Racial Differences in Antidepressant Use Among Older Home Health Care Patients
ABSTRACT The objective of this study was to determine the association of race (black and white) with depression diagnosis and antidepressant use among older home health care patients.
Cross-sectional data were obtained from the 2007 National Home and Hospice Care Survey of patients 65 years and older (N=3,157). Data were analyzed by race, antidepressant use, and charted depression diagnosis.
Whites had greater odds than blacks of receiving a depression diagnosis (adjusted odds ratio [AOR]=4.46, 95% confidence interval [CI]=1.52-13.09). Whites with no depression diagnosis were also more likely to receive an antidepressant (AOR=2.62, CI=1.58-4.36); however, the difference in receipt of an antidepressant between whites and blacks with a depression diagnosis was not significant.
Older blacks were less likely than older whites to receive antidepressants, independent of a depression diagnosis. This finding suggests that older blacks with depression in home health care may face two disparities relative to whites: underdiagnosis and undertreatment of depression.
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ABSTRACT: Major depression is disproportionately common among elderly adults receiving home healthcare and is characterized by greater medical illness, functional impairment, and pain. Depression is persistent in this population and is associated with numerous poor outcomes such as increased risk of hospitalization, injury-producing falls, and higher health care costs. Despite the need for mental health care in these patients, significant barriers unique to the home healthcare setting contribute to under-detection and under-treatment of depression. Intervention models target the home healthcare nurse as liaison between patients and physicians, and instruct in the identification and management of depression for their patients. Successful implementation requires interventions that 'fit' how home healthcare is organized and practiced, and long distance implementation strategies are required to increase the reach of these interventions.Aging Health 06/2012; 8(3):273-284. DOI:10.2217/ahe.12.28
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ABSTRACT: OBJECTIVE: Determine the racial/ethnic effect on depression treatment among home healthcare patients. DESIGN: Cross-sectional analyses of administrative data. SETTING: A large home healthcare agency in Bronx, NY. PARTICIPANTS: Patients 65 years and older admitted to homecare in 2010 (N = 3,744). MEASUREMENTS: Patient Health Questionnaire (PHQ)-2 depression screen. Other data, such as diagnosis, medications, and demographics, were collected from the patient electronic medical record. RESULTS: 6.52% of the sample had a depression diagnosis, 11.11% screened positive for depression (+PHQ-2), and 13.39% were prescribed antidepressants. The odds of receiving an antidepressant among those who screened positive for depression were 0.42 (95% confidence interval [CI]: 0.22-0.79) for African Americans and 0.49 (95% CI: 0.26-0.93) for Hispanics compared with Caucasians. CONCLUSIONS: These findings suggest that disparities continue to exist in depression treatment for older minority home healthcare patients compared with older Caucasians.The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 05/2013; DOI:10.1016/j.jagp.2013.01.078 · 3.52 Impact Factor
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ABSTRACT: OBJECTIVE: The population of older African Americans is expected to triple by 2050, highlighting the public health importance of understanding their mental health needs. Despite evidence of the negative impact of late-life depression, less is known of how this disorder affects the lives of older African Americans. Lack of studies focusing on how depression presents in older African Americans and their subsequent treatment needs lead to a gap in epidemiologic and clinical knowledge for this population. In this review, we aim to present a concise report of prevalence, correlates, course, outcomes, symptom recognition, and treatment of depression for these individuals. METHOD: We performed a literature review of English-language articles identified from PubMed and Medline published between January 1990 and June 2012. Studies included older adults and contained the key words 'geriatric depression in African Americans', 'geriatric depression in Blacks', and 'geriatric depression in minorities'. RESULTS: Although in most studies, older African Americans had higher or equivalence prevalence of depression compared with Caucasian Americans, we also found lower rates of recognition of depression and treatment. Many studies reported worse outcomes associated for depression among older African Americans compared with older Caucasians. CONCLUSIONS: Serious racial and ethnic disparities persist in the management of older African Americans with depression. Understanding their unmet needs and improving depression care for these individuals is necessary to reduce these disparities. Copyright © 2012 John Wiley & Sons, Ltd.International Journal of Geriatric Psychiatry 09/2013; 28(9). DOI:10.1002/gps.3908 · 3.09 Impact Factor