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Racial and Ethnic Disparity in Major Depressive Disorder

Abstract

Major depressive disorder (MDD) is one of the most common and disabling psychiatric disorders in the USA. Early diagnosis and appropriate treatment are extremely important to prevent disability and improve quality of life. Recent studies have demonstrated racial and ethnic disparities in the diagnosis and treatment of MDD. African Americans (AA), Hispanics, and Asian Americans were significantly less likely to receive a depression diagnosis from a health-care provider than were non-Hispanic whites. The underdiagnosis of MDD in minority groups may be due to differences in socioeconomic status (SES), care affordability, cultural beliefs about depression, help-seeking patterns, access to culturally and linguistically appropriate care, patient-physician relationship, clinical presentation of depression, etc. Meanwhile, the likelihood of both having access to and receiving adequate care for depression was significantly low for AA, Hispanics, and Asian Americans, in contrast to whites. Similar disparities also exist in treatment outcomes. Besides the reasons for MDD underdiagnosis, additional contributing factors include access barriers to preferred mode of treatment, cultural concerns about antidepressants and different metabolism of antidepressants, etc. There are many ways to address these disparities and improve MDD care in minority populations, including universal depression screening, public financial incentives to ensure access to care in low-income and minority neighborhoods, quality improvement programs, cultural competency of mental health professionals, collaborative care management, community engagement and planning, and enhanced participation of minorities in clinical research.

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Abbreviations

AA:

African Americans

AOR:

Adjusted odds ratio

BDI:

Beck’s Depression Inventory

CDM:

Chronic disease management

CEP:

Community engagement and planning

CES-D:

Centers for Epidemiological Studies Depression Scale

CI:

Confidence interval

CIDI:

Composite International Diagnostic Interview

CSTs:

Culturally sensitive treatments

DPC:

Doctor-patient communication

ECT:

Electroconvulsive therapy

HRQL:

Health-related quality of life

HTR2A:

Serotonin 2A receptor

MDD:

Major depressive disorder

OR:

Odds ratio

PHQ:

Patient Health Questionnaire

QI:

Quality improvement

SES:

Socioeconomic status

SSRIs:

Selective serotonin reuptake inhibitors

UC:

Usual primary care

VA:

Veterans affairs

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Correspondence to Zhili Shao.

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Funding

This work was supported by Health Disparities Research Center at Meharry, NIH/NIMHD grant P20MD000515 and Department of Health and Human Services/Human Resources and Services Administration grant D55HP23199.

Conflict of Interest

Dr. Bailey was supported by grants from the Substance Abuse and Mental Health Services Administration, State of Tennessee Department of Mental Health and Substance Abuse Services, American Psychiatric Association, Tennessee Psychiatric Association, and National Medical Association. Dr. Bailey also received funding from several pharmaceutical companies: Jannssen, Sunovion, and McMerl. Drs. Bailey, Richie and Shao were previously supported by a writing collaborative project in Health Disparities Research Center at Meharry, which was partly funded by the grants from NIH/NIMHD and US Department of Health and Human Services.

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Shao, Z., Richie, W.D. & Bailey, R.K. Racial and Ethnic Disparity in Major Depressive Disorder. J. Racial and Ethnic Health Disparities 3, 692–705 (2016). https://doi.org/10.1007/s40615-015-0188-6

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  • DOI: https://doi.org/10.1007/s40615-015-0188-6

Keywords

  • Racial and ethnic disparity
  • Major depressive disorder
  • African Americans
  • Hispanics
  • Asian Americans
  • Non-Hispanic whites