The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients.
BACKGROUND
Ethnic minority patients are less likely than white patients to receive guideline-concordant care for depression. It is uncertain whether racial and ethnic differences exist in patient beliefs, attitudes, and preferences for treatment.


METHODS
A telephone survey was conducted of 829 adult patients (659 non-Hispanic whites, 97 African Americans, 73 Hispanics) recruited from primary care offices across the United States who reported 1 week or more of depressed mood or loss of interest within the past month and who met criteria for Major Depressive Episode in the past year. Within this cohort, we examined differences among African Americans, Hispanics, and whites in acceptability of antidepressant medication and acceptability of individual counseling.


RESULTS
African Americans (adjusted OR, 0.30; 95% CI 0.19-0.48) and Hispanics (adjusted OR, 0.44; 95% CI, 0.26-0.76) had lower odds than white persons of finding antidepressant medications acceptable. African Americans had somewhat lower odds (adjusted OR, 0.63; 95% CI, 0.35-1.12), and Hispanics had higher odds (adjusted OR, 3.26; 95% CI, 1.08-9.89) of finding counseling acceptable than white persons. Some negative beliefs regarding treatment were more prevalent among ethnic minorities; however adjustment for these beliefs did not explain differences in acceptability of treatment for depression.


CONCLUSIONS
African Americans are less likely than white persons to find antidepressant medication acceptable. Hispanics are less likely to find antidepressant medication acceptable, and more likely to find counseling acceptable than white persons. Racial and ethnic differences in beliefs about treatment modalities were found, but did not explain differences in the acceptability of depression treatment. Clinicians should consider patients' cultural and social context when negotiating treatment decisions for depression. Future research should identify other attitudinal barriers to depression care among ethnic minority patients.
Cooper
Lisa A
LA
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. lisa.cooper@jhmi.edu
Gonzales
Junius J
JJ
Gallo
Joseph J
JJ
Rost
Kathryn M
KM
Meredith
Lisa S
LS
Rubenstein
Lisa V
LV
Wang
Nae-Yuh
NY
Ford
Daniel E
DE
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003376:Counseling / Q000706:statistics & numerical data; D003657:Decision Making; D003863:Depression / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology*; D008960:Models, Psychological; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012944:Social Support; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology
D000928:Antidepressive Agents