title: Variations in depression care and outcomes among high-risk mothers from different racial/ethnic groups.
abstract: PURPOSE. To examine variations in depression care and outcomes among high-risk pregnant and parenting women from different racial/ethnic groups served in community health centres.
  
  
  METHODS
  As part of a collaborative care programme that provides depression treatment in primary care clinics for high-risk mothers, 661 women with probable depression (Patient Health Questionnaire-9 ≥ 10), who self-reported race/ethnicity as Latina (n = 393), White (n = 126), Black (n = 75) or Asian (n = 67), were included in the study. Primary outcomes include quality of depression care and improvement in depression. A Cox proportional hazard model adjusting for sociodemographic and clinical characteristics was used to examine time to treatment response.
  
  
  RESULTS
  We observed significant differences in both depression processes and outcomes across ethnic groups. After adjusting for other variables, Blacks were found to be significantly less likely to improve than Latinas [hazard ratio (HR): 0.53, 95% confidence interval (CI): 0.44-0.65]. Other factors significantly associated with depression improvement were pregnancy (HR: 1.52, 95% CI: 1.27-1.82), number of clinic visits (HR: 1.26, 95% CI: 1.17-1.36) and phone contacts (HR: 1.45, 95% CI: 1.32-1.60) by the care manager in the first month of treatment. After controlling for depression severity, having suicidal thoughts at baseline was significantly associated with a decreased likelihood of depression improvement (HR: 0.75, 95% CI: 0.67-0.83).
  
  
  CONCLUSIONS
  In this racially and ethnically diverse sample of pregnant and parenting women treated for depression in primary care, the intensity of care management was positively associated with improved depression. There was also appreciable variation in depression outcomes between Latina and Black patients.
authors.affiliation: Department of Psychiatry & Behavioral Sciences, University of Washington Medical School, Seattle, WA 98195-6560, USA. Huang123@uw.edu
authors.forename: Hsiang
authors.initials: H
authors.lastname: Huang
authors.forename: Ya-Fen
authors.initials: YF
authors.lastname: Chan
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Karen
authors.initials: K
authors.lastname: Tabb
authors.forename: Nida
authors.initials: N
authors.lastname: Sieu
authors.forename: Amy M
authors.initials: AM
authors.lastname: Bauer
authors.forename: Jessica Knaster
authors.initials: JK
authors.lastname: Wasse
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
mesh_terms: D000293:Adolescent; D000328:Adult; D003151:Community Health Centers; D019033:Delivery of Health Care, Integrated; D003863:Depression / Q000208:ethnology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology / Q000628:therapy; D011320:Primary Health Care; D016016:Proportional Hazards Models; D011581:Psychological Tests; D012306:Risk; D014861:Washington; D055815:Young Adult
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