Racial disparity seen in care of depressed seniors

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About one in five elderly Medicaid recipients diagnosed with depression get neither psychotherapy nor a prescription for antidepressants, a new study shows. African-Americans are disproportionately affected, the researchers found, with more than one in three going untreated.

“We thought that there would be a difference—we didn’t think there would be that big a difference,” Dr. Harry Strothers, III, of Morehouse School of Medicine in East Point, Georgia, told AMN Health.

Strothers and his team looked at 1998 Medicaid claims data for five US states, which included 7339 patients 65 to 84 years old who had been diagnosed with depression.

Past research suggests depression is undiagnosed and untreated more often in older adults and there is evidence that the problem is worse in elderly African Americans, the researchers note in the Journal of the American Geriatrics Society.

Overall, 22 percent of the subjects did not receive an antidepressant or psychotherapy, the researchers found. By race, 37 percent of African-Americans received no treatment, compared to 24 percent of Hispanics, 22 percent of whites and 14 percent of Asians.

After adjusting for other factors, the researchers found that African-Americans were twice as likely as whites to not be prescribed an antidepressant.

Strothers said he and his colleagues were surprised by the disparities their study identified. “Medicaid should have leveled both playing fields, and there was still a big gap,” he said.

While the study was not designed to determine why such gaps might exist, Strothers suspects “it has something to do with the patient-physician interaction and stereotypes or assumptions on one side or the other.”

He noted that the disparity also was seen among patients in nursing homes, for whom patient preferences in determining treatment would be less of a factor. He and his colleagues are currently looking into this issue in more detail.

SOURCE: Journal of the American Geriatrics Society, March 2005.

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