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Racial and Ethnic Disparities in Detection and Treatment of Depression and Anxiety Among Psychiatric and Primary Health Care Visits, 1995–2005

Stockdale, Susan E. PhD*; Lagomasino, Isabel T. MD, MSHS; Siddique, Juned DrPH; McGuire, Thomas PhD§; Miranda, Jeanne PhD*

doi: 10.1097/MLR.0b013e3181789496
Original Article

Context: Recent evidence questions whether formerly documented disparities in care for common mental disorders among African Americans and Hispanics still remain. Also, whether disparities exist mainly in psychiatric settings or primary health care settings is unknown.

Objective: To comprehensively examine time trends in outpatient diagnosis and treatment of depression and anxiety among ethnic groups in primary care and psychiatric settings.

Design and Setting: Analyses of office-based outpatient visits from the National Ambulatory Medical Care Study from 1995–2005 (n = 96,075).

Participants: Visits to office-based primary care physicians and psychiatrists in the United States.

Main Outcome Measures: Diagnosed with depression or anxiety, received counseling or a referral for counseling, received an antidepressant prescription, and any counseling or antidepressant care.

Results: In these analyses of 10-year trends in treatment of common mental disorders, disparities in counseling/referrals for counseling, antidepressant medications, and any care vastly improved or were eliminated over time in psychiatric visits. Continued disparities in diagnoses, counseling/referrals for counseling, antidepressant medication, and any care are found in primary care visits.

Conclusions: Disparities in care for depression and anxiety among African Americans and Hispanics remain in primary care. Quality improvement efforts are needed to address cultural and linguistic barriers to care.

From the *UCLA Semel Institute Health Services Research Center; †USC Keck School of Medicine, Department of Psychiatry, Los Angeles, California; ‡Department of Health Studies, The University of Chicago, Chicago, Illinois; and §Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.

Supported by the John D. and Catherine T. MacArthur Foundation and by the Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME), National Institute on Aging Grant 3P03AG021684; UCLA/Drew Project EXPORT was funded by the National Center for Minority Health and Health Disparities Grant 1P20MD00148-01; and the UCLA-RAND Center for Research on Quality in Managed Care, National Institute of Mental Health Grant MH068639-01.

The lead author (Susan Stockdale) had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Reprints: Susan E. Stockdale, PhD, UCLA Semel Institute Health Services Research Center, 10920 Wilshire Boulevard, Ste 300, Los Angeles, CA 90024. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.