title: Patient ethnicity and the identification and active management of depression in late life.
abstract: BACKGROUND
  Black Americans are more likely to obtain mental health care from a primary care physician than from a mental health specialist. We investigated the association of ethnicity with the identification and active management of depression among older patients.
  
  
  METHODS
  Cross-sectional survey of 355 older adults with and without significant depressive symptoms. At the index visit, the physician's ratings of depression and reports of active management were obtained on 341 of the 355 patients who completed in-home interviews.
  
  
  RESULTS
  Older black patients were less likely than older white patients to be identified as depressed (unadjusted odds ratio [OR], 0.40; 95% confidence interval [CI], 0.25-0.63) and their depression was less likely to be actively managed in the 6 months before the interview (unadjusted OR, 0.63; 95% CI, 0.19-2.16). In multivariate models that controlled for potentially influential characteristics such as patient age, sex, marital status, level of education, functional status, physical health, severity of depressive symptoms, severity of anxiety symptoms, attitudes about depression, number of office visits in the last 6 months, and the physician's rating of how well they knew the patient, the associations of identification (OR, 0.25; 95% CI, 0.17-0.39) and management (OR, 0.57; 95% CI, 0.19-1.77) with patient ethnicity remained substantially unchanged.
  
  
  CONCLUSIONS
  Our study calls attention to the role ethnicity may play in the identification and active management of depression among older primary care patients.
authors.affiliation: Department of Family Practice and Community Medicine, University of Pennsylvania, 3400 Spruce St, 2 Gates Pavilion, Philadelphia, PA 19104, USA. galloj@uphs.upenn.edu
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Bogner
authors.forename: Knashawn H
authors.initials: KH
authors.lastname: Morales
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ford
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care