Racial disparities in the treatment of depression in low-income persons with diabetes.
OBJECTIVE
Individuals with diabetes are at higher risk for depression than the general population. Although depression can be treated with antidepressant medications, patients with diabetes and comorbid depression often go untreated. The goal of this study was to examine racial disparities in the treatment of depression with antidepressant medication in the southeastern U.S.


METHODS
Cross-sectional data were collected at baseline from 69,068 participants (71% African American, 60% female, and 82% with incomes <$25,000) recruited from community health centers and enrolled in the Southern Cohort Community Study (SCCS). The SCCS is a prospective epidemiological cohort study designed to explore causes of health disparities in adults aged 40-79 years. Binary logistic regression was used to identify factors associated with antidepressant use among those with diabetes (n = 14,279).


RESULTS
Individuals with diagnosed diabetes (14,279) were classified with no depressive symptoms (54.7%), or with mild (24.2%), moderate (12.8%), or severe depressive symptoms (8.3%). After controlling for sex, age, insurance, income, education, BMI, smoking status, alcohol consumption, and level of depression, African Americans with diabetes were much less likely to report taking antidepressant medication than whites (adjusted odds ratio 0.32 [95% CI 0.29-0.35], P < 0.0001).


CONCLUSIONS
Antidepressant use is much less common among African Americans than among whites with diabetes. Reasons for racial disparities in treatment of depressive symptoms are unclear but may include a combination of differential diagnosis and treatment by health professionals as well as cultural differences in seeking help for emotional distress.
Osborn
Chandra Y
CY
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. chandra.osborn@vanderbilt.edu
Trott
Hollister W
HW
Buchowski
Maciej S
MS
Patel
Kushal A
KA
Kirby
Leslie D
LD
Hargreaves
Margaret K
MK
Blot
William J
WJ
Cohen
Sarah S
SS
Schlundt
David G
DG
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000188:drug therapy* / Q000208:ethnology*; D003920:Diabetes Mellitus / Q000208:ethnology*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data; D012307:Risk Factors; D015144:Southeastern United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
D000928:Antidepressive Agents