Ischemic Heart Disease”, Silvina V. Waldman, MD; James A. Blumenthal, PhD; Michael A. Babyak, PhD; Andrew Sherwood, PhD; Michael Sketch, MD; Jonathan Davidson, MD; Lana L. Watkins, PhD, Am Heart J.  2009;157(1):77-83. Medscape Psychiatry: www.medscape.com/viewarticle/585978. Posted 2/20/09, retrieved 3/4/09.

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