Moderate Rates of Initial Depression Treatment Found; Especially in People of Color
Following depression screenings, moderate rates of treatment initiation among patients with elevated depressive symptoms and/or suicidal ideation (SI) were found, particularly for those in more-vulnerable groups, according to recent cohort study results published in JAMA Internal Medicine.
“To improve depression outcomes with screening, practices must ensure appropriate and equitable treatment of those diagnosed with depression,” authors noted. “Targeted interventions are needed for patients at risk of undertreatment, including patients with SI, African American or Black and Asian patients, and older adults.”
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Researchers used electronic health record data from September 2017 to September 2021, from a large US academic health system. Participants were adult primary care patients with elevated depressive symptoms (Patient Health Questionnaire-9 score ≥10) and/or SI. Patients with baseline depression, bipolar disorder, schizophrenia, schizoaffective disorder, or dementia were excluded. Researchers analyzed data from December 30, 2022, to February 17, 2024.
A total of 60,062 patients were screened, of which 3980 (7%) reported elevated depressive symptoms or SI. The study cohort was 68.1% women and had a mean age of 46.5 years. Of participants who had elevated depressive symptoms or SI, 12.4% were Black (493), .8% were American Indian or Alaska Native (30), 24.8% were Asian (988), 14.6% were Latino/Latina/Latinx (582), 1.5% were Pacific Islander (58), and 36.9% were White (1470), and 9.0% identified as other/unknown (359). Approximately 38% received antidepressants/referrals when screened (including 44% of 461 patients with SI). By 8 weeks, 70% received antidepressant/referral and/or follow-up (including 75% of patients with SI).
There was no statistically significant difference found in the primary outcome by gender, preferred language, or health insurance. However, Black and Asian patients had lower estimated probabilities of treatment being ordered when screened (34.0% [95% CI, 28.4%-39.6%] for Black patients and 35.4% [95% CI, 31.5%-39.4%] for Asian patients) than White patients (40.5% [95% CI 37.4%-43.5%]). Estimated treatment also decreased with increasing age (46.4% [95% CI, 41.2%-51.5%] for patients aged 18-30 years and 17.5% [95% CI, 12.1%-22.9%] for patients aged ≥75 years). Patients with SI had greater estimated treatment than those without SI (43.5% [95% CI, 39.9%-47.1%] vs 35.2% [95% CI, 33.0%-37.5%]), although treatment was overall low for this high-risk group.
Researchers noted that they have no way of measuring how many patients declined or didn’t initiate treatment, and they cannot account for loss to follow-up, as patients may have left the health system, changed insurance, or sought care elsewhere. Both factors may have limited study results.
“Health systems should track treatment rates and develop approaches to ensure equitable patient-centered treatment and follow-up for all patients, specifically for groups at risk of undertreatment,” authors concluded, “including African American or Black and Asian patients, older adults, and those screened via the patient portal.”