More receive psychotherapy than medication: Study provides new detail on disparities

Detroit - Only about half of Americans diagnosed with major depression in a given year receive treatment for it and even fewer - about one-fifth - receive treatment consistent with current practice guidelines, according to data from national surveys supported by the National Institute of Mental Health of the National Institutes of Health. Among the groups surveyed, African- Americans and Mexican-Americans had the lowest rates of depression care, and all groups reported higher use of psychotherapy versus medication treatment.

Major depressive disorders (MDD) is the main cause of disability in the United States, and it is projected that over the next 20 years MDD will be the second leading cause of disability around the globe.

A team of researchers from Wayne State University, the University of Michigan, the University of California, Los Angeles and Harvard University, have published a paper in the January 2010 edition of the Archives of General Psychiatry that gives a detailed picture of the care received for major depression among different ethnic/racial groups and factors that contribute to disparities. The paper reports that too few Americans with recent major depressive disorders receive adequate depression care, and most receive no care at all.

African-Americans and Mexican-Americans, in particular, may be facing greater barriers to mental health care. "Contrary to our expectations that most Americans with depression would be using antidepressant drugs, we actually found higher psychotherapy use, especially among ethnic and racial minorities," said Hector González, professor, Institute of Gerontology and Family Medicine and Public Health Sciences Department at Wayne State University.

Mexican-Americans make up more than two-thirds of Latinos in the U.S. "We found in our study that there are really distinctive difference in mental healthcare use between Mexican-Americans and other Latino subgroups that have not been previously reported," said González. The authors note that Latinos will make up one-third of the U.S. population by mid-century; the study findings suggest that Mexican-Americans should be a focus of efforts to reduce health disparities to ensure the nation's health in coming decades.

The authors provided evidence of well-defined disparities in depression care that mostly affected African-Americans and Mexican-Americans. "The problem with most previous research we have seen is that ethnic groups, particularly Latinos, are inappropriately lumped together rather than examining important ethnic subgroups," said González. "I believe our study sets a new standard for understanding healthcare access disparities."

All groups were more likely to have received psychotherapy than pharmacotherapy. Caribbean blacks and African-Americans were particularly unlikely to receive pharmacotherapy consistent with APA guidelines; enabling factors such as education, health insurance, and income did not explain the lower rates of medication use. The authors note possible reasons for this, including research indicating that perceived discrimination can shape health care seeking. They speculate that the non-immigrant status of Puerto Ricans—and with that, greater predominance of English language use within this group—may be factors in their relatively high rates of health care use.

Findings from this study will inform future research on adherence to various depression therapies, and the factors that shape differences in care among racial/ethnic groups. "Future studies," said the authors, "should explore the extent to which patients' subjective experiences of racial bias may affect their access and utilization of mental healthcare."

The other researchers participating in this study are William Vega of UCLA's Department of Family Medicine, David Williams of Harvard School of Public Health, Wassim Tarraf of WSU's Institute of Gerontology and Department of Family Medicine, and Brady West and Harold Neighbors of the University of Michigan's Center for Statistical Consultation and Research and Institute of Social Research, respectively.

For further information about this study, please visit http://research.wayne.edu/communications/forms/gonzalez_depression_care_12-15-09_-_journal_synopsis.doc. To view the full paper, "Depression Care in the United States: Too Little for Too Few" see the January 2010 edition of Archives of General Psychiatry 2010;67[1]:37-46, available pre-embargo to the media at www.jamamedia.org.

For media inquiries, contact Julie O'Connor, director of research communications at Wayne State University via phone 313-577-8845 or 734-748-4207 (cell), or email at julie.oconnor@wayne.edu.

Editor's Note: This work was supported by the National Institutes of Health's National Institute of Mental Health and the National Institute on Aging. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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