Diagnosis of depression unaffected by sex, race

Doctors are just as likely to diagnose depression in an older adult regardless of whether the person is white or black, male or female, the results of a study indicate.

"We were somewhat surprised, " said Dr. Helen C. Kales from the Veterans Affairs Ann Arbor Healthcare System, Michigan, because much recent attention "focuses on physicians' bias as a potentially large contributor to health disparities."

Kales and her associates explain in the Journal of the American Geriatrics Society that lower rates of diagnosed depression have been reported in African Americans, and this might be due to physicians' attitudes.

The team used standardized video vignettes, in which the patient-actor's race or sex was varied, to see how that did or did not affect primary care physicians' diagnosis of late-life depression.

Of the 178 physicians who participated in the study, 151 (85 percent) correctly diagnosed major depression in the elderly patient(s), the investigators report.

The diagnosis rate was similar for African American men and women and white men and women portraying a depressed patient. In fact, the physicians were most confident in their diagnosis of African American women.

The doctors did not differ in their treatment recommendations, follow-up choices, or potential psychiatric referral for the different races and sexes, the report indicates. Moreover, the physicians did not judge different patient groups as more or less likely to adhere to or benefit from treatment, the researchers note.

"Our findings suggest that physician bias based simply on apparent race is not a likely explanation" for lower rates of diagnosed depression in African Americans, Kales said.

There may be "a multitude of other explanations," she continued - including a number on the patient side: "lower use of formal health care settings for depression, different presentations of symptoms, and patient treatment preferences."

The team is planning a study to look into "adherence to depression medication by race," Kales added. "We plan to examine factors such as spirituality and religiosity that may underlie racial differences in the willingness to take medications for depression."

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