Health disparities in care for depression possibly obscured by the clinical significance criterion.
BACKGROUND
In addition to symptoms, DSM-IV criteria for major depression require clinical significance, operationalized via reports of receipt of care or interference in functioning. The authors examined whether this confounding of symptoms with receipt of care and/or impairment affected racial differences in rates of major depression in the community.


METHODS
Analysis of data from the 1999 National Health Interview Survey for a nationally representative community sample of 30,801 adults administered the depression module of the Composite International Diagnostic Interview-Short Form.


RESULTS
There were no differences between African American subjects and white/other subjects when diagnosis was based solely on symptoms. Symptomatic African American individuals were less likely to endorse either receipt of care or interference in functioning, so that the clinical significance criterion served to reduce their rates of DSM-IV diagnosis.


CONCLUSIONS
The clinical significance criterion underestimates of the rate of depression for African American individuals relative to white/other subjects, which may in turn underestimate their need for services.
Coyne
James C
JC
Department of Psychiatry, University of Pennsylvania Health System, 3400 Spruce St., 11 Gates, Philadelphia, PA 19106, USA. jcoyne@mail.med.upenn.edu
Marcus
Steven C
SC
D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data