Intersection of race-ethnicity and gender in depression care: screening, access, and minimally adequate treatment.
OBJECTIVE
This study examined the interaction of race-ethnicity and gender in depression screening, receipt of any mental health care, and receipt of adequate care.


METHODS
Data from electronic health records (2010-2012) of adult primary care patients from a New England urban health care system were used (N=65,079). Multivariate logit regression models were estimated to assess associations between race-ethnicity, gender, and other covariates and depression screening, any depression care among those with a positive screen, and adequate depression care. To measure disparities in utilization, we controlled for need variables but not for non-need variables, including insurance, marital status, and socioeconomic status.


RESULTS
Among males and females, blacks and Asians were less likely and Latinos were more likely to be screened for depression compared with whites. Among those with moderate or severe depression, black males and females, Latino males, and Asian males and females were less likely than whites to receive any mental health care. The disparity in screening between blacks and whites was greater among females compared with males. The disparity between Latinos and whites in receipt of any mental health care and of adequate care was greater among males than females.


CONCLUSIONS
This approach underscored the importance of identifying disparities at each step of depression care by both race-ethnicity and gender. Targeting certain groups in specific stages of care, for example, screening of black females or providing any mental health care and adequate care for Latino males, would be more effective than a blanket approach to disparities reduction.
Dr. Hahm is with the School of Social Work, Boston University, Boston (e-mail: hahm@bu.edu ). At the time the paper was written, Dr. Hahm was with the Department of Psychiatry, Harvard Medical School, Boston, where the other authors are affiliated. Dr. Cook, Dr. Ault-Brutus, and Dr. Alegría are also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts.
Hyeouk Chris
HC
Hahm
Benjamin Lê
BL
Cook
Andrea
A
Ault-Brutus
Margarita
M
Alegría
D000293:Adolescent; D000328:Adult; D000368:Aged; D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / 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; D009511:New England; D044469:Racial Groups / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult