The Acceptability of Treatment for Depression Among African-American, Hispanic, and White Primary Care Patients : Medical Care

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The Acceptability of Treatment for Depression Among African-American, Hispanic, and White Primary Care Patients

Cooper, Lisa A. MD, MPH*†; Gonzales, Junius J. MD‡; Gallo, Joseph J. MD, MPH§; Rost, Kathryn M. PhD; Meredith, Lisa S. PhD∥; Rubenstein, Lisa V. MD, MSPH∥#; Wang, Nae-Yuh PhD*; Ford, Daniel E. MD, MPH*†

Author Information

From the *Department of Medicine, School of Medicine,

and the †Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.

‡From the National Institute of Mental Health, Rockville, Maryland.

§From the Department of Family Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

¶From the Department of Family Medicine, University of Colorado Health Sciences Center, Denver, Colorado.

∥From RAND Health Program, Santa Monica, California.

#From the Department of Medicine, VA Greater Los Angeles Healthcare System and the Department of Medicine, University of California at Los Angeles, Los Angeles, California.

Address correspondence and reprint requests to: Lisa A. Cooper, MD, MPH, Welch Center for Prevention, Epidemiology, and Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21205-2223. E-mail: [email protected]

Supported by the National Institute of Mental Health R10 Cooperative Agreement Quality Improvement for Depression (MH57992, MH5444, and MH5443), and the John D. and Catherine T. MacArthur Foundation. Dr. Cooper was a Fellow in the Robert Wood Johnson Foundation Minority Medical Faculty Development Program at the time this work was conducted.

Presented in part at the 12th International Conference on Mental Health Problems in the General Health Care Sector, July 13–14, 1998, Baltimore, Maryland.

Received February 19, 2002; initial review April 11, 2002; accepted September 27, 2002.

Medical Care 41(4):p 479-489, April 2003. | DOI: 10.1097/01.MLR.0000053228.58042.E4

Abstract

Background.  

Ethnic minority patients are less likely than white patients to receive guideline-concordant care for depression. It is uncertain whether racial and ethnic differences exist in patient beliefs, attitudes, and preferences for treatment.

Methods.  

A telephone survey was conducted of 829 adult patients (659 non-Hispanic whites, 97 African Americans, 73 Hispanics) recruited from primary care offices across the United States who reported 1 week or more of depressed mood or loss of interest within the past month and who met criteria for Major Depressive Episode in the past year. Within this cohort, we examined differences among African Americans, Hispanics, and whites in acceptability of antidepressant medication and acceptability of individual counseling.

Results.  

African Americans (adjusted OR, 0.30; 95% CI 0.19–0.48) and Hispanics (adjusted OR, 0.44; 95% CI, 0.26–0.76) had lower odds than white persons of finding antidepressant medications acceptable. African Americans had somewhat lower odds (adjusted OR, 0.63; 95% CI, 0.35–1.12), and Hispanics had higher odds (adjusted OR, 3.26; 95% CI, 1.08–9.89) of finding counseling acceptable than white persons. Some negative beliefs regarding treatment were more prevalent among ethnic minorities; however adjustment for these beliefs did not explain differences in acceptability of treatment for depression.

Conclusions.  

African Americans are less likely than white persons to find antidepressant medication acceptable. Hispanics are less likely to find antidepressant medication acceptable, and more likely to find counseling acceptable than white persons. Racial and ethnic differences in beliefs about treatment modalities were found, but did not explain differences in the acceptability of depression treatment. Clinicians should consider patients’ cultural and social context when negotiating treatment decisions for depression. Future research should identify other attitudinal barriers to depression care among ethnic minority patients.

© 2003 Lippincott Williams & Wilkins, Inc.

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