Disparities in the Adequacy of Depression Treatment in the United States

Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, P.O. Box 100195, Gainesville, Florida 32611-0195, USA.
Psychiatric Services (Impact Factor: 2.41). 01/2005; 55(12):1379-85. DOI: 10.1176/
Source: PubMed


There is evidence of disparities in depression treatment by factors such as age, race or ethnicity, and type of insurance. The purpose of this study was to assess whether observed disparities in treatment are due to differences in rates of treatment initiation or to differences in the quality of treatment once treatment has been initiated.
Logistic regression models using data from the 2000 Medical Expenditure Panel Survey were estimated to assess the role of age, race or ethnicity, and type of insurance on rates of initiation of depression treatment for persons with self-reported depression and on rates of adequate treatment for those receiving treatment.
African Americans and Latinos were significantly less likely to fill an antidepressant prescription than Caucasians. However, among patients who filled at least one prescription for an antidepressant, there were no racial or ethnic disparities in the probability of receiving an adequate trial of antidepressant medication. African Americans were more likely than Latinos and Caucasians to receive an adequate course of psychotherapy. Persons who did not have insurance coverage were less likely to initiate any depression treatment compared with those who did have insurance. However, if treatment was initiated, no difference in the probability of receiving adequate treatment was observed. Elderly persons were less likely to receive an adequate course of psychotherapy or counseling compared with younger persons.
Disparities in depression treatment appear to be due mainly to differences in rates of initiation of depression treatment, given that rates of adequate care generally did not differ once treatment was initiated.

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    • "Practitioners’ attitudes towards and experience with depressed elderly patients affect the probability of providing a patient with an adequate treatment strategy [12], and patients’ attitudes and beliefs towards the treatments might affect adherence and outcomes [13,14]. Elderly patients with depression are less likely to be offered a course of psychotherapy [15], and GPs’ latency before reaching a decision with regard to a treatment strategy is longer. In Norway elderly patients are not referred to district psychiatric centres to the same degree as younger adults and when referred, the duration of contact for the treatment is shorter [16]. "
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    ABSTRACT: The prevalence of depression is high and the elderly have an increased risk of developing chronic course. International data suggest that depression in the elderly is under-recognised, the latency before clinicians provide a treatment plan is longer and elderly patients with depression are not offered psychotherapy to the same degree as younger patients. Although recommendations for the treatment of elderly patients with depression exist, health-care professionals adhere to these recommendations to a limited degree only. We conducted a systematic review to identify recommendations for managing depression in the elderly and prioritised six recommendations. We identified and prioritised the determinants of practice related to the implementation of these recommendations in primary care, and subsequently discussed and prioritised interventions to address the identified determinants. The objective of this study is to evaluate the effectiveness of these tailored interventions for the six recommendations for the management of elderly patients with depression in primary care.Methods/design: We will conduct a pragmatic cluster randomised trial comparing the implementation of the six recommendations using tailored interventions with usual care. We will randomise 80 municipalities into one of two groups: an intervention group, to which we will deliver tailored interventions to implement the six recommendations, and a control group, to which we will not deliver any intervention. We will randomise municipalities rather than patients, individual clinicians or practices, because we will deliver the intervention for the first three recommendations at the municipal level and we want to minimise the risk of contamination across GP practices for the other three recommendations. The primary outcome is the proportion of actions taken by GPs that are consistent with the recommendations. This trial will investigate whether a tailored implementation approach is an effective strategy for improving collaborative care in the municipalities and health-care professionals' practice towards elderly patients with depression in primary care. The effectiveness evaluation described in this protocol will be accompanied with a process evaluation exploring why and how the interventions were effective or ineffective.Trial registration: NCT01913236.
    Full-text · Article · Jan 2014 · Trials
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    • "). Treatment seeking for depression is in particular lower in men, the oldest and youngest age groups, in those who have a lower educational or income level or who are married (Bramesfeld et al., 2007; Harman et al., 2004; Prins et al., 2010; Wang et al., 2007). Even when depression is diagnosed, only half of the individuals receive depression-specific treatment. "
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    ABSTRACT: BACKGROUND: Stigmatizing attitudes toward depression and toward help-seeking are important barriers for people with mental health problems to obtain adequate professional help. This study aimed to examine: (1) population attitudes toward depression and toward seeking professional help in four European countries; (2) the relation between depression stigma and attitudes toward help-seeking; (3) the relation between both attitudes and socio-demographic characteristics; and (4) differences in attitudes across countries. METHODS: A representative general population survey (n=4011) was conducted in Germany, Hungary, Ireland, and Portugal, assessing attitudes toward depression and toward help-seeking, and a number of socio-demographic variables. RESULTS: Respondents showed a moderate degree of personal stigma toward depression and a strikingly higher degree of perceived stigma. Although a substantial majority showed openness to seek professional help, only half of the people perceived professional help as valuable. More negative attitudes were found in Hungary and were associated with male gender, older age, lower educational level and living alone. Also, personal stigma was related to less openness to and less perceived value of professional treatment. LIMITATIONS: The survey was cross-sectional, so no causal inferences could be drawn. CONCLUSIONS: Personal and perceived stigma toward depression deserves public health attention, since they impact upon the intention of people with depression to seek professional help. Public media campaigns should focus on the credibility of the mental health care sector, and target males, older people, and those with a lower educational level and living alone. The content of each campaign should be adapted to the cultural norms of the country for which it is intended.
    Full-text · Article · May 2013 · Journal of Affective Disorders
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    • "This study found greater likelihood of antidepressants use and lower likelihood of psychotherapy among elderly compared to younger adults. These findings are consistent with evidence from published literature that suggests an association between increasing age and decreasing odds of receiving psychotherapy [35,36]. As mentioned in the introduction combination therapy has been found to be effective in reducing pain and improving depressive symptoms among older adults [4]. "
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    ABSTRACT: Background Arthritis and depression often co-occur; however, studies that describe patterns of depression treatment among individuals with arthritis are scant. The purpose of the study was to examine depression treatment patterns among individuals with osteoarthritis (OA) by predisposing, enabling, need factors, personal health practices and external health environment. Methods Retrospective cross-sectional design was used. Data were obtained from 2008 and 2010 Medical Expenditure Panel Survey (MEPS). The sample consisted of 647adults aged over 21 years with depression and OA. Depression treatment was categorized as: 1) No treatment;2) antidepressant use only and 3) both antidepressants and psychotherapy (combination therapy). Chi- square tests and multinomial logistic regressions were used to describe patterns of depression treatment. All analysis was performed using Statistical Analysis Software (SAS) version 9.3. Results Overall, 13.0% of the study sample reported no depression treatment, 67.8% used antidepressants only and 19.2% used combination therapy. Among individuals with OA significant subgroup differences in depression treatment were observed. For example, African Americans were less likely to report depression treatment compared to whites [antidepressants: AOR=0.33, 95% CI=0.21,0.51; combination therapy: AOR=0.39, 95% CI=0.23, 0.65]. Elderly adults were more likely to receive antidepressants and less likely to receive psychotherapy as compared to younger adults [AOR=0.53, 95% CI= 0.28,0.98]. Adults with anxiety were more likely to report depression treatment compared to those without anxiety [antidepressants: AOR=1.53, 95% CI=1.06, 2.22; combination therapy: AOR=3.52, 95% CI=2.40, 5.15]. Conclusion Future research needs to examine the reason for low rates of combination therapy as well as subgroup differences in combination therapy among individuals with OA.
    Full-text · Article · Apr 2013 · BMC Psychiatry
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