In the study "Racial and Ethnic Disparities in Depression Care in Community-Dwelling Elderly in the United States," lead author Ayse Akincigil, an assistant professor in Rutgers' School of Social Work, and colleagues found that African Americans were significantly less likely to receive a depression diagnosis from a health care provider than were non-Hispanic whites. In addition, those diagnosed were less likely to be treated for depression. "Vigorous clinical and public health initiatives are needed to address this persisting disparity in care," she said.
Depression is a significant public health problem for older Americans – about 6.6 percent of elderly Americans experience an episode of major depression each year. "If untreated or undertreated, depression can significantly diminish quality of life," Akincigil said. In addition, depression can complicate such medical conditions commonly found in older populations as congestive heart failure, diabetes and arthritis.
For their study, Rutgers researchers culled data from the U.S. Medicare Current Beneficiary Survey, 2001-2005 obtaining information on health care use and costs, health status, medical and prescription drug insurance coverage, access to care and use of services. Based on a national survey of 33,708 Medicare beneficiaries, depression diagnosis rates were 6.4 percent for non-Hispanic whites, 4.2 percent for African Americans, 7.2 percent for Hispanics and 3.8 percent for others. The heterogeneity of Hispanics makes it difficult to determine why they are undertreated and their treatment preferences, Akincigil said.
"Are there cultural differences or systemic differences regarding health care quality and access for treatment of depression?" Akincigil asked. "If African Americans prefer psychotherapy over drugs, then accessing therapists for treatment in poorer neighborhoods is a lot more difficult than it is for whites, who generally have higher incomes and live in neighborhoods more likely for therapists and doctors to be located. "Whites use more antidepressants than African Americans. We presume they have better access to doctors and pharmacies, and more money to spend on drugs."
The investigation focused on whether there are racial/ethnic differences in the rate of diagnosis of depression among the elderly, controlling for sociodemographic characteristics and depression symptoms (depressed mood, anhedonia) reported on a two-item screener, and also in treatment provided to those diagnosed with depression by a health care provider. Akincigil said there is evidence that help-seeking patterns differ by race/ethnicity, contributing to the gap in depression diagnosis rates. Stigma, patient attitudes and knowledge also may vary by race and ethnicity.
"African Americans might turn to their pastors or lay counselors in the absence of psychotherapists," she said. "Low-income African Americans who were engaged in psychotherapy reported that stigma, dysfunctional coping behavior, shame and denial could be reasons some African Americans do not seek professional help."
The researchers also noted that racial and ethnic differences in the clinical presentation of depression may further explain the lower rates of depression detection among African-American patients.
MEDICA.de; Source: Rutgers University