Racial variation in antidepressant treatment in a Medicaid population

• Published in: The journal of clinical psychiatry Vol. 61; no. 1; pp. 16 - 21
• Main Authors: MELFI, C. A, CROGHAN, T. W, HANNA, M. P, ROBINSON, R. L
• Format: Journal Article
• Language: English
• Published: Memphis, TN Physicians Postgraduate Press 01-01-2000
• Subjects: Adult; African Americans - statistics & numerical data; Aid to Families with Dependent Children - statistics & numerical data; Antidepressive Agents - therapeutic use; Biological and medical sciences; Delivery of Health Care - statistics & numerical data; Depressive Disorder - drug therapy; Drug Prescriptions - statistics & numerical data; Drug Utilization; European Continental Ancestry Group - statistics & numerical data; Female; Health Policy; Humans; Male; Medicaid - statistics & numerical data; Medical sciences; Neuropharmacology; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Regression Analysis; Serotonin Uptake Inhibitors - therapeutic use; United States; United States; North America; America; Mood disorder; Social environment; Human; Accessibility; Serotonin; Decision making; Psychotropic; Mental health; Negroid; Depression; Tricyclic compound; Reuptake inhibitor; Chemotherapy; Treatment; Medical prescription; Race; Antidepressant agent; Black American; Caucasoid; Inaugural sign; Comparative study; Public health
• ISSN: 0160-6689; 1555-2101
• DOI: 10.4088/jcp.v61n0105

Many studies have found racial and socioeconomic variation in medical care for a variety of conditions. Undertreatment of depression for individuals of all races is a concern, but especially may affect vulnerable populations such as Medicaid recipients and minorities. With this study, we examine racial differences in the antidepressant usage in a Medicaid population.
Treatment of 13,065 depressed patients (ICD-9-CM criteria) was examined in a state Medicaid database covering the years 1989 through 1994. Treatment differences were assessed in terms of whether an antidepressant was received at the time of the initial depression diagnosis and the type of antidepressant prescribed (tricyclic antidepressants [TCAs] vs. selective serotonin reuptake inhibitors [SSRIs]), using logistic regression techniques.
African Americans were less likely than whites to receive an antidepressant at the time of their initial depression diagnosis (27.2% vs. 44.0%, p < .001). Of those receiving an antidepressant, whites were more likely than African Americans to receive SSRIs versus TCAs. These findings remained even after adjusting for other covariates.
Despite the easy availability of effective treatments, we found that only a small portion of depressed Medicaid recipients receive adequate usage of antidepressants. Within this Medicaid population, limited access to treatment was especially pronounced among African Americans. Racial differences existed in terms of whether an antidepressant was received and the type of medication used.