Depression treatment by race : an examination of pharmacotherapy, provider, complementary and alternative medicine (CAM) and associated alcohol and drug abuse
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Objective: To determine: 1) 12-month prevalence rates of major depressive disorder (MDD) by race, comparing African Americans and Hispanics with whites, while controlling for covariates; 2) if there are any differences in treatment (i.e., pharmacotherapy, provider, and CAM) for MDD among African Americans, Hispanics and whites diagnosed with major depressive disorder (MDD) in the past 12 months; and 3) if there are any racial differences in DSM-IV diagnosed alcohol and/or drug abuse among those with a diagnosis of 12-month MDD. Methods: This retrospective study utilized data from the National Comorbidity Survey-Replication, which was designed to collect information on the mental health status of a nationally representative sample (n = 9282) of U.S. adults. Respondents with an MDD diagnosis in the past 12 months were included. The dependent variables were: 12-month MDD, pharmacotherapy, provider (mental health specialist), CAM and alcohol and/or drug abuse. Pharmacotherapy was examined by assessing respondents’ reported antidepressant use and whether the medication used was an SSRI/SNRI. The primary independent variable was race. Additional covariates included: age, gender, income, education, marital and employment status. Logistic regression was used to address the study objectives. Results: African Americans were significantly less likely to be diagnosed with MDD during the preceding 12-month period, when compared to whites, while controlling for covariates (OR= 0.6, p = 0.0169). Other significant variables for prevalence were female gender (OR= 1.8, p <0.0001), divorced/separated (OR= 2.0, p <0.0001) and not in the labor force (e.g., homemaker/retired) (OR= 1.5, p = 0.0033). Although African Americans and Hispanics reported lower antidepressant use, the results were not significant. With respect to SSRIs/SNRIs, African Americans reported significantly lower use, when compared to whites (OR= 0.3, p = 0.0309). Hispanics in the study were less likely to see a mental health professional (OR = 0.2, p = 0.0002). CAM use was significantly lower among individuals with less than 12 years, 12 years and 13 to 15 years of education (OR = 0.3, p = 0.0110; OR = 0.3, p = 0.0035; OR = 0.7, p = 0.0368, respectively) when compared to respondents with 16 years or more of education. When examining alcohol and/or drug use in those with diagnosed MDD in the preceding 12 months, females were less likely to be abusers (OR = 0.4, p = 0.0204). Conclusion: Among respondents with a diagnosis of MDD, race plays an important role in the types of treatment utilized to manage the disorder. Considering, the disability associated with depression, greater efforts are needed to improve antidepressant therapy for African Americans and mental health specialty treatment for Hispanics.