Many U.S. adults with major depression do not receive treatment for depression or therapy based on treatment guidelines, and some racial and ethnic groups have even lower rates of adequate depression care, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Depression is a leading cause of disability among many racial and ethnic groups in the United States, according to background information in the article. Pharmacotherapy (including antidepressants) and psychotherapy are both effective, well tolerated treatments for depression when provided according to established guidelines (such as those from the American Psychiatric Association), the authors note. Previous research suggests that many individuals are untreated or undertreated, but most studies of depression care have not distinguished between the two modalities and have also aggregated major racial and ethnic groups (for instance, combining all Latino individuals instead of examining specific subgroups, such as Mexican Americans and Puerto Ricans).
Hector M. Gonzαlez, Ph.D., of Wayne State University, Detroit, and colleagues assessed the prevalence and adequacy of depression care among different racial and ethnic groups in the United States by analyzing data from the National Institute of Mental Health's Collaborative Psychiatric Epidemiology Surveys. This initiative combines three nationally representative studies, during which face-to-face interviews were conducted with 15,762 individuals age 18 and older throughout the country between 2001 and 2003.
Of the adults surveyed, 8.3 percent had major depression, including 8 percent of Mexican Americans, 11.8 percent of Puerto Ricans, 7.9 percent of Caribbean blacks, 6.7 percent of African Americans and 8.5 percent of non-Latino whites.
Overall, more than half of those with depression received at least one form of depression care, but only about one in five (21.3 percent) had received at least one form of therapy that conformed to established treatment guidelines within the previous year. Psychotherapy was more commonly used than pharmacotherapy, and individuals undergoing psychotherapy were more likely to receive treatment in alignment with clinical guidelines than were individuals taking medications.
Mexican American and African American individuals with depression consistently had lower odds of receiving any type of care or care in concordance with treatment guidelines during the year prior. "The proportions of Puerto Rican and non-Latino white individuals who used concordant therapies in the past year were nearly twice those of Mexican American, Caribbean black and African American individuals," the authors write.
The findings illustrate the importance of breaking down large ethnic and racial groups into smaller sub-categories, they note. "Failing to do so obscures depression care research, especially for the largest and fastest-growing segment of the U.S. population, Latino individuals, and especially Mexican American individuals."
"With the recent passing of a U.S. Mental Health Parity Act, our findings should provide guidance to better-enabled mental health to improve the depression care of all Americans and for reducing disparities among ethnic/racial minorities," they conclude.
This work was supported by the National Institutes of Health National Institute of Mental Health and the National Institute on Aging.
- Hector M. Gonzalez; William A. Vega; David R. Williams; Wassim Tarraf; Brady T. West; Harold W. Neighbors. Depression Care in the United States: Too Little for Too Few. Arch Gen Psychiatry, 2010; 67 (1): 37-46 [link]
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