Disparities in Care for Depression Among Primary Care Patients

Authors

  • Jeanne Miranda PhD,

    Corresponding author
       Address correspondence and requests for reprints to Dr. Miranda: UCLA-Neuropsychiatric Institute, Center for Health Services Research, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024 (e-mail: Mirandaj@ucla.edu).
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  • Lisa A. Cooper MD, MPH


  • Received from UCLA-Neuropsychiatric Institute and Department of Biobehavioral Services (JM), Los Angeles, Calif; Department of Medicine and Department of Health Policy and Management and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health (LAC), Baltimore, Md.

 Address correspondence and requests for reprints to Dr. Miranda: UCLA-Neuropsychiatric Institute, Center for Health Services Research, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024 (e-mail: Mirandaj@ucla.edu).

Abstract

CONTEXT:  Ethnic minorities traditionally receive less care for depression than do white populations; we examine ethnic minority care for depression in a large cross-national primary care sample.

DESIGN:  This is a cross-sectional study of identification and treatment of depression among diverse primary care patients, using self-report of symptoms and care.

SUBJECTS:  One thousand four hundred and ninety-eight depressed primary care patients participating in four large studies of quality improvement for depression care are examined at baseline.

RESULTS:  Primary care providers recommend depression treatments for Latino and African-American patients as frequently as they do for white patients. However, Latino and African-American patients are less likely to take antidepressant medications (adjusted odds ratio [OR], 0.30; 95% confidence interval [CI], 0.21 to 0.42 and adjusted OR, 0.56; 95% CI, 0.36 to 0.87, respectively) and Latinos are less likely to obtain specialty mental health care (adjusted OR, 0.50; 95% CI, 0.36 to 0.75).

CONCLUSIONS:  Primary care providers are now able to recognize depression and recommend treatment for Latino and African-American patients, with this care recommended at equal rates to that of white patients. However, Latino and African-American patients remain less likely to obtain appropriate care, such as antidepressant medications or specialty care. New approaches to improving access to appropriate care for Latino and African-American primary care patients are needed.

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