title: Racial and ethnic differences in receipt of antidepressants and psychotherapy by veterans with chronic depression.
abstract: OBJECTIVE
  This study characterized racial-ethnic differences in treatment of veterans with chronic depression by examining antidepressant and psychotherapy use among non-Hispanic black, non-Hispanic white, Hispanic, Asian, and American Indian-Alaska Native (AI/AN) veterans.
  
  
  METHODS
  Logistic regression models were estimated with data from the U.S. Department of Veterans Affairs (VA) medical records for a sample of 62,095 chronically depressed patients. Data (2009-2010) were from the VA External Peer Review Program. Three primary outcome measures were used: receipt of adequate antidepressant therapy (≥80% medications on hand), receipt of adequate psychotherapy (at least six sessions in six months), and receipt of guideline-concordant treatment (either of these treatments).
  
  
  RESULTS
  Compared with whites, nearly all minority groups had lower odds of adequate antidepressant use and guideline-concordant care in unadjusted and adjusted models (antidepressant adjusted odds ratio [AOR] range=.53-.82, p<.05; guideline-concordant AOR range=.59-.83, p<.05). Although receipt of adequate psychotherapy was more common among veterans from minority groups in unadjusted analyses, differences between Hispanic, AI/AN, and white veterans were no longer significant after covariate adjustment. After adjustment for distance to the VA facility, the difference between black and white veterans was no longer significant.
  
  
  CONCLUSIONS
  A better understanding of how patient preferences and provider and system factors interact to generate differences in depression care is needed to improve care for patients from racial-ethnic minority groups. It will become increasingly important to differentiate between health service use patterns that stem from genuine differences in patient preferences and those that signify inequitable quality of depression care.
authors.forename: Ana R
authors.initials: AR
authors.lastname: Quiñones
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Thielke
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Beaver
authors.forename: Ranak B
authors.initials: RB
authors.lastname: Trivedi
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Fan
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002908:Chronic Disease / Q000208:ethnology / Q000628:therapy; D003865:Major Depressive Disorder / Q000208:ethnology / Q000628:therapy*; D005006:Ethnicity / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D011446:Prospective Studies; D011613:Psychotherapy / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000208:ethnology / Q000706:statistics & numerical data*; D014481:United States / Q000208:ethnology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D000928:Antidepressive Agents