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.
Similar content being viewed by others
References
Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA. National trends in the outpatient treatment of depression. JAMA. 2002;287:203–9.
Robins LN, Regier DA, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York, NY: The Free Press; 1991.
Padgett DK, Patrick C, Burns BJ, Schlesinger HJ. Ethnic differences in use of inpatient mental health services by blacks, whites, and Hispanics in a national insured population. Health Serv Res. 1994;29:135–53.
Blazer DG, Hybels CF, Simonsick EM, Hanlon JT. Marked differences in antidepressant use by race in an elderly community sample: 1986–96. Am J Psychiatry. 2000;157:1089–94.
Zito JM, Safer DJ. Services and prevention: pharmacoepidemiology of antidepressant use. Biol Psychiatry. 2001;49:1121–7.
Hough RL, Landsverk JA, Karno M, et al. Utilization of health and mental health services by Los Angeles Mexican Americans and non-Hispanic whites. Arch Gen Psychiatry. 1987;44:702–9.
Vega WA, Kolody B, Aguilar-Gaxiola S, Catalano R. Gaps in service utilization by Mexican Americans with mental health problems. Am J Psychiatry. 1999;156:928–34.
Sussman LK, Robins LN, Earls F. Treatment-seeking for depression by black and white Americans. Soc Sci Med. 1987;24:187–96.
Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.
Borowsky SJ, Rubenstein LV, Meredith LS, Camp P, Jackson-Triche M, Wells KB. Who is at risk of nondetection of mental health problems in primary care? J Gen Intern Med. 2000;15:381–8.
Meredith LS, Rubenstein LV, Rost K, et al. Treating depression in staff-model versus network-model managed care organizations. J Gen Intern Med. 1999;14:39–48.
Rost KM, Duan N, Rubenstein LV, et al. The Quality Improvement for Depression Collaboration: general analytic strategies for a coordinated study of quality improvement in depression care. Gen Hosp Psychiatry. 2001;23:239–53.
World Health Organization. Composite International Diagnostic Interview (CIDI), Version 2.1 Geneva, Switzerland: World Health Organization; 1995.
Robins LN, Barrett JE. The Validity of Psychiatric Diagnosis. New York, NY: Raven Press; 1989.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measurement. 1977;1:385–401.
McHorney CA, Ware JE Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–63.
Stata Statistical Software, Version 7. College Station, Tex: Stata Corporation; 2001.
Orlando M, Sherbourne DC, Thissen D. Summed score linking using item response theory: application to depression measurement. Psych Assess. 2000;12:354–9.
Brody DS, Khaliq AA, Thompson TL 2nd. Patients’ perspectives on the management of emotional distress in primary care settings. J Gen Intern Med. 1997;12:403–6.
Dwight-Johnson M, Sherbourne CD, Liao D, Wells KB. Treatment preferences among depressed primary care patients. J Gen Intern Med. 2000;15:527–34.
Cooper LA, Gonzales JJ, Gallo JJ, et al. The acceptability of treatment for depression among African-American, Hispanic, Latino, and white primary care patients. Med Care. 2003;41:479–89.
Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988;26:657–75.
Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.
Cooper LA, Brown C, Ford DE, Vu HT, Powe NR. How important is intrinsic spirituality in depression care? A comparison of white and African-American primary care patients. J Gen Intern Med. 2001;16:634–8.
Author information
Authors and Affiliations
Corresponding author
Additional information
This work was supported by the John D. and Catherine T. MacArthur Foundation and the National Institute of Mental Health R0 Cooperative Agreement Quality Improvement for Depression (MH57992, MH5444, and MH5443) and the Agency for Healthcare Research & Quality (R01-HS08349). Three Center grants supported Dr Miranda’s writing of this paper (P01HS19758, AG-02-004, and MH59876). This work was also supported by a grant to Dr Cooper from the Quality Care Research Fund of Aetna Foundation, Inc., Hartford, CT.
Rights and permissions
About this article
Cite this article
Miranda, J., Cooper, L.A. Disparities in care for depression among primary care patients. J GEN INTERN MED 19, 120–126 (2004). https://doi.org/10.1111/j.1525-1497.2004.30272.x
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2004.30272.x