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Study Examines Ethnic Differences in Receipt of Depression Care


BACKGROUND:
Despite VA's efforts to standardize the delivery of high-quality care, including the adoption of nation-wide depression screening, studies have found disparate treatment rates between racial/ethnic minority and white Veterans with depression. This study sought to characterize differences in treatment for multiple racial/ethnic groups of Veterans with ongoing depression. Using VA data, investigators identified Veterans with chronic depression who had a VA outpatient visit for depression in FY09 and/or FY10. Three primary outcome measures were examined: 1) receipt of adequate antidepressant therapy (sufficient prescriptions to take medication for >80% of 6 months); 2) receipt of adequate psychotherapy (>6 psychotherapy visits in 6 months); and 3) receipt of guideline-concordant depression treatment (either adequate antidepressant therapy or adequate psychotherapy during the 6 months after the depression visit). Investigators also assessed patient socio-demographics; comorbidities and health behavior (e.g., presence of PTSD and/or substance use disorder, and current drinking); healthcare access and utilization; as well as race and ethnicity. Of the 62,095 Veterans in this study, 72% were white, 16% black, 4% Hispanic, 2% Asian, 2% AI/AN (American Indian/Alaska Native), and 4% were categorized as unknown race.

FINDINGS:

  • There were significant differences in the receipt of depression care between multiple racial/ethnic groups of chronically depressed Veterans. Compared to white Veterans, nearly all minority groups had lower odds of adequate antidepressant use; adequate psychotherapy was more common among minority Veterans in initial analyses but differences between Hispanic, AI/AN, and white Veterans were no longer significant in adjusted analyses. Primarily due to lower use of antidepressants, nearly all minority groups had lower rates of guideline-concordant care than white Veterans with depression.
  • Overall, 51% of Veterans received adequate antidepressant care for the 6-month period following their most recent VA healthcare visit for depression; 10% of Veterans attended at least 6 psychotherapy visits within the same time period; and 55% recevied guideline-concordant care.

LIMITATIONS:

  • Veterans may have received psychotherapy or antidepressants from non-VA providers.
  • Investigators were unable to ascertain depression severity or treatment details; e.g., providers may have prescribed antidepressants and/or psychotherapy, but patients may have refused them.

IMPLICATIONS:

  • This study suggests that racial/ethnic differences in depression care may persist in VA. Further research is needed to determine whether the observed differences in treatment arise from patient-centered preferences for care (for example, lower willingness to take anti-depressant medication among minority patients) or from providers' failure to adhere to best-care practices.

AUTHOR/FUNDING INFORMATION:
This study was funded by VA/HSR&D's Quality Enhancement Research Initiative (RRP 10-105). Dr. Trivedi also was funded by an HSR&D Career Development Award. Dr. Quiñones is part of HSR&D's Center to Improve Veteran Involvement in Care, Portland, OR; Dr. Trivedi is part of HSR&D's Center for Innovation to Implementation, Palo Alto; and Drs. Williams and Fan are part of HSR&D's Center for Innovation for Veteran-Centered and Value-Driven Care, Seattle.


PubMed Logo Quiñones A, Thielke S, Beaver K, Trivedi R, Williams E, and Fan V. Racial and Ethnic Differences in the Receipt of Antidepressants and Psychotherapy among Veterans with Depression. Psychiatric Services November 1, 2013;e-pub ahead of print.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.