Article

Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States

Center for Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Medical School, Somerville, MA 02143, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 1.99). 11/2008; 59(11):1264-72. DOI: 10.1176/appi.ps.59.11.1264
Source: PubMed

ABSTRACT Prior research on racial and ethnic disparities in depression treatment has been limited by the scarcity of national samples that include an array of diagnostic and quality indicators and substantial numbers of non-English-speaking individuals from minority groups. Using nationally representative data for 8,762 persons, the authors evaluated differences in access to and quality of depression treatments between patients in racial-ethnic minority groups and non-Latino white patients.
Access to mental health care was assessed by past-year receipt of any mental health treatment. Adequate treatment for acute depression was defined as four or more specialty or general health provider visits in the past year plus antidepressant use for 30 days or more or eight or more specialty mental health provider visits lasting at least 30 minutes, with no antidepressant use.
For persons with past-year depressive disorder, 63.7% of Latinos, 68.7% of Asians, and 58.8% of African Americans, compared with 40.2% of non-Latino whites, did not access any past-year mental health treatment (significantly different at p<.001). Disparities in the likelihood of both having access to and receiving adequate care for depression were significantly different for Asians and African Americans in contrast to non-Latino whites.
Simply relying on present health care systems without consideration of the unique barriers to quality care that ethnic and racial minority populations face is unlikely to affect the pattern of disparities observed. Populations reluctant to visit a clinic for depression care may have correctly anticipated the limited quality of usual care.

Download full-text

Full-text

Available from: David Takeuchi, Sep 05, 2015
2 Followers
 · 
144 Views
 · 
99 Downloads
  • Source
    • "Also, Latinos that utilize mental health resources report difficulties in obtaining adequate services (Alegr et al., 2002) and generally tend to be underrepresented in specialty psychiatric treatment programs (Hough et al., 2002). Of the mental health problems, anxiety and depressive symptoms and clinical disorders are particularly evident among Latinos (Alegría et al., 2008; Grant et al., 2004; Vega et al., 1998). "
  • Source
    • "This information was collected from medical records; appointment keeping was derived from clinical chart or electronic record review. Lack of continuance in care is an especially persistent source of disparities in mental health care, as it represents the failure of health care clinicians to retain patients of color in treatment after an initial visit and to not achieve the minimum dose of treatment needed for quality care (Alegría, Chatterji et al., 2008; Atdjian & Vega, 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Advances in information technology within clinical practice have rapidly expanded over recent years. Despite the documented benefits of using electronic health records, which often necessitate computer use during the clinical encounter, little is known about the impact of computer use during the mental health visit and its effect on the quality of the therapeutic alliance. We investigated the association between computer use and quality of the working alliance and continuance in care in 104 naturalistic mental health intake sessions. Data were collected from 8 safety-net outpatient clinics in the Northeast offering mental health services to a diverse client population. All intakes were video recorded. Use of computer during the intake session was ascertained directly from the recording of the session (n = 22; 22.15% of intakes). Working alliance was assessed from the session videotapes by independent reliable coders, using the Working Alliance Inventory, Observer Form-bond scale. Therapist computer use was significantly associated with the quality of the observer-rated therapeutic alliance (Coefficient = -6.29, SE = 2.2, p < .01; Cohen's effect size of d = -0.76), and client's continuance in care (Odds ratio = .11, CI = 0.03-0.38; p < .001). The quality of the observer-rated working alliance and client's continuance in care were significantly lower in intakes in which the therapist used a computer during the session. Findings indicate a cautionary call in advancing computer use within the mental health intake, and demonstrate the need for future research to identify the specific behaviors that promote or hinder a strong working alliance within the context of psychotherapy in the technological era. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Psychotherapy Theory Research Practice Training 07/2015; DOI:10.1037/pst0000022 · 3.01 Impact Factor
  • Source
    • "Also, Latinos that utilize mental health resources report difficulties in obtaining adequate services (Alegr et al., 2002) and generally tend to be underrepresented in specialty psychiatric treatment programs (Hough et al., 2002). Of the mental health problems, anxiety and depressive symptoms and clinical disorders are particularly evident among Latinos (Alegría et al., 2008; Grant et al., 2004; Vega et al., 1998). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The present investigation examined the interactive effects of anxiety sensitivity and mindful attention in relation to anxiety and depressive symptoms and psychopathology among 145 adult Latinos (85.5% female; Mage=39.9, SD=10.8 and 98.6% used Spanish as their first language) who attended a community-based primary healthcare clinic. As expected, the interaction between anxiety sensitivity and mindful attention was significantly related to number of mood and anxiety disorders, social anxiety, and depressive symptoms. No significant interaction, however, was evident for panic (anxious arousal) symptoms. The form of the significant interaction indicated that Latinos reporting co-occurring higher levels of anxiety sensitivity and lower levels of mindful attention evinced the greatest levels of anxiety/depressive psychopathology, social anxiety, and depressive symptoms. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between anxiety sensitivity and mindful attention in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    07/2015; DOI:10.1016/j.psychres.2015.07.026
Show more