Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States

Alegrı́a, Margarita; Chatterji, Pinka; Wells, Kenneth B.; Cao, Zhun; Chen, Chih-Nan; Takeuchi, David T.; Jackson, James S.; Meng, Xiao‐Li

doi:10.1176/ps.2008.59.11.1264

Cited by 688 publications

(330 citation statements)

References 47 publications

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“…Racial disparities exist for depressive symptom severity, recognition, and treatment15, 44, 45 and CVD outcomes 46. Nevertheless, we found that race did not appear to moderate the association between depressive symptoms and CVD.…”

Section: Discussioncontrasting

confidence: 52%

“…In addition to unmeasured confounders, research also remains inconsistent as to whether race truly moderates the association between depressive symptoms and incident CVD 11, 12, 13, 14. Prior studies suggest that racial and ethnic minorities face unique barriers to depression treatment in the United States,15 and as such, it is unclear how race and time‐dependent depressive symptoms interact to influence CVD events.…”

Section: Introductionmentioning

confidence: 99%

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Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Moise

Khodneva

Richman

et al. 2016

JAHA

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BackgroundDepression is a relapsing and remitting disease. Prior studies on the association between depressive symptoms and incident cardiovascular disease (CVD) have been limited by single measurements, and few if any have examined both incident coronary heart disease and stroke in a large biracial national cohort. We aimed to assess whether time‐dependent depressive symptoms conferred increased risk of incident CVD.Methods and ResultsBetween 2003 to 2007, 22 666 black and white participants (aged ≥45 years) without baseline CVD in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were recruited. Cox proportional hazards regression analyses assessed the association between up to 3 measurements of elevated depressive symptoms (4‐item Center for Epidemiologic Studies Depression Scale score ≥4) and incident coronary heart disease, stroke, and CVD death adjusting for age, sex, region, income, health insurance, education, blood pressure, cholesterol, medication, obesity, diabetes mellitus, kidney disease, C‐reactive protein, corrected QT interval, atrial fibrillation, left ventricular hypertrophy, smoking, alcohol, physical inactivity, medication adherence, and antidepressant use. The participants’ average age was 63.4 years, 58.8% were female, and 41.7% black. Time‐varying depressive symptoms were significantly associated with CVD death (adjusted hazard ratio 1.30, 95% CI 1.04–1.63), with a trend toward significance for fatal and nonfatal stroke (adjusted hazard ratio 1.26, 95% CI 0.99–1.60) but not fatal and nonfatal coronary heart disease (adjusted hazard ratio 1.11, 95% CI 0.89–1.38). Race did not moderate the association between depressive symptoms and CVD.ConclusionsProximal depressive symptoms were associated with incident fatal and nonfatal stroke and CVD death even after controlling for multiple explanatory factors, further supporting the urgent need for timely management of depressive symptoms.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Moise

Khodneva

Richman

et al. 2016

JAHA

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“…Studies have consistently found disparities in access to and utilization and quality of mental health care (10–13) and other types of health services (14–16). However, findings on substance abuse treatment disparities have been mixed.…”

mentioning

confidence: 99%

Racial-Ethnic Disparities in Substance Abuse Treatment: The Role of Criminal History and Socioeconomic Status

Cook¹,

Alegrı́a²

2011

Psychiatric Services

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Objective Among persons with substance use disorders, those from racial-ethnic minority groups have been found to receive substance abuse treatment at rates equal to or higher than those of non-Latino whites. Little is known about factors underlying this apparent lack of disparities. This study examines racial-ethnic disparities in treatment receipt and mechanisms that reduce or contribute to disparities. Methods Black-white and Latino-white disparities in any and in specialty substance abuse treatment were measured among adult respondents with substance use disorders from the 2005–2009 National Survey on Drug Use and Health (N=25,159). Three staged models were used to measure disparities concordant with the Institute of Medicine definition, assess the extent to which criminal history and socioeconomic indicators contributed to disparities, and identify correlates of treatment receipt. Results Treatment was rare (about 10%) for all racial-ethnic groups. Odds ratios for black-white and Latino-white differences decreased and became significantly less than 1 after adjustment for criminal history and socioeconomic status factors. Higher rates of criminal history and enrollment in Medicaid among blacks and Latinos and lower income were specific mechanisms that influenced changes in estimates of disparities across models. Conclusions The greater likelihood of treatment receipt among persons with a criminal history and lower socioeconomic status is a pattern unlike those seen in most other areas of medical treatment and important to the understanding of substance abuse treatment disparities. Treatment programs that are mandated by the criminal justice system may provide access to individuals resistant to care, which raises concerns about perceived coercion.

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“…Such factors include provider competence, the extent of community resources, and ease of access to the clinic and to medication. Understanding adherence, quality of treatment, and access to care is an important concern in outcomes studies in which race-ethnicity is examined (12). …”

Section: Discussionmentioning

confidence: 99%

“…One clinical trial of haloperidol treatment for acute mania reported higher remission rates for Latinos than for whites and a trend toward higher remission rates with olanzapine for Latinos (11). In any study of race-ethnicity and treatment outcomes, consideration of socioeconomic differences is crucial in interpreting outcomes across race-ethnicity, given the average lower income and education level and higher rates of uninsured among U.S. African Americans and Hispanics compared with non-Hispanic whites (12). …”

mentioning

confidence: 99%

One-Year Treatment Outcomes of African-American and Hispanic Patients With Bipolar I or II Disorder in STEP-BD

Gonzalez¹,

Bowden²,

Berman³

et al. 2010

Psychiatric Services

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Objective Few studies have compared treatment outcomes of African-American, Hispanic, and non-Hispanic white patients with bipolar disorder. The U.S. Systematic Treatment Enhancement Program for Bipolar Disorder compared one-year outcomes for bipolar I or II disorder from each of these racial-ethnic groups. Methods African Americans (N=155) were retrospectively compared with a matched group of non-Hispanic whites (N=729), and Hispanics (N=152) were compared with a separate matched group of non-Hispanic whites (N=822). Response and recovery outcomes were examined. Survival analysis was used to compare time to treatment response for depression (Montgomery-Asberg Depression Rating Scale) and mania (Young Mania Rating Scale) as well as global assessment of functioning (Global Assessment of Functioning). Results For manic and depressive symptoms, time to response and proportion of responders were similar across groups. Over the study year the proportion of days well was similar across groups. A smaller proportion of African Americans met criteria for improved global functioning. Depression response among African Americans with psychotic symptoms was slower than the response among African Americans without psychotic symptoms and among non-Hispanic whites with or without psychotic symptoms. No differences between Hispanics and non-Hispanic whites in response times and recovery were observed. Conclusions Results are consistent with U.S. clinical trials for other psychiatric disorders, which have reported similar outcomes for ratings of primary symptoms. Baseline psychotic symptoms are likely a significant contributor when African Americans with bipolar disorder are slow to recover. These results may be less generalizable to uninsured patients.

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Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States

Cited by 688 publications

References 47 publications

Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Racial-Ethnic Disparities in Substance Abuse Treatment: The Role of Criminal History and Socioeconomic Status

One-Year Treatment Outcomes of African-American and Hispanic Patients With Bipolar I or II Disorder in STEP-BD

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