Does minority racial-ethnic status moderate outcomes of collaborative care for depression?
OBJECTIVE
The authors examined racial differences in response rates to an intervention involving collaborative care and usual care among 360 veterans treated for depression at Department of Veterans Affairs community-based primary care clinics.


METHODS
Individuals who screened positive for depression were assigned randomly to usual care (N=200) or to a collaborative care intervention (N=160) that provided phone contact when necessary with a registered nurse and clinical pharmacist to address issues related to compliance with medication and side effect management as well as supervision by a psychiatrist through video chats with the collaborative care team. Data about patients' characteristics, treatment history, and response to treatment were collected by telephone at baseline and after six months.


RESULTS
Seventy-five percent (N=272) of the veterans were Caucasian, and 25% (N=88) belonged to a minority group, including 18% (N=64) who were African American, 3% (N=11) who were Native American, and 3.6% (N=13) who were of other minority groups. There were no significant differences between response rates between the Caucasian and minority group to usual care (18% and 8%, respectively), but the minority group had a higher response rate (42%) than Caucasians (19%) to the intervention (χ²=8.2, df=1, p=.004). Regression analysis indicated that the interaction of minority group status by intervention significantly predicted response (odds ratio [OR]=6.2, 95% confidence interval [CI]=1.6-24.5, p=.009), even after adjustment for other factors associated with minority status (OR=6.0, 95% CI=1.5-24.3, p=.01).


CONCLUSIONS
Racial disparities in depression care may be ameliorated through collaborative care programs.
South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72204, USA. tdavis2@uams.edu
Teri D
TD
Davis
Tisha
T
Deen
Keneshia
K
Bryant-Bedell
Vera
V
Tate
John
J
Fortney
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003156:Community Mental Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000188:drug therapy / Q000208:ethnology / Q000628:therapy*; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D010348:Patient Care Team; D012044:Regression Analysis; D012424:Rural Population; D017216:Telemedicine / Q000458:organization & administration; D014481:United States; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data
D000928:Antidepressive Agents