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

Authors

  • Lisa S. Parker,

    1. Philosopher-bioethicist, is an Associate Professor of Human Genetics and Director of Graduate Education for the Center for Bioethics and Health Law at the University of Pittsburgh where she conducts research on ethical issues in genetic research and directs the Master of Arts Program in Bioethics.
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  • Valerie B. Satkoske

    1. Assistant Professor of Medicine and the bioethicist for the Clinical and Translational Science Institute at the University of Pittsburgh.
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Abstract

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.

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