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Kashyap A, Aziz M, Sun TY, Lipsky-Gorman S, Opoku-Anane J, Elhadad N. Investigating Racial Disparities in Drug Prescriptions for Patients with Endometriosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.02.23296435. [PMID: 37873254 PMCID: PMC10593032 DOI: 10.1101/2023.10.02.23296435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Endometriosis is a chronic disease with a long time to diagnosis and several known comorbidities that requires a range of treatments including of pain management and hormone-based medications. Racial disparities specific to endometriosis treatments are unknown. Objective We aim to investigate differences in patterns of drug prescriptions specific to endometriosis management in Black and White patients prior to diagnosis and after diagnosis of endometriosis and compare these differences to racial disparities established in the general population. Study Design We conduct a retrospective cohort study using observational health data from the IBM MarketScan® Multi-state Medicaid dataset. We identify a cohort of endometriosis patients consisting of women between the ages of 15 and 49 with an endometriosis-related surgical procedure and a diagnosis code for endometriosis within 30 days of this procedure. Cohort is further restricted to patients with at least 3 years of continuous observation prior to diagnosis.We identify a non-endometriosis cohort of women between the ages of 15 and 49 with no endometriosis diagnosis and at least 1 year of continuous observation. We compare prevalence of prescriptions across selected drug classes for Black vs. White endometriosis patients. We further examine prevalence differences in the non-endometriosis cohort and prevalence differences pre- and post-diagnosis in the endometriosis cohort. Results The endometriosis cohort comprised 16,372 endometriosis patients (23.3% Black, 66.0% White). Of the 28 drug classes examined, 17 were prescribed significantly less in Black patients compared to 21 in non-endometriosis cohort (n=3,663,904), and 4 were prescribed significantly more in Black patients compared to 6 in the non-endometriosis cohort. Of the 17 drugs prescribed more often in White patients, 16 have larger disparities pre-diagnosis than post-diagnosis. Conclusions Our analysis identified significant differences in medication prescriptions between White and Black patients with endometriosis, notably in hormonal treatments, pain management, and treatments for common endometriosis co-morbidities. Racial disparities in drug prescriptions are well established in healthcare, and better understanding these disparities in the specific context of chronic reproductive conditions and chronic pain is important for increasing equity in drug prescription practices.
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Manning-Bennett AT, Hopkins AM, Sorich MJ, Proudman SM, Foster DJR, Abuhelwa AY, Wiese MD. The association of depression and anxiety with treatment outcomes in patients with rheumatoid arthritis - a pooled analysis of five randomised controlled trials. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111613. [PMID: 35898566 PMCID: PMC9310212 DOI: 10.1177/1759720x221111613] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is an inflammatory autoimmune condition associated
with an increased risk of developing depression and anxiety. Depression and
anxiety are associated with worse outcomes in RA, but the magnitude of the
effect of each condition on RA outcomes is unclear. It is also unknown how
pharmacological treatment of depression affects RA outcomes. Objective: The primary aim of this study was to investigate the association of comorbid
depression and anxiety with remission in patients with RA. Secondary aims
were to determine the association between comorbid depression and anxiety on
patient-reported outcomes and the relationship between concomitant use of
antidepressants and remission in patients with depression. Design: Data from patients with moderate to severe RA were pooled from five
randomised controlled trials investigating tocilizumab and conventional
synthetic disease-modifying agents. Methods: Remission was defined as a clinical disease activity index (CDAI) of ⩽2.8 and
simple disease activity index (SDAI) of ⩽3.3. The association between the
time to reach remission and depression and anxiety was analysed using Cox
proportional hazard analysis. Results: Individual patient data were available from 5502 subjects, of whom 511 had
depression, 236 had anxiety and 387 were using antidepressants. Depression
was significantly associated with reduced remission [adjusted HR (95% CI):
0.62 (0.48–0.80), p < 0.001 and adjusted HR (95% CI):
0.59 (0.44–0.79), p < 0.001] using CDAI and SDAI,
respectively. Depression was associated with a lower likelihood of achieving
more subjective outcomes (⩽1 physician global assessment, ⩽1 patient global
assessment) and ⩽1 28-swollen joint count, but not ⩽1 28-tender joint count
or C-reactive protein measurement. Treatment with antidepressants did not
improve outcomes for patients with depression. Anxiety was not significantly
associated with RA remission. Conclusion: Comorbid depression, but not anxiety, was associated with less frequent
remission. Concomitant antidepressant use was not associated with
improvements in RA outcomes in patients with depression.
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Affiliation(s)
- Arkady T Manning-Bennett
- UniSA: Clinical & Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Ashley M Hopkins
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michael J Sorich
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - David J R Foster
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ahmad Y Abuhelwa
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michael D Wiese
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
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Zahodne LB. Biopsychosocial pathways in dementia inequalities: Introduction to the Michigan Cognitive Aging Project. AMERICAN PSYCHOLOGIST 2021; 76:1470-1481. [PMID: 35266748 PMCID: PMC9205325 DOI: 10.1037/amp0000936] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Racial/ethnic inequalities in dementia risk are a major public health and health justice concern. Group differences that persist despite adjustment for socioeconomic and vascular indicators suggest that known dementia risk factors exhibit differential impact across race/ethnicity and/or there are unrecognized dementia risk factors that are racially patterned. This article provides targeted examples of both of these possibilities. First, depressive symptoms and white matter hyperintensities represent two known dementia risk factors that more strongly relate to negative cognitive outcomes among Black older adults than Whites, pointing to the need to consider contextual factors. Second, racial discrimination and external perceived control predict worse brain and cognitive aging above and beyond known risk factors. These psychosocial factors warrant explicit consideration in dementia cohort studies. Several challenges appear to be particularly relevant to the study of dementia inequalities, including selective survival and recruitment. These challenges complicate not only cross-study comparisons, but also within-study causal inferences. This article provides recommendations for addressing these challenges in order to accelerate high-quality research on dementia inequalities. Stemming from these recommendations, the article introduces the design and methods of the Michigan Cognitive Aging Project, a new, racially-balanced cohort study of Black and White adults transitioning to late life. In sum, careful research with community partners is needed to more fully explore the factors and contexts that create and sustain racial/ethnic disparities, as well as those that buffer against them. The ultimate goal of this research is to facilitate the dismantling of structural barriers to health justice for diverse older people. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Hudson D, McCrary S, Murugan V, Gerassi L, Proctor EK. Documenting Behavioral Health Needs in an Urban Setting. Front Public Health 2021; 9:493884. [PMID: 34527648 PMCID: PMC8435602 DOI: 10.3389/fpubh.2021.493884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Most local communities lack the capacity to conduct behavioral health needs assessments. The purpose of this paper is to describe a mixed-methods approach to estimate the behavioral health needs in St. Louis, MO. Data were drawn from multiple sources including local and state government prevalence estimates, medical records, and key informant interviews. The most prevalent behavioral conditions were depression, alcohol, and drug abuse. Priority populations were residents with co-occurring disorders, youth transitioning into the adult behavioral system, and homeless individuals with behavioral health needs. Treatment rates for behavioral health conditions were low, relative to identified needs. There are significant provider shortages and high staff turnover, which extend wait times, diminish the quality of care, and contribute to the use of emergency departments for behavioral health care. The data and methods described in this paper could be helpful to other municipalities that are looking to conduct behavioral health needs assessments.
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Affiliation(s)
- Darrell Hudson
- Brown School at Washington University in St. Louis, St. Louis, MI, United States
| | - Stacey McCrary
- Brown School at Washington University in St. Louis, St. Louis, MI, United States
| | - Vithya Murugan
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MI, United States
| | - Lara Gerassi
- School of Social Work, University of Wisconsin-Madison, Madison, WI, United States
| | - Enola K Proctor
- Brown School at Washington University in St. Louis, St. Louis, MI, United States
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Ford CD, Gray MS, Crowther MR, Wadley VG, Austin AL, Crowe MG, Pulley L, Unverzagt F, Kleindorfer DO, Kissela BM, Howard VJ. Depressive Symptoms and Risk of Stroke in a National Cohort of Black and White Participants From REGARDS. Neurol Clin Pract 2021; 11:e454-e461. [PMID: 34484944 DOI: 10.1212/cpj.0000000000000983] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022]
Abstract
Objective The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among Black and White participants. Methods The study comprised 9,529 Black and 14,516 White stroke-free participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (2003-2007). Incident stroke was the first occurrence of stroke. Association between baseline depressive symptoms (assessed via the 4-item Center for Epidemiologic Studies Depression Scale [CES-D-4]: 0, 1-3, or ≥4) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographics, stroke risk factors, and social factors. Results There were 1,262 strokes over an average follow-up of 9.21 (SD 4.0) years. Compared to participants with no depressive symptoms, after demographic adjustment, participants with CES-D-4 scores of 1-3 had 39% increased stroke risk (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.23-1.57), with slight attenuation after full adjustment (HR = 1.27, 95% CI = 1.11-1.43). Participants with CES-D-4 scores of ≥4 experienced 54% higher risk of stroke after demographic adjustment (HR = 1.54, 95% CI = 1.27-1.85), with risk attenuated in the full model similar to risk with 1-3 symptoms (HR = 1.25, 95% CI = 1.03-1.51). There was no evidence of a differential effect by race (p = 0.53). Conclusions The association of depressive symptoms with increased stroke risk was similar among a national sample of Black and White participants. These findings suggest that assessment of depressive symptoms should be considered in primary stroke prevention for both Black and White participants.
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Affiliation(s)
- Cassandra D Ford
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Marquita S Gray
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Martha R Crowther
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Virginia G Wadley
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Audrey L Austin
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Michael G Crowe
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - LeaVonne Pulley
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Frederick Unverzagt
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Dawn O Kleindorfer
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Brett M Kissela
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Virginia J Howard
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
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Parikh RB, Gallo JJ, Wong YN, Robinson KW, Cashy JP, Narayan V, Jayadevappa R, Chhatre S. Long-term depression incidence and associated mortality among African American and White prostate cancer survivors. Cancer 2021; 127:3476-3485. [PMID: 34061986 DOI: 10.1002/cncr.33656] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/13/2021] [Accepted: 04/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression is common after a diagnosis of prostate cancer and may contribute to poor outcomes, particularly among African Americans. The authors assessed the incidence and management of depression and its impact on overall mortality among African American and White veterans with localized prostate cancer. METHODS The authors used the Veterans Health Administration Corporate Data Warehouse to identify 40,412 African American and non-Hispanic White men diagnosed with localized prostate cancer from 2001 to 2013. Patients were followed through 2019. Multivariable logistic regression was used to measure associations between race and incident depression, which were ascertained from administrative and depression screening data. Cox proportional hazards models were used to measure associations between incident depression and all-cause mortality, with race-by-depression interactions used to assess disparities. RESULTS Overall, 10,013 veterans (24.5%) were diagnosed with depression after a diagnosis of prostate cancer. Incident depression was associated with higher all-cause mortality (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.23-1.32). African American veterans were more likely than White veterans to be diagnosed with depression (29.3% vs 23.2%; adjusted odds ratio [aOR], 1.15; 95% CI, 1.09-1.21). Among those with depression, African Americans were less likely to be prescribed an antidepressant (30.4% vs 31.7%; aOR, 0.85; 95% CI, 0.77-0.93). The hazard of all-cause mortality associated with depression was greater for African American veterans than White veterans (aHR, 1.32 [95% CI, 1.26-1.38] vs 1.15 [95% CI, 1.07-1.24]; race-by-depression interaction P < .001). CONCLUSIONS Incident depression is common among prostate cancer survivors and is associated with higher mortality, particularly among African American men. Patient-centered strategies to manage incident depression may be critical to reducing disparities in prostate cancer outcomes.
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Affiliation(s)
- Ravi B Parikh
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph J Gallo
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yu-Ning Wong
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyle W Robinson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Cashy
- VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
| | - Vivek Narayan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ravishankar Jayadevappa
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sumedha Chhatre
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Molina K, Baskin ML, Long D, Carson TL. Psychological and behavioral pathways between perceived stress and weight change in a behavioral weight loss intervention. J Behav Med 2021; 44:822-832. [PMID: 34003418 DOI: 10.1007/s10865-021-00231-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
Black women have a higher prevalence of obesity and tend to have suboptimal outcomes in behavioral weight loss programs for reasons that are not fully understood. Studies have shown a potential relationship between perceived psychological stress and weight loss in behavioral interventions. This study sought to assess whether baseline stress was directly or indirectly associated with 6-month weight change among Black women participating in a behavioral weight loss study. Indirect pathways of interest included depressive symptoms and dietary intake. A secondary analysis of data (n = 409) collected from a cluster, randomized behavioral weight loss trial was conducted. Demographics, anthropometry, surveys, and dietary data were collected at baseline and 6 months. Path analysis was used to test for direct and indirect effects of baseline stress on 6-month weight change while controlling for sociodemographic factors and intervention group. Baseline stress was not directly associated with 6-month weight change nor was it indirectly associated via depressive symptoms in the adjusted model. However, each of the direct paths linking baseline stress to weight loss were statistically significant. Stress was not associated with 6-month weight change via dietary intake. Baseline stress was positively associated with 6-month depressive symptoms which in turn was associated with less weight change. Depressive symptoms may offer an additional psychosocial target to consider when designing behavioral weight loss interventions for Black women.
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Affiliation(s)
- Kristine Molina
- Department of Psychological Sciences, University of California Irvine, Irvine, CA, USA
| | - Monica L Baskin
- School of Medicine, Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dustin Long
- School of Public Health, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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Donneyong M, Reynolds C, Mischoulon D, Chang G, Luttmann-Gibson H, Bubes V, Guilds M, Manson J, Okereke O. Protocol for studying racial/ethnic disparities in depression care using joint information from participant surveys and administrative claims databases: an observational cohort study. BMJ Open 2020; 10:e033173. [PMID: 31915172 PMCID: PMC6955513 DOI: 10.1136/bmjopen-2019-033173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Current evidence indicates that older racial/ethnic minorities encounter disparities in depression care. Because late-life depression is common and confers major adverse health consequences, it is imperative to reduce disparities in depression care. Thus, the primary objectives of this protocol are to: (1) quantify racial/ethnic disparities in depression treatment and (2) identify and quantify the magnitude of these disparities accountable for by a multifactorial combination of patient, provider and healthcare system factors. METHODS AND ANALYSIS Data will be derived from the Vitamin D and Omega-3 Trial-Depression Endpoint Prevention (VITAL-DEP) study, a late-life depression prevention ancillary study to the VITAL trial. A total of 25 871 men and women, aged 50+ and 55+ years, respectively, were randomised in a 2×2 factorial randomised trial of heart disease and cancer prevention to receive vitamin D and/or fish oil for 5 years starting from 2011. Most participants were aged 65+ years old at randomisation. Medicare claims data for over 19 000 VITAL/VITAL-DEP participants were linked to conduct our study.The major study outcomes are depression treatment (antidepressant use and/or receipt of psychotherapy services) and adherence to medication treatment (antidepressant adherence and acceptability). The National Academy of Medicine framework for studying racial disparities was leveraged to select patient-level, provider-level and healthcare system-level variables and to address their potential roles in depression care disparities. Blinder-Oaxaca regression decomposition methods will be implemented to quantify and identify correlates of racial/ethnic disparities in depression treatment and adherence. ETHICS AND DISSEMINATION This study received Institutional Review Board (IRB) approval from the Partners Healthcare (PHS) IRB, protocol# 2010P001881. We plan to disseminate our results through publication of manuscripts patient engagement activities, such as study newsletters regularly sent out to VITAL participants, and presentations at scientific meetings. TRIAL REGISTRATION NUMBER NCT01696435.
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Affiliation(s)
- Macarius Donneyong
- Pharmacy Practice and Science, College of Pharmacy, The Ohio University State University, Columbus, Ohio, USA
| | - Charles Reynolds
- Psychiatry, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Grace Chang
- Psychiatry, Harvard University, Cambridge, Massachusetts, USA
- Psychiatry, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Heike Luttmann-Gibson
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Vadim Bubes
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Joann Manson
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Olivia Okereke
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Busch AM, Louie ME, SantaBarbara NJ, Ajayi AA, Gleason N, Dunsiger SI, Carey MP, Ciccolo JT. Effects of resistance training on depression and cardiovascular disease risk in Black men: Protocol for a randomized controlled trial. Ment Health Phys Act 2019; 17:100299. [PMID: 32863882 PMCID: PMC7451250 DOI: 10.1016/j.mhpa.2019.100299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression is severely undertreated in Black men. This is primarily because Black men are less likely to seek traditional psychiatric treatment, have less access and more barriers to treatment, and perceive more stigma associated with treatment. Depression contributes to cardiovascular disease (CVD), and Black men have the highest rate of mortality from CVD. Resistance training (RT) can have beneficial effects on both depression and CVD. This study will be the first randomized controlled trial to test the effects of RT on depression and cardiovascular health in a sample of depressed Black men. METHOD/DESIGN Fifty Black men with clinically significant symptoms of depression will be randomized to either (a) a 12-week RT or (b) an attention-control group. Behavioral Activation techniques will be used to support adherence to home-based RT goals. Both groups will meet on-site twice/week during the 12-week program, and follow-up assessments will occur at the end-of-treatment and 3 months post-treatment. Qualitative interviews will be conducted after the 3-month follow-up. The objectives of this study are (1) to assess the feasibility and acceptability of recruitment, retention, and intervention procedures, (2) to obtain preliminary evidence of efficacy, and (3) to explore potential mediators of the effects of RT on depression. DISCUSSION This study will advance the field of minority men's health by producing new data on the effects of RT for depression, the potential mechanisms of action that may support its use, and its effects on markers of CVD risk in Black men. TRIAL REGISTRATION ClinicalTrials.gov (NCT03107039).
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Affiliation(s)
- Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, 715 South 8th Street, Minneapolis, MN 55404, United States
- Department of Medicine, University of Minnesota Medical School, 401 East River Parkway, Minneapolis, MN 55455, United States
| | - Mark E. Louie
- Department of Behavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
| | - Nicholas J. SantaBarbara
- Department of Behavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
| | - Alex A. Ajayi
- Department of Psychology, Augsburg University, 2211 Riverside Ave, Minneapolis, MN 55454, United States
| | - Neil Gleason
- Hennepin Healthcare Research Institute, 701 Park Ave., Suite PP7.700, Minneapolis, MN 55415, United States
| | - Shira I. Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 167 Point Street Providence, RI 02903, United States
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, Rhode Island 02903, United States
| | - Michael P. Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 167 Point Street Providence, RI 02903, United States
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, Rhode Island 02903, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School Brown University, 700 Butler Dr. Providence, RI 02906, United States
| | - Joseph T. Ciccolo
- Department of Behavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, United States
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Goldstein E. Rise in mortality involving poisoning by medicaments other than narcotics, including poisoning by psychotropic drugs in different age/racial groups in the US. PLoS One 2019; 14:e0219711. [PMID: 31323036 PMCID: PMC6641145 DOI: 10.1371/journal.pone.0219711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/29/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Increase in mortality involving poisoning, particularly by narcotics, is known to have been one of the factors that affected life expectancy in the US during the last two decades, especially for white Americans and Native Americans. However, the contribution of medicaments other than narcotics to mortality in different racial/age groups is less studied. METHODS We regressed annual rates of mortality involving poisoning by medicaments but not narcotics/psychodysleptics (ICD-10 codes T36-39.xx or T41-50.8 but not T40.xx present as either underlying or contributing causes of death), as well as annual rates of mortality for certain subcategories of the above, including mortality involving poisoning by psychotropic drugs but not narcotics/psychodysleptics (ICD-10 codes T43.xx but not T40.xx present as either underlying or contributing causes of death) in different age/racial groups for both the 2000-2011 period and the 2011-2017 period against calendar year. RESULTS Annual numbers of deaths involving poisoning by medicaments but not narcotics/psychodysleptics grew from 4,332 between 2000-2001 to 11,401 between 2016-2017, with the growth in the rates of those deaths being higher for the 2011-2017 period compared to the 2000-2011 period. The largest increases in the rates of mortality involving poisoning by medicaments but not narcotics/psychodysleptics were in non-elderly Non-Hispanic Native Americans, followed by Non-Hispanic whites. Most of those increases came from increases in the rates of mortality involving poisoning by psychotropic medications; the latter rates grew for the period of 2015-2017 vs. 2000-2002 by factors ranging from 2.75 for ages 35-44y to 5.37 for ages 55-64y. CONCLUSIONS There were major increases in mortality involving poisoning by non-narcotic, particularly psychotropic medicaments, especially in non-elderly non-Hispanic whites and Native Americans. Our results support the need for a comprehensive evaluation of the effect of psychotropic medications on health-related outcomes, including mortality for causes other than poisoning, and the impact of medication misuse.
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Affiliation(s)
- Edward Goldstein
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States of America
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11
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Alwhaibi M, Madhavan S, Bias T, Kelly K, Walkup J, Sambamoorthi U. Depression Treatment Among Elderly Medicare Beneficiaries With Incident Cases of Cancer and Newly Diagnosed Depression. Psychiatr Serv 2017; 68:482-489. [PMID: 28045347 PMCID: PMC5513147 DOI: 10.1176/appi.ps.201600190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Depression treatment can improve the health outcomes of elderly cancer survivors. There is a paucity of studies on the extent to which depression is treated among elderly cancer survivors. Therefore, this study estimated the rates of depression treatment among elderly cancer survivors and identified the factors affecting depression treatment. METHODS A retrospective cohort study design was adopted, and data were obtained from the linked Surveillance, Epidemiology and End Results (SEER) and Medicare database. Elderly individuals (≥ 66 years) with incident cases of breast, colorectal, or prostate cancer and newly diagnosed depression (N=1,673) were followed for six months after the depression diagnosis to identify depression treatment (antidepressants only, psychotherapy only, combined treatment with both antidepressants and psychotherapy, and no depression treatment). Chi-square tests and multinomial logistic regressions were used to analyze the factors associated with depression treatment. RESULTS In this study population, 46% received antidepressants only, 27% received no treatment, 18% received combined therapy, and 9% received psychotherapy only. Factors associated with depression treatment included anxiety, the percentage of psychologists at the county level, the number of visits to primary care physicians, ongoing cancer treatment, the presence of other chronic conditions, and race-ethnicity. CONCLUSIONS The study findings indicate that two-thirds of cancer survivors received depression treatment in the first six months after depression diagnosis. Our study findings indicate that racial-ethnic disparities in depression treatment persist and competing demands for cancer treatment may take priority over depression care. Also, the availability of psychologists may influence receipt of psychotherapy among cancer survivors.
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Affiliation(s)
- Monira Alwhaibi
- Dr. Alwhaibi, Dr. Madhavan, Dr. Bias, Dr. Kelly, and Dr. Sambamoorthi are with the School of Pharmacy, West Virginia University, Morgantown, and Dr. Alwhaibi is also with the School of Pharmacy, King Saud University, Riyadh, Saudi Arabia (e-mail: ). Dr. Walkup is with the Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey
| | - Suresh Madhavan
- Dr. Alwhaibi, Dr. Madhavan, Dr. Bias, Dr. Kelly, and Dr. Sambamoorthi are with the School of Pharmacy, West Virginia University, Morgantown, and Dr. Alwhaibi is also with the School of Pharmacy, King Saud University, Riyadh, Saudi Arabia (e-mail: ). Dr. Walkup is with the Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey
| | - Thomas Bias
- Dr. Alwhaibi, Dr. Madhavan, Dr. Bias, Dr. Kelly, and Dr. Sambamoorthi are with the School of Pharmacy, West Virginia University, Morgantown, and Dr. Alwhaibi is also with the School of Pharmacy, King Saud University, Riyadh, Saudi Arabia (e-mail: ). Dr. Walkup is with the Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey
| | - Kimberly Kelly
- Dr. Alwhaibi, Dr. Madhavan, Dr. Bias, Dr. Kelly, and Dr. Sambamoorthi are with the School of Pharmacy, West Virginia University, Morgantown, and Dr. Alwhaibi is also with the School of Pharmacy, King Saud University, Riyadh, Saudi Arabia (e-mail: ). Dr. Walkup is with the Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey
| | - Jamie Walkup
- Dr. Alwhaibi, Dr. Madhavan, Dr. Bias, Dr. Kelly, and Dr. Sambamoorthi are with the School of Pharmacy, West Virginia University, Morgantown, and Dr. Alwhaibi is also with the School of Pharmacy, King Saud University, Riyadh, Saudi Arabia (e-mail: ). Dr. Walkup is with the Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey
| | - Usha Sambamoorthi
- Dr. Alwhaibi, Dr. Madhavan, Dr. Bias, Dr. Kelly, and Dr. Sambamoorthi are with the School of Pharmacy, West Virginia University, Morgantown, and Dr. Alwhaibi is also with the School of Pharmacy, King Saud University, Riyadh, Saudi Arabia (e-mail: ). Dr. Walkup is with the Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, New Jersey
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12
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Chang SC, Wang W, Pan A, Jones RN, Kawachi I, Okereke OI. Racial Variation in Depression Risk Factors and Symptom Trajectories among Older Women. Am J Geriatr Psychiatry 2016; 24:1051-1062. [PMID: 27639290 PMCID: PMC5069193 DOI: 10.1016/j.jagp.2016.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess racial variation in depression risk factors and symptom trajectories among older women. METHODS Using Nurses' Health Study data, participants (29,483 non-Hispanic white and 288 black women) aged 60 years or older, free of depression in 2000, were followed until 2012. Data on race and risk factors, selected a priori, were obtained from biennial questionnaires. Incident depression was defined as depression diagnosis, antidepressant use, or presence of severe depressive symptoms. Group-based trajectories of depressive symptoms were determined using latent variable modeling approaches. RESULTS Black participants had lower risk (hazard ratio: 0.76; 95% confidence interval: 0.57-0.99) of incident late-life depression compared with whites. Although blacks had higher prevalence than whites of some risk factors at study baseline, distributions of major contributors to late-life depression risk (low exercise, sleep difficulty, physical/functional limitation, pain) were comparable. There was evidence of effect modification by race for relations of region of birth (Southern birthplace), smoking, and medical comorbidity to depression risk; however, wide confidence intervals occurred among blacks because of smaller sample size. Four trajectories were identified: minimal symptoms-stable (58.3%), mild symptoms-worsening (31.4%), subthreshold symptoms-worsening (4.8%), and subthreshold symptoms-improving (5.5%). Probabilities of trajectory types were similar for blacks and whites. CONCLUSION Although overall trajectories of late-life depressive symptoms were comparable by race, there was racial variation in depression risk estimates associated with less-studied factors, such as U.S. region of birth. Future work may address unmeasured health and resilience determinants that may underlie observed findings and that could inform clinical assessment of late-life depression risk factors.
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Affiliation(s)
- Shun-Chiao Chang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - An Pan
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Richard N Jones
- Aging Brain Center, Hebrew SeniorLife, Institute for Aging Research, Boston, MA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Olivia I Okereke
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
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13
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Assari S. Race and Ethnic Differences in Additive and Multiplicative Effects of Depression and Anxiety on Cardiovascular Risk. Int J Prev Med 2016; 7:22. [PMID: 26941923 PMCID: PMC4755257 DOI: 10.4103/2008-7802.173931] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 04/03/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Shervin Assari
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Research on Ethnicity, Culture, and Health, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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14
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Hall CA, Simon KM, Lenze EJ, Dew MA, Begley A, Butters MA, Blumberger DM, Stack JA, Mulsant B, Reynolds CF. Depression Remission Rates Among Older Black and White Adults: Analyses From the IRL-GREY Trial. Psychiatr Serv 2015; 66:1303-11. [PMID: 26278231 PMCID: PMC4666813 DOI: 10.1176/appi.ps.201400480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored whether older black and white adults with major depressive disorder differed in rates of remission or attrition during open-label treatment with venlafaxine and supportive care. METHODS A total of 47 black (10%) and 412 white (90%) adults age ≥60 were treated with open-label venlafaxine extended-release (≤300 mg per day) for 12-14 weeks during the initial phase of an multisite, randomized, placebo-controlled augmentation trial. Participants were help-seeking older adults with nonpsychotic major depressive disorder (single or recurrent episode) referred from specialty clinics, primary care practices, advertisements, and research programs. Remission was defined as a Montgomery-Asberg Depression Rating Scale score of ≤10 for two consecutive assessments at the end of 12 weeks. Kaplan-Meier curves displayed time to dropout and time to initial remission. Cox proportional hazards models assessed differences in attrition and remission rates. RESULTS Black participants had greater baseline general medical comorbidity, worse physical health-related quality of life, and poorer cognitive function than white participants. White participants were more likely to have received an adequate trial of antidepressant and psychotherapy before study entry. Baseline depression severity, depression duration, age at onset, and recurrence history did not differ between groups. The groups had similar final doses of venlafaxine and similar rates of attrition and remission. Side-effect profiles were comparable between the groups. CONCLUSIONS Despite greater medical comorbidity, lower cognitive function, and less adequate prior exposure to antidepressant treatment and psychotherapy, black participants were no more likely to discontinue antidepressant pharmacotherapy and experienced a rate of remission comparable to white participants.
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Affiliation(s)
- Charles A Hall
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Kevin M Simon
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Eric J Lenze
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Mary Amanda Dew
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Amy Begley
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Meryl A Butters
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Daniel M Blumberger
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Jacqueline A Stack
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Benoit Mulsant
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
| | - Charles F Reynolds
- Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: )
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Screening for Depression in African-American Churches. Am J Prev Med 2015; 49:526-33. [PMID: 26232907 PMCID: PMC4575828 DOI: 10.1016/j.amepre.2015.03.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Substantial racial/ethnic disparities exist in the identification and management of major depression. Faith-Based Health Promotion interventions reduce disparities in health screenings for numerous medical conditions. However, the feasibility of systematically screening for depression in faith-based settings has not been investigated. The purpose of this study was to assess the feasibility of using a validated instrument to screen for depression in African-American churches. METHODS Participants were recruited between October and November 2012 at three predominantly African-American churches in New York City. A participatory research approach was used to determine screening days. The Patient Health Questionnaire-9 (PHQ-9) was administered to 122 participants. Positive depression screen was defined as a PHQ-9 score ≥10. Descriptive statistics were used to report sample characteristics, prevalence of participants who screened positive, and history of help seeking. Logistic regression analyses were conducted to determine the association of positive depression screen and sociodemographic characteristics. Initial analyses were conducted in 2013, with additional analyses in 2014. RESULTS The prevalence estimate for positive depression screen was 19.7%. More men (22.5%) screened positive than women (17.7%). Total household income was inversely related to positive depression screen. A similar percentage of respondents had previously sought help from primary care providers as from clergy. CONCLUSIONS It was feasible to screen for depression with the PHQ-9 in African-American churches. The prevalence of positive depression screen was high, especially among black men. Churches may be an important setting in which to identify depressive symptoms in this underserved population.
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Difference by sex but not by race/ethnicity in the visceral adipose tissue-depressive symptoms association: the Multi-Ethnic Study of Atherosclerosis. Psychoneuroendocrinology 2014; 47:78-87. [PMID: 25001957 PMCID: PMC4134940 DOI: 10.1016/j.psyneuen.2014.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 05/06/2014] [Accepted: 05/06/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Prior studies have investigated the association of clinical depression and depressive symptoms with body weight (i.e. body mass index (BMI) and waist circumference), but few have examined the association between depressive symptoms and intra-abdominal fat. Of these a limited number assessed the relationship in a multi-racial/ethnic population. METHODS Using data on 1017 men and women (45-84 years) from the Multi-Ethnic Study of Atherosclerosis (MESA) Body Composition, Inflammation and Cardiovascular Disease Study, we examined the cross-sectional association between elevated depressive symptoms (EDS) and CT-measured visceral fat mass at L2-L5 with multivariable linear regression models. EDS were defined as a Center for Epidemiological Studies Depression score ≥16 and/or anti-depressant use. Covariates included socio-demographics, inflammatory markers, health behaviors, comorbidities, and body mass index (BMI). Race/ethnicity (Whites [referent group], Chinese, Blacks and Hispanics) and sex were also assessed as potential modifiers. RESULTS The association between depressive symptoms and visceral fat differed significantly by sex (p=0.007), but not by race/ethnicity. Among men, compared to participants without EDS, those with EDS had greater visceral adiposity adjusted for BMI and age (difference=122.5 cm2, 95% CI=34.3, 210.7, p=0.007). Estimates were attenuated but remained significant after further adjustment by socio-demographics, inflammatory markers, health behaviors and co-morbidities (difference=94.7 cm2, 95% CI=10.5, 178.9, p=0.028). Among women, EDS was not significantly related to visceral adiposity in the fully adjusted model. CONCLUSIONS Sex, but not race/ethnicity, was found to modify the relationship between EDS and visceral fat mass. Among men, a significant positive association was found between depressive symptoms and visceral adiposity. No significant relationship was found among women.
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Chao SZ, Matthews BR, Yokoyama JS, Betty Lai N, Ong H, Tse M, Yuan RF, Lin A, Kramer J, Yaffe K, Miller BL, Rosen HJ, Rosen HJ. Depressive symptoms in Chinese-American subjects with cognitive impairment. Am J Geriatr Psychiatry 2014; 22:642-52. [PMID: 24021225 PMCID: PMC4309267 DOI: 10.1016/j.jagp.2012.10.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 08/22/2012] [Accepted: 10/12/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare the prevalence of depressive symptoms and frequency of antidepressant use between a group of elderly Chinese-American subjects with and without cognitive impairment and a group of matched white subjects. A secondary aim was to examine the clinical and demographic predictors of depressive symptoms across these groups. METHODS The study was conducted at an academic neurology subspecialty clinic. This was a case-control study with 140 Chinese-American subjects and 140 demographically and cognitively matched white subjects. In each group, there were 48 cognitively normal and 92 cognitively impaired participants (49 with mild cognitive impairment, 43 with Alzheimer disease). The proportion of individuals with significant depressive symptoms, as indicated by a Geriatric Depression Scale score ≥6 of 15, and frequency of antidepressant use were compared across groups by using χ(2) analysis. Factors predicting depressive symptoms, including racial and diagnostic group, age, gender, Mini-Mental State Examination score, level of functional impairment, education level, and medical comorbidities, were assessed by using linear regression analysis. RESULTS Significant depressive symptoms were more common in cognitively impaired Chinese-American (35%) than cognitively impaired white (15%; χ(2)[1] = 9.4; p = 0.004) subjects. Chinese-American subjects with cognitive impairment were less likely to be receiving treatment for depression (12%) than white subjects with cognitive impairment (37%; χ(2)[1] = 15.6; p = 0.002). Racial and diagnostic group, age, level of functional impairment, Mini-Mental State Examination score, and education level were all statistically significant independent predictors of Geriatric Depression Scale score. CONCLUSIONS Elderly Chinese-American subjects with cognitive impairment are at increased risk for unrecognized and untreated depressive symptoms compared with elderly white subjects with cognitive impairment. Education level may contribute to this risk or it may be a surrogate marker for other factors contributing to depressive symptoms in this group.
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Affiliation(s)
- Steven Z. Chao
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California,Department of Neurology, VA Palo Alto Health Care System, Palo Alto, California
| | - Brandy R. Matthews
- Department of Neurology, Indiana University School of Medicine, Indiana Alzheimer Disease Center, Indianapolis, IN
| | - Jennifer S. Yokoyama
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Ngan Betty Lai
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Hilary Ong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Marian Tse
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Runfen Frances Yuan
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Amy Lin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Joel Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco and Memory Disorders Clinic, San Francisco VA Medical Center
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA.
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Reinlieb ME, Persaud A, Singh D, Garcon E, Rutherford BR, Pelton GH, Devanand DP, Roose SP, Sneed JR. Vascular depression: overrepresented among African Americans? Int J Geriatr Psychiatry 2014; 29:470-7. [PMID: 24123266 DOI: 10.1002/gps.4029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/27/2013] [Accepted: 09/06/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Our primary aim was to compare the rate of vascular depression among a clinical sample of African American and Caucasian depressed older adults. Secondary aims included characterizing the clinical and neuropsychological profile of vascular depression and comparing antidepressant response rates between patients with vascular and nonvascular depression. METHODS This was a two-site, multi-ethnic, open 8-week trial of antidepressant medication in older adults with depression. Men and women 50 years or older meeting DSM-IV criteria for nonpsychotic unipolar depression participated in this trial. Each participant underwent a comprehensive psychiatric and neuropsychological evaluation and a brain MRI, which were performed at baseline. RESULTS Forty-six patients met inclusion and exclusion criteria. Forty-two of those patients received an MRI at baseline. Sixteen patients met criteria for vascular depression. Patients with vascular depression were significantly more likely to be African American and have a higher likelihood of being female, a higher rate of hypertension and psychomotor retardation, a lower rate of family history of affective illness, and frontal systems dysfunction on neuropsychological testing. The difference in response rates between patients with vascular and nonvascular depression did not reach statistical significance. CONCLUSIONS This is the first study to document high rates of vascular depression in a clinical sample of African Americans and Caucasians. Our findings suggest that vascular depression may be overrepresented among African Americans, which is consistent with the high rates of cardiovascular disease, hypertension, and stroke in this population.
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Affiliation(s)
- Michelle E Reinlieb
- The Graduate Center, City University of New York, New York, NY, USA; UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Carmasin JS, Mast BT, Allaire JC, Whitfield KE. Vascular risk factors, depression, and cognitive change among African American older adults. Int J Geriatr Psychiatry 2014; 29:291-8. [PMID: 23877973 PMCID: PMC3900598 DOI: 10.1002/gps.4007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/20/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Vascular burden has been linked to future depression and cognitive change in predominately European American samples. This study investigated these relationships in older African Americans. METHODS To examine the connection between vascular risk factors, depression, and cognitive change, this study utilized data from 435 older African Americans. Specifically, the study examined the link between vascular risk at baseline with depression and cognitive functioning at a 2.5-year follow-up visit. RESULTS High baseline vascular risk was associated with increased odds of future depression while controlling for age and current depression. A series of path analyses demonstrated links between baseline vascular risk, increases in depression, and decreases in processing speed. CONCLUSIONS These findings suggest that African Americans with greater vascular burden are at greater risk for depression and cognitive change.
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Affiliation(s)
- Jeremy S Carmasin
- Psychological and Brain Sciences, University of Louisville, Louisville, KY, 40292, USA
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20
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Racial/Ethnic Differences in the Relationship between Obesity and Depression Treatment. J Behav Health Serv Res 2014; 42:486-503. [PMID: 24464180 DOI: 10.1007/s11414-014-9391-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Using data from the 2004 to 2008 Medical Expenditure Panel Survey (MEPS), this study examined the relationship between obesity and the treatment of depression across racial/ethnic subgroups, controlling for depressive symptoms, self-rated mental health, health status, and socioeconomic characteristics. The association between obesity and depression-related medication was significant for white women but not for black or Hispanic women. Similarly, the association between obesity and depression-related ambulatory visits was significant for white women but not for black or Hispanic women. The results for men were, in general, mixed and inconsistent. The significant racial/ethnic differences found in the relationship between obesity and depression treatment among women suggest that social and cultural factors might play important roles in depression treatment among women.
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Murphy EJ, Kassem L, Chemerinski A, Rush AJ, Laje G, McMahon FJ. Retention and attrition among African Americans in the STAR*D study: what causes research volunteers to stay or stray? Depress Anxiety 2013; 30:1137-44. [PMID: 23723044 PMCID: PMC3818393 DOI: 10.1002/da.22134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/02/2013] [Accepted: 05/04/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND High attrition rates among African-Americans (AA) volunteers are a persistent problem that makes clinical trials less representative and complicates estimation of treatment outcomes. Many studies contrast AA with other ethnic/racial groups, but few compare the AA volunteers who remain in treatment with those who leave. Here, in addition to comparing patterns of attrition between African Americans and Whites, we identify predictors of overall and early attrition among African Americans. METHOD Sample comprised non-Hispanic African-American (n = 673) and White (n = 2,549) participants in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Chi-square tests were used to examine racial group differences in reasons for exit. Multivariate logistic regression was used to examine predictors of overall attrition, early attrition (by level 2) and top reasons cited for attrition among African Americans. RESULTS Both African-American and White dropouts most commonly cited noncompliance reasons for attrition during the earlier phases of the study, while citing reasons related to efficacy and medication side effects later in the study. Satisfaction with treatment strongly predicted overall attrition among African Americans independent of socioeconomic, clinical, medical or psychosocial factors. Early attrition among African American dropouts was associated with less psychiatric comorbidity, and higher perceived physical functioning but greater severity of clinician-rated depression. CONCLUSIONS Compliance, efficacy, and side effects are important factors that vary in relative importance during the course of a clinical trial. For African Americans in such trials, retention strategies should be broadened to emphasize patient engagement and satisfaction during the critical periods immediately following enrollment and treatment initiation.
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Affiliation(s)
- Eleanor J Murphy
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, NIH, USDHHS,Corresponding Author, 35 Convent Drive, Building 35, Porter Bldg, RM 1A-209, Bethesda, MD, 20892. Tel: (301) 451-3813; Fax (301) 402-7094;
| | - Layla Kassem
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, NIH, USDHHS
| | - Anat Chemerinski
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, NIH, USDHHS
| | - A. John Rush
- Duke-National University of Singapore, Singapore
| | - Gonzalo Laje
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, NIH, USDHHS
| | - Francis J. McMahon
- Human Genetics Branch, Intramural Research Program, National Institute of Mental Health, NIH, USDHHS
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Munshi KD, Shih YCT, Brown LM, Dagogo-Jack S, Wan JY, Wang J. Disparity implications of the Medicare medication therapy management eligibility criteria: a literature review. Expert Rev Pharmacoecon Outcomes Res 2013; 13:201-16. [PMID: 23570431 DOI: 10.1586/erp.13.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The emphasis on eliminating racial and ethnic disparities in healthcare has received national attention, with various policy initiatives addressing this problem and proposing solutions. However, in the current economic era requiring tight monetary constraints, emphasis is increasingly being placed on economic efficiency, which often conflicts with the equality doctrine upon which many policies have been framed. The authors' review aims to highlight the disparity implications of one such policy provision - the predominantly utilization-based eligibility criteria for medication therapy management services under Medicare Part D - by identifying studies that have documented racial and ethnic disparities in health status and the use of and spending on prescription medications. Future design and evaluation of various regulations and legislations employing utilization-based eligibility criteria must use caution in order to strike an equity-efficiency balance.
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Affiliation(s)
- Kiraat D Munshi
- Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, 881 Madison Ave., Room 212, Memphis, TN 38163, USA
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Pickett YR, Bazelais KN, Bruce ML. Late-life depression in older African Americans: a comprehensive review of epidemiological and clinical data. Int J Geriatr Psychiatry 2013; 28:903-13. [PMID: 23225736 PMCID: PMC3674152 DOI: 10.1002/gps.3908] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/16/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The population of older African Americans is expected to triple by 2050, highlighting the public health importance of understanding their mental health needs. Despite evidence of the negative impact of late-life depression, less is known of how this disorder affects the lives of older African Americans. Lack of studies focusing on how depression presents in older African Americans and their subsequent treatment needs lead to a gap in epidemiologic and clinical knowledge for this population. In this review, we aim to present a concise report of prevalence, correlates, course, outcomes, symptom recognition, and treatment of depression for these individuals. METHOD We performed a literature review of English-language articles identified from PubMed and Medline published between January 1990 and June 2012. Studies included older adults and contained the key words 'geriatric depression in African Americans', 'geriatric depression in Blacks', and 'geriatric depression in minorities'. RESULTS Although in most studies, older African Americans had higher or equivalence prevalence of depression compared with Caucasian Americans, we also found lower rates of recognition of depression and treatment. Many studies reported worse outcomes associated for depression among older African Americans compared with older Caucasians. CONCLUSIONS Serious racial and ethnic disparities persist in the management of older African Americans with depression. Understanding their unmet needs and improving depression care for these individuals is necessary to reduce these disparities.
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Affiliation(s)
- Yolonda R. Pickett
- Weill-Cornell Medical College, Department of Psychiatry,Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences
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Delaney KR, Robinson KM, Chafetz L. Development of integrated mental health care: critical workforce competencies. Nurs Outlook 2013; 61:384-91. [PMID: 23702474 DOI: 10.1016/j.outlook.2013.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/24/2013] [Accepted: 03/31/2013] [Indexed: 11/18/2022]
Abstract
In integrated care, a person will have his or her medical and behavioral health needs addressed within one health care system. Support for integrated models has grown with the increasing awareness of how the medical comorbidities of individuals with serious mental illness contribute to their morbidity and mortality, the prevalence of mental health problems in the general population, and the mental health issues among those with chronic medical problems. The enactment of effective integrated care will demand developing clinicians who are trained to work with mental health needs at various levels of intensity, who are capable of addressing complex comorbidities, and who operate from a person-centered approach to care. In this light we argue that given their unique skill set and clinical training, Psychiatric-Mental Health Advanced Practice Nurses could play a critical role in integrated care and present policy recommendations which support the development of the Psychiatric-Mental Health Advanced Practice Nurses role in such models.
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Le Cook B, Manning W, Alegria M. Measuring disparities across the distribution of mental health care expenditures. THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 2013; 16:3-12. [PMID: 23676411 PMCID: PMC3662479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 02/17/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Previous mental health care disparities studies predominantly compare mean mental health care use across racial/ethnic groups, leaving policymakers with little information on disparities among those with a higher level of expenditures. AIMS OF THE STUDY To identify racial/ethnic disparities among individuals at varying quantiles of mental health care expenditures. To assess whether disparities in the upper quantiles of expenditure differ by insurance status, income and education. METHODS Data were analyzed from a nationally representative sample of white, black and Latino adults 18 years and older (n=83,878). Our dependent variable was total mental health care expenditure. We measured disparities in any mental health care expenditures, disparities in mental health care expenditure at the 95th, 97.5 th, and 99 th expenditure quantiles of the full population using quantile regression, and at the 50 th, 75 th, and 95 th quantiles for positive users. In the full population, we tested interaction coefficients between race/ethnicity and income, insurance, and education levels to determine whether racial/ethnic disparities in the upper quantiles differed by income, insurance and education. RESULTS Significant Black-white and Latino-white disparities were identified in any mental health care expenditures. In the full population, moving up the quantiles of mental health care expenditures, Black-White and Latino-White disparities were reduced but remained statistically significant. No statistically significant disparities were found in analyses of positive users only. The magnitude of black-white disparities was smaller among those enrolled in public insurance programs compared to the privately insured and uninsured in the 97.5 th and 99 th quantiles. Disparities persist in the upper quantiles among those in higher income categories and after excluding psychiatric inpatient and emergency department (ED) visits. DISCUSSION Disparities exist in any mental health care and among those that use the most mental health care resources, but much of disparities seem to be driven by lack of access. The data do not allow us to disentangle whether disparities were related to white respondent's overuse or underuse as compared to minority groups. The cross-sectional data allow us to make only associational claims about the role of insurance, income, and education in disparities. With these limitations in mind, we identified a persistence of disparities in overall expenditures even among those in the highest income categories, after controlling for mental health status and observable sociodemographic characteristics. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Interventions are needed to equalize resource allocation to racial/ethnic minority patients regardless of their income, with emphasis on outreach interventions to address the disparities in access that are responsible for the no/low expenditures for even Latinos at higher levels of illness severity. IMPLICATIONS FOR HEALTH POLICIES Increased policy efforts are needed to reduce the gap in health insurance for Latinos and improve outreach programs to enroll those in need into mental health care services. IMPLICATIONS FOR FURTHER RESEARCH Future studies that conclusively disentangle overuse and appropriate use in these populations are warranted.
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Affiliation(s)
- Benjamin Le Cook
- Center for Multicultural Mental Health Research, Somerville, MA 02143, USA.
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Pickett YR, Weissman J, Bruce ML. Racial differences in antidepressant use among older home health care patients. Psychiatr Serv 2012; 63:827-9. [PMID: 22854728 PMCID: PMC4537070 DOI: 10.1176/appi.ps.201100233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to determine the association of race (black and white) with depression diagnosis and antidepressant use among older home health care patients. METHODS Cross-sectional data were obtained from the 2007 National Home and Hospice Care Survey of patients 65 years and older (N=3,157). Data were analyzed by race, antidepressant use, and charted depression diagnosis. RESULTS Whites had greater odds than blacks of receiving a depression diagnosis (adjusted odds ratio [AOR]=4.46, 95% confidence interval [CI]=1.52-13.09). Whites with no depression diagnosis were also more likely to receive an antidepressant (AOR=2.62, CI=1.58-4.36); however, the difference in receipt of an antidepressant between whites and blacks with a depression diagnosis was not significant. CONCLUSIONS Older blacks were less likely than older whites to receive antidepressants, independent of a depression diagnosis. This finding suggests that older blacks with depression in home health care may face two disparities relative to whites: underdiagnosis and undertreatment of depression.
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Affiliation(s)
- Yolonda Renee Pickett
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Rd,White Plains, NY 10605, USA.
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González HM, Tarraf W, Whitfield K, Gallo JJ. Vascular depression prevalence and epidemiology in the United States. J Psychiatr Res 2012; 46:456-61. [PMID: 22277303 PMCID: PMC3447181 DOI: 10.1016/j.jpsychires.2012.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 12/16/2011] [Accepted: 01/05/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine and describe vascular depression epidemiology in the United States. METHODS Cross-sectional data from a national probability sample of household resident adults (18-years and older; N = 16,423) living in the 48 coterminous United States were analyzed to calculate prevalence estimates of vascular depression, associated disability and treatment rates. In this study, vascular depression was defined as the presence of cardiovascular and cerebrovascular disease (CVD) and CVD major risk factors (e.g., diabetes, hypertension, heart disease, and obesity) among adults 50-years and older who also met 12-month DSM-IV major depression criteria. RESULTS We estimated that about 3.4% or approximately 2.64 million American adults 50-years and older met our criteria for vascular depression. Among adults who met criteria for lifetime major depression, over one-in-five (22.1%) were considered to have the vascular depression subtype. Secondly, vascular depression was associated with significantly increased functional impairment relative to the non-depressed population and adults meeting criteria for major depression alone. Although depression care use was significantly higher among vascular depression respondents relative to those with major depression alone, practice guideline concordant therapy use was not. CONCLUSIONS Vascular depression appears to be an important public health problem that affects a large portion of the U.S. adult population with major depression, and that it is associated with excess functional impairment without concomitant better depression care.
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Affiliation(s)
- Hector M González
- Wayne State University, Institute of Gerontology, Department of Family Medicine and Public Health Sciences, 87 East Ferry Street, 226 Knapp Building, Detroit, MI 48202, USA.
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Akincigil A, Olfson M, Siegel M, Zurlo KA, Walkup JT, Crystal S. Racial and ethnic disparities in depression care in community-dwelling elderly in the United States. Am J Public Health 2012; 102:319-28. [PMID: 22390446 PMCID: PMC3483986 DOI: 10.2105/ajph.2011.300349] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2011] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We investigated racial/ethnic disparities in the diagnosis and treatment of depression among community-dwelling elderly. METHODS We performed a secondary analysis of Medicare Current Beneficiary Survey data (n = 33,708) for 2001 through 2005. We estimated logistic regression models to assess the association of race/ethnicity with the probability of being diagnosed and treated for depression with either antidepressant medication or psychotherapy. RESULTS Depression diagnosis rates were 6.4% for non-Hispanic Whites, 4.2% for African Americans, 7.2% for Hispanics, and 3.8% for others. After we adjusted for a range of covariates including a 2-item depression screener, we found that African Americans were significantly less likely to receive a depression diagnosis from a health care provider (adjusted odds ratio [AOR] = 0.53; 95% confidence interval [CI] = 0.41, 0.69) than were non-Hispanic Whites; those diagnosed were less likely to be treated for depression (AOR = 0.45; 95% CI = 0.30, 0.66). CONCLUSIONS Among elderly Medicare beneficiaries, significant racial/ethnic differences exist in the diagnosis and treatment of depression. Vigorous clinical and public health initiatives are needed to address this persisting disparity in care.
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Affiliation(s)
- Ayse Akincigil
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
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Demographic, clinical, and functional factors associated with antidepressant use in the home healthcare elderly. Am J Geriatr Psychiatry 2011; 19:1042-5. [PMID: 21989320 PMCID: PMC3683659 DOI: 10.1097/jgp.0b013e318235b743] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Determine rates and demographic, clinical, and functional correlates of antidepressants (ADs) in home healthcare patients. METHODS Year 2007 cross-sectional National Home Health and Hospice Care Survey (N = 3,226) of patients 65 years or older (mean 80.11, confidence interval [CI] = 79.65-80.57). RESULTS Overall 33.50% used ADs. Among the 6.76% with depression, 70.84% used ADs compared with 29.15% who used ADs without a documented depression diagnosis. In a regression, controlling for depression, blacks used less ADs than whites (odds ratio [OR] = 0.41, CI = 0.24-0.70). Younger age (OR = 0.96, CI = 0.94-0.98), activities of daily living impairments (OR = 1.15, CI = 1.05-1.26), benzodiazepines (OR = 2.63, CI = 1.88-3.69), antipsychotics (OR = 2.08, CI = 1.29-3.36), and nonpsychotropics (OR = 1.07, CI = 1.04-1.10) were related to AD use. CONCLUSION Among home healthcare patients, more than one-third took ADs including patients without depression. Blacks used fewer ADs than whites. Increased use was associated with younger age, disability, and nonpsychotropics.
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Weissman J, Meyers BS, Ghosh S, Bruce ML. Sociodemographic and clinical factors associated with antidepressant type in a national sample of the home health care elderly. Gen Hosp Psychiatry 2011; 33:587-93. [PMID: 21920609 PMCID: PMC3208729 DOI: 10.1016/j.genhosppsych.2011.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 07/18/2011] [Accepted: 07/26/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study examined in home health care (HHC) the demographic, functional and clinical factors by antidepressant (AD) type including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and "Other" ADs such as bupropion and mirtazapine. METHOD Cross-sectional sample (N=909) was analyzed from the 2007 National Home Health and Hospice Care Survey that included patients 65 years and older [mean=78.79 years, confidence interval (CI)=77.88-79.69 years] taking one AD. RESULTS Selective serotonin reuptake inhibitors were the most commonly used (63.89%) AD, followed by "Other" ADs (14.29%), TCAs (11.31%) and SNRIs. In a multinomial regression referencing SSRIs, blacks had increased odds of tricyclic use compared to whites [odds ratio (OR)=5.96, CI=1.85-19.19]. Hispanics had decreased odds of "Other" AD (OR=0.13, CI=0.02-0.73) and SNRI use (OR=0.06, CI=0.008-0.45) compared to non-Hispanics. The HHC elderly taking psychotropic medications besides ADs were less likely to use SNRIs (OR=0.31, CI=0.11-0.88) and tricyclics (OR=0.27, CI=0.08-0.87). Advancing age was marginally associated with tricyclic use (OR=1.04, CI=0.99-1.09). CONCLUSION Race/ethnicity and age differences by AD type - including blacks' increased TCA use, Hispanics' decreased SNRI and "Other" AD use, and older elderly's increased tricyclic use - suggest systematic differences in prescribing practice variations including differences by geography, patient preferences or access to care in the HHC elderly.
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Affiliation(s)
- Judith Weissman
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10601, USA.
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Hankerson SH, Fenton MC, Geier TJ, Keyes KM, Weissman MM, Hasin DS. Racial differences in symptoms, comorbidity, and treatment for major depressive disorder among black and white adults. J Natl Med Assoc 2011; 103:576-84. [PMID: 21999032 PMCID: PMC3866690 DOI: 10.1016/s0027-9684(15)30383-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Racial differences in the clinical nature of major depressive disorder (MDD) could contribute to treatment disparities, but national data with large samples are limited. Our objective was to examine black-white differences in clinical characteristics and treatment for MDD from one of the largest, national community samples of US adults. METHODS Non-Hispanic black and white adults (n=32752) from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions produced data on 1866 respondents who met criteria for MDD based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) in the preceding 12 months. Outcome measures were depressive symptoms, comorbid psychiatric and medical disorders, disability, and treatment. RESULTS Blacks with MDD had significantly higher odds of initial insomnia, early-morning awakening, and restlessness than whites. Odds of hypertension (odds ratio [OR), 2.16; 95% confidence interval [CI], 1.48-3.14), obesity (OR, 1.98; 95% CI, 1.45-2.69), and liver disease (OR, 3.68; 95% CI, 1.20-11.30) were higher among blacks than whites. In unadjusted models, blacks had greater impairment than whites in social and physical functioning. However, adjusting for sociodemographic characteristics eliminated these differences. Blacks were less likely than whites to receive outpatient services (OR, 0.51; 95% CI, 0.36-0.72) and be prescribed medications for MDD, but were more likely to receive emergency room and inpatient treatment. CONCLUSIONS We found few racial differences in depressive symptoms, psychiatric comorbidity, and disability after adjusting for sociodemographic factors. Blacks' lower utilization of ambulatory treatment for MDD and greater medical comorbidity, emergency department use, and hospitalization suggests that management of MDD among blacks should be emphasized in primary care or other settings where treatment is more accessible.
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Affiliation(s)
- Sidney H Hankerson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Lewis TT, Guo H, Lunos S, Mendes de Leon CF, Skarupski KA, Evans DA, Everson-Rose SA. Depressive symptoms and cardiovascular mortality in older black and white adults: evidence for a differential association by race. Circ Cardiovasc Qual Outcomes 2011; 4:293-9. [PMID: 21505153 PMCID: PMC3097274 DOI: 10.1161/circoutcomes.110.957548] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An emerging body of research suggests that depressive symptoms may confer an "accelerated risk" for cardiovascular disease (CVD) in blacks compared with whites. Research in this area has been limited to cardiovascular risk factors and early markers; less is known about black-white differences in associations with important clinical end points. METHODS AND RESULTS The authors examined the association between depressive symptoms and overall CVD mortality, ischemic heart disease (IHD) mortality, and stroke mortality in a sample of 6158 (62% black; 61% female) community-dwelling older adults. Cox proportional hazards models were used to model time-to-CVD, IHD, and stroke death over a 9- to 12-year follow-up. In race-stratified models adjusted for age and sex, elevated depressive symptoms were associated with CVD mortality in blacks (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.61 to 2.36; P<0.001) but were not significantly associated with CVD mortality in whites (HR, 1.26; 95% CI, 0.95 to 1.68; P=0.11; race by depressive symptoms interaction, P=0.03). Similar findings were observed for IHD mortality (black: HR, 1.99; 95% CI, 1.49 to 2.64; P<0.001; white: HR, 1.28; 95% CI, 0.86 to 1.89; P=0.23) and stroke mortality (black: HR, 2.08; 95% CI, 1.32 to 3.27; P=0.002; white: HR, 1.32; 95% CI, 0.69 to 2.52; P=0.40). Findings for total CVD mortality and IHD mortality were attenuated but remained significant after adjusting for standard risk factors. Findings for stroke were reduced to marginal significance. CONCLUSIONS Elevated depressive symptoms were associated with multiple indicators of CVD mortality in older blacks but not in whites. Findings were not completely explained by standard risk factors. Efforts aimed at reducing depressive symptoms in blacks may ultimately prove beneficial for their cardiovascular health.
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Affiliation(s)
- Tené T Lewis
- Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College Street, New Haven, CT 06520, USA.
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González HM, Vega WA, Williams DR, Tarraf W, West BT, Neighbors HW. Depression care in the United States: too little for too few. ACTA ACUST UNITED AC 2010; 67:37-46. [PMID: 20048221 DOI: 10.1001/archgenpsychiatry.2009.168] [Citation(s) in RCA: 292] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the prevalence and adequacy of depression care among different ethnic and racial groups in the United States. DESIGN Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of depression care. SETTING The 48 coterminous United States. PARTICIPANTS Household residents 18 years and older (N = 15 762) participated in the study. MAIN OUTCOME MEASURES Past-year depression pharmacotherapy and psychotherapy using American Psychiatric Association guideline-concordant therapies. Depression severity was assessed with the Quick Inventory of Depressive Symptomatology Self-Report. Primary predictors were major ethnic/racial groups (Mexican American, Puerto Rican, Caribbean black, African American, and non-Latino white) and World Mental Health Composite International Diagnostic Interview criteria for 12-month major depressive episode. RESULTS Mexican American and African American individuals meeting 12-month major depression criteria consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies despite depression severity ratings not significantly differing between ethnic/racial groups. All groups reported higher use of any past-year psychotherapy and guideline-concordant psychotherapy compared with pharmacotherapy; however, Caribbean black and African American individuals reported the highest proportions of this use. CONCLUSIONS Few Americans with recent major depression have used depression therapies and guideline-concordant therapies; however, the lowest rates of use were found among Mexican American and African American individuals. Ethnic/racial differences were found despite comparable depression care need. More Americans with recent major depression used psychotherapy over pharmacotherapy, and these differences were most pronounced among Mexican American and African American individuals. This report underscores the importance of disaggregating ethnic/racial groups and depression therapies in understanding and directing efforts to improve depression care in the United States.
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Affiliation(s)
- Hector M González
- Institute of Gerontology and Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI 48202, USA.
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González HM, Tarraf W, West BT, Chan D, Miranda PY, Leong FT. Research article: Antidepressant use among Asians in the United States. Depress Anxiety 2010; 27:46-55. [PMID: 20013960 PMCID: PMC2805045 DOI: 10.1002/da.20636] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We examined the prevalence and predictors of past-year antidepressant use in a nationally representative sample of Asian Americans and non-Latino Whites. METHODS Analyses of 12-month antidepressant medication use were based on data from the Collaborative Psychiatric Epidemiology Surveys that surveyed Asian (Chinese, Filipino, Vietnamese, and others; N=2,284) and non-Latino White (N=6,696) household residents ages 18 years and older in the 48 contiguous United States and Hawaii. RESULTS Prevalence rates for 12-month antidepressant use for Asians with major depression ranged from 8.7% among Vietnamese to 17% among Chinese respondents. Compared to non-Latino Whites (32.4%), all Asians (10.9%) meeting criteria for 12-month depressive and anxiety disorders, but especially Filipinos (8.8%) were less likely to report past-year antidepressant use. CONCLUSIONS We found disparities in past-year antidepressant use among all the examined major Asian groups meeting criteria for 12-month depressive and anxiety disorders. These disparities were not explained by mental health need or socioeconomic factors that enable access to care.
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Affiliation(s)
- Hector M. González
- Wayne State University, Institute of Gerontology and School of Medicine, Department of Family Medicine
| | - Wassim Tarraf
- Wayne State University, Institute of Gerontology and School of Medicine, Department of Family Medicine
| | - Brady T. West
- University of Michigan, Center for Statistical Consultation and Research
| | - Domin Chan
- University of Washington, Department of Psychiatry and Behavioral Sciences
| | - Patricia Y. Miranda
- University of Texas M. D. Anderson Cancer Center, Center for Research on Minority Health, Department of Health Disparities Research
| | - Fredrick T. Leong
- Michigan State University, Center for Multicultural Psychology Research
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González HM, Tarraf W, West BT, Croghan TW, Bowen ME, Cao Z, Alegría M. Antidepressant use in a nationally representative sample of community-dwelling US Latinos with and without depressive and anxiety disorders. Depress Anxiety 2009; 26:674-81. [PMID: 19306305 PMCID: PMC2882071 DOI: 10.1002/da.20561] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antidepressant drugs are among the most widely prescribed drugs in the United States; however, little is known about their use among major ethnic minority groups. METHOD Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of Latino and non-Latino White adults antidepressant use. SETTING The 48 coterminous United States was the setting. PARTICIPANTS Household residents aged 18 years and older (N=9,250). MAIN OUTCOME Past year antidepressant use. RESULTS Compared to non-Latino Whites, few Latinos, primarily Mexican Americans, with 12-month depressive and/or anxiety disorders reported past year antidepressant use. Mexican Americans (OR=0.48; 95%CI=0.30-0.77) had significantly lower odds of use compared to non-Latino Whites, which were largely unaffected by factors associated with access to care. Over half of antidepressant use was by respondents not meeting 12-month criteria for depressive or anxiety disorders. Lifetime depressive and anxiety disorders explained another 21% of past year antidepressant use, leaving another 31% of drug use unexplained. DISCUSSION We found a disparity in antidepressant use for Mexican Americans compared to non-Latino Whites that was not accounted for by differences in need and factors associated with access to care. About one third of antidepressant use was by respondents not meeting criteria for depressive or anxiety disorders. Our findings underscore the importance of disaggregating Latino ethnic groups. Additional work is needed to understand the medical and economic value of antidepressant use beyond their primary clinical targets.
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Affiliation(s)
- Hector M. González
- Institute of Gerontology, Wayne State University, Detroit, Michigan,Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan,Program for Research on Black Americans, Institute of Social Research, Research Center for Group Dynamics, University of Michigan-Ann Arbor, Ann Arbor, Michigan,Correspondence to: Hector M. González, Institute of Gerontology, Wayne State University, 87 East Ferry Street, Room 234, Detroit, MI 48202.
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, Michigan
| | - Brady T. West
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Thomas W. Croghan
- Mathematica Policy Research, Washington, District of Columbia,Departments of Medicine and Psychiatry, School of Medicine, Georgetown University, Washington, District of Columbia
| | - Mary E. Bowen
- Institute of Gerontology, Wayne State University, Detroit, Michigan
| | - Zhun Cao
- Cambridge Health Alliance, Center for Multicultural Mental Health Research, Cambridge, Massachusetts
| | - Margarita Alegría
- Cambridge Health Alliance, Center for Multicultural Mental Health Research, Cambridge, Massachusetts
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