October 30, 2007 — Racial minorities in the United States are significantly less likely to receive treatment for depression or adequate care when treatment is available, a new study suggests.
Investigators at Harvard Medical School, in Boston, Massachusetts, found that, among individuals with any depressive disorder within the past 12 months, 63.7% of Latinos, 68.7% of Asians, and 58.8% of African Americans did not access any mental health treatment, compared with 40.2% of non-Latino whites.
Further, the study revealed that among those who did receive treatment for depression, members of ethnic minorities were significantly less likely than whites to receive adequate care in the past year — 12% of African Americans, 13% of Asians, and 22% of Latinos compared with 33% of whites.
"The findings paint a stark, recent picture of care for depression among racial- and ethnic-minority populations in the United States and clearly point to areas in need of further sustained attention," the authors write.
The study is published in the November issue of Psychiatric Services.
Previous Research Hampered
According to the authors, prior research on racial and ethnic disparities in depression treatment has been hampered by a paucity of national samples that include large numbers of non–English-speaking minorities.
However, the National Institute of Mental Health Collaborative Psychiatric Epidemiology Surveys (CPES) provided the investigators with the type of comprehensive data needed to conduct an accurate evaluation of differences in access to and quality of depression treatments between patients in racial and ethnic groups and non-Latino white patients.
According to the investigators, the 3 studies that constitute the CPES — the National Latino and Asian American Study, the National Comorbidity Survey Replication, and the National Survey of American Life — include the same measures of need and quality and include significant numbers of non–English-speaking subjects belonging to racial- and ethnic-minority groups.
The study included 8762 individuals. Access to mental healthcare was assessed by past-year receipt of any mental health treatment. Adequate treatment for acute depression was defined as 4 or more specialty or general health provider visits in the past year plus antidepressant use for 30 days or more or 8 or more specialty mental health provider visits lasting at least 30 minutes with no antidepressant use.
On average, the authors report, "Latinos, Asians, and African Americans with depression were 9 to 23 percentage points less likely to access mental health treatment and receive adequate depression treatment than non-Latino whites with similar observed characteristics."
Interestingly, the authors point out that although the vast majority of patients without depression received no treatment, 3.2% of non-Latino whites who did not meet criteria for past-year depression received 4 or more visits to a healthcare professional and received 30 days or more of antidepressant treatment. This compared with 0.7% of Latinos, 1.2% of Asians, and 1.3% of African Americans.
According to the authors, the study findings show that even after adjustment for social class–related variables such as poverty, insurance coverage, and education, ethnicity and race still had an independent effect on access to depression treatment.
However, they also point out that regardless of race or ethnicity, the majority of individuals who accessed depression treatment received inadequate care.
"Despite recent advances in the treatment of mental illness and considerable efforts to improve quality of and access to treatment, there appears to be a significant mismatch between need and treatment in the United States," they write.
The researchers cite several potential factors that may contribute to disparities in access to depression care and adequate treatment, including:
Symptom presentation for mental health disorders varies across racial and ethnic groups, potentially resulting in misdiagnosis.
Losing pay from work or the stigma that surrounds mental illness may constrain service utilization in racial- and ethnic-minority communities.
Members of racial/ethnic minorities often mistrust healthcare providers.
Minority families may be less likely to recognize depression or feel they can provide care without formal providers.
Insufficient funding for mental health services in safety-net settings for uninsured, Medicaid, and other vulnerable patients.
"Our findings shift the debate to developing policy, practice, and community solutions to address the barriers that generate these disparities. Simply relying on current systems, without considering the unique barriers to high-quality care that apply for underserved ethnic- and racial-minority populations, is unlikely to affect the pattern of disparity we observed," the researchers write.
The authors have no relevant disclosures.