Disparities in depression treatment for Latinos and site of care.
OBJECTIVE
This study examined the impact of patient characteristics and source of care on differences between whites and Latinos in use and quality of depression treatment in managed primary care settings.


METHODS
Data were examined for 1,175 patients (398 Latinos and 777 whites) in 46 managed primary care practices who screened positive for probable depressive disorder. Patient baseline assessments were used to compile sociodemographic and clinical characteristics and to derive variables for receipt of any depression care and depression care that met minimum guidelines (antidepressant use or specialty counseling) in the past six months. Clinics were classified by the percentage of their patient population that consisted of Latinos to determine whether patients in highly Latino clinics reported lower rates of care. Predictors of use and quality of depression care were examined by using logistic regression.


RESULTS
Rates of receipt of any depression care and guideline-level depression care were low, and Latinos were less than half as likely as whites to receive such care, even after the analyses controlled for independent predictors (that is, younger age, higher educational level, current unemployment, more comorbid medical illness, and a diagnosis of a depressive or anxiety disorder). The likelihood of receiving any care or care that met guidelines did not significantly vary according to whether clinics served a low, moderate, or high percentage of Latinos.


CONCLUSIONS
Disparities in depression care for Latinos were not attributable to sociodemographic and clinical characteristics, and they were not attributable to receiving care in clinics that served ethnically similar or dissimilar clientele. These findings suggest that other patient or provider factors may be responsible.
Lagomasino
Isabel T
IT
Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 1520 San Pablo Street, Suite 4100, Los Angeles, California 90033, USA. lagomasi@usc.edu
Dwight-Johnson
Megan
M
Miranda
Jeanne
J
Zhang
Lily
L
Liao
Diana
D
Duan
Naihua
N
Wells
Kenneth B
KB
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000208:ethnology* / Q000628:therapy*; D019983:Guideline Adherence; D006297:Health Services Accessibility; D006302:Health Services Research; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology*; D011320:Primary Health Care / Q000592:standards*; D017749:Total Quality Management / Q000379:methods; D014481:United States; D044465:White People / Q000523:psychology
D000928:Antidepressive Agents