Racial and ethnic variation in home healthcare nurse depression assessment of older minority patients.
OBJECTIVE
The objective of this study is to determine the racial/ethnic effect of depression symptom recognition by home healthcare nurses.


METHODS
This is a secondary analysis of administrative data from a large urban home healthcare agency. Patients' age were 65 years and older with a valid depression screen, identified as Caucasian, African American, or Hispanic and admitted to homecare in 2010 (N = 3711). All demographic and clinical information were obtained from the electronic medical record.


RESULTS
Subjects were 29.34% Caucasian, 37.81% African American, and 32.85% Hispanic. About 6.52% had a formal chart diagnosis of depression, and 13.39% received antidepressant therapy. The rates of positive depression screens by nurses were higher in Caucasians than that of in African Americans or Hispanics (13.41% vs. 9.27% vs. 10.99%; χ(2)  = 10.70, df [degrees of freedom] = 2; p < 0.01). Depression screening rates were then stratified by the number of clinical indicators from the chart (depression diagnosis or antidepressant on medication list). The proportion of positive screen increased for minorities with an increase in the number of indicators. African Americans had significantly greater positive screens with two indicators compared with that of the Caucasians and Hispanics (50.00% vs. 23.81% vs. 35.59%; χ(2)  = 6.65, df = 2; p = 0.04).


CONCLUSIONS
These findings show a wide range of variation in screening for depression among ethnic groups. The rates increase for minorities with the presence of increased clinical indicators, suggesting that nurses may screen higher in minorities when there is higher clinical suspicion. Future research in home healthcare should be aimed at training nurses to conduct culturally tailored depression screening to improve management of depression in older minorities.
Weill Cornell Medical College, Department of Psychiatry, White Plains, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA.
Yolonda R
YR
Pickett
Kisha N
KN
Bazelais
Rebecca L
RL
Greenberg
Martha L
ML
Bruce
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006699:Home Care Services / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000451:nursing / Q000592:standards; D009519:New York City; D044465:White People / Q000706:statistics & numerical data
D000928:Antidepressive Agents
geriatric depression; mental health disparities; race/ethnicity