2011 National Meeting

1019 — Racial Differences in Treatment Response to a Depression Intervention

Davis TD (VA-North Little Rock) , Bryant-Bedell K (University of Arkansas Medical Sciences), Deen T (VA-North Little Rock), Tate V (University of Arkansas Medical Sciences), Fortney J (University of Arkansas Medical Sciences & VA North Little Rock)

Objectives:
Racial disparities in depression care may exist in VA healthcare settings. Specifically, minorities may respond worse to usual care (UC) compared to Caucasians. Efforts to improve the quality of depression care for minorities have largely involved collaborative care models. One randomized trial of collaborative care demonstrated a greater improvement in outcomes for minority populations than for Caucasians. However, researchers have not examined why minorities respond better to collaborative care.

Methods:
This randomized trial examined racial differences in treatment response (defined as a 50% reduction in symptom severity) to telemedicine-based collaborative care for 395 rural male veterans treated for depression in CBOCs. Hypotheses included: 1) minorities will have a worse treatment response to UC compared to Caucasians; 2) minorities will have a similar treatment response to telemedicine-based collaborative care compared to Caucasians; 3) minority status will moderate the intervention effect on treatment response; 4) prior depression treatment, current depression treatment, perceived barriers, and antidepressants acceptability will also moderate the intervention effect on treatment response; and 5) when these other moderators are included as covariates, minority status will not moderate the intervention effect.

Results:
Minorities comprised 25% of the study sample. Minorities randomized to UC had a lower response rate (7.7%) than Caucasians (18.24%) (X2 = 3.7 (1), p = .05). Minorities randomized to the intervention had a higher response rate (41.7%) than Caucasians (18.6%) (X2 = 7.6 (1), p = .005). The minority status by intervention interaction term was positive and significant (OR = 6.18, 95% CI = 1.56-24.50; p < .05) indicating that minority status was an intervention moderator. Minority status was highly correlated with the other hypothesized moderators. However, none of the other moderator interaction terms were significant, while minority status remained a significant moderator.

Implications:
Findings indicate that minorities receiving UC had worse outcomes, while minorities receiving telemedicine-based collaborative care had better outcomes. Unmeasured characteristics accounted for why minorities fared better than Caucasians in the intervention group.

Impacts:
Collaborative care can decrease racial disparities among rural veterans treated for depression. Further research is needed to understand the association between minority status and treatment response.