Disparities in the adequacy of depression treatment in the United States.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Harman
Jeffrey S
JS
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. jharman@phhp.ufl.edu
Edlund
Mark J
MJ
Fortney
John C
JC
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003376:Counseling / Q000379:methods; D003866:Depressive Disorder / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D008875:Middle Aged; D011336:Probability; D011613:Psychotherapy / Q000592:standards*; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data
D000928:Antidepressive Agents