Racial and ethnic disparities in detection and treatment of depression and anxiety among psychiatric and primary health care visits, 1995-2005
Open accessAbstract
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.
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People who identify as racial/ethnic minorities are less likely to have access to and to use mental health services.
“Given that people who identify as racial/ethnic minorities are less likely to have access to and to use mental health services (49), this is a sobering finding.”
From Improving Acceptability and Uptake Behavior for Internet-Based Cognitive-Behavioral Therapy (2021) · cites this paper as [49]
The Results report that African American and Hispanic patients were underrepresented in psychiatric visits, and the Conclusions report persistent disparities in depression and anxiety care in primary care. These findings support lower use of the services studied, but the paper does not directly measure access to mental health services generally. It also says race and ethnicity were recorded by physicians or office staff, not self-identified. (LLM, conf=0.86)
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BackgroundPrevalence and Predictors of Probable Depression in Prostate Cancer Survivors
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“Other studies have showed that disparities in depression are found for female, racial/ethnic minorities, and those with low socioeconomic status [4].”
BackgroundRacial-Ethnic Disparities in Outpatient Mental Health Visits to U.S. Physicians, 1993–2008
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“The care that persons from minority groups receive has been shown to be of lower quality for depression (9,12,17), substance use disorders (18–20), and schizophrenia (21), to be less likely to include psychotherapy (4,6,12,22), and to consist of shorter office visits (23).”
BackgroundMinority Primary Care Patients With Depression
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Coping mediates the association between gender and depressive symptomatology in adolescence
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“There is evidence indicating inequities in the diagnosis of anxiety and mood disorders with underdiagnosis in some racial or ethnic minority groups.(15,37) These inequities in diagnosis can lead to observed disparities in our data.”
BackgroundDiagnosis of Depression and Use of Antidepressant Pharmacotherapy Among Adults in the United States
Sclar, D. A., Robison, L. M., Schmidt, J. M., Bowen, K. A., Castillo, L. V., & Oganov, A. M. (2012) · Clinical Drug Investigation · doi:10.2165/11598950-000000000-00000 · Cited by 40 · see citing works
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Carpenter-Song, E. A., Whitley, R., Lawson, W. B., Quimby, E., & Drake, R. E. (2009) · Community Mental Health Journal · doi:10.1007/s10597-009-9233-4 · Cited by 39 · see citing works
“at the primary care level ( Stockdale et al. 2008 ).”
BackgroundDo racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care?
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“Race and ethnicity were recorded by the provider or the provider’s staff (13).”
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“It is well established that racial/ethnic disparities in mental health care in the US exist and are, in fact, increasing over time (Ault-Brutus 2012; Blanco et al. 2007; Cook, Thomas, and Jeanne 2007; Stockdale et al. 2007; US Department of Health and Human Services 2001).”
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“2007) and other mental health care (Cook, McGuire, and Miranda 2007; Stockdale et al. 2008).”
BackgroundLagomasino, I. T., Stockdale, S. E., & Miranda, J. M. (2011) · Psychiatric Services · doi:10.1176/appi.ps.62.9.1019 · Cited by 33 · see citing works
Safeguarding children's rights in psychopharmacological research: ethical and legal issues.
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“[77, 93, 94].”
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“For mental health care overall, studies have found either no change (Stockdale et al. 2008) or worsening health care disparities over time (Zuvekas 2005; Cook, McGuire, and Miranda 2007).”
BackgroundImproving Acceptability and Uptake Behavior for Internet-Based Cognitive-Behavioral Therapy
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“” Given that people who identify as racial/ethnic minorities are less likely to have access to and to use mental health services (49), this is a sobering finding.”
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“Yet, they are less likely to receive appropriate mental health services and treatment, and when received, these services often do not meet the minimum accepted standards of care in the US [7–9].”
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The Costs and Benefits of Reducing Racial-Ethnic Disparities in Mental Health Care
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Racial Differences in the Effectiveness of Internet-Delivered Mental Health Care
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“Yet, some studies have raised questions about whether formerly documented ethnic disparities in care for common mental disorders in primary and specialty care settings still remain [26].”
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“These groups are less likely to receive depression care [15-19], show greater treatment discontinuation [20], and experience higher rates of clinically significant depression.”
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Development of a composite trauma exposure risk index.
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“This result mirrors previous study findings showing continued disparities for black patients in prescribed antidepressant medication compared to NHWs (Melfi et al. 2000; Skaer et al. 2000; Stockdale et al. 2008).”
ResultArora, P. G., Godoy, L., & Hodgkinson, S. C. (2017) · Professional Psychology Research and Practice · doi:10.1037/pro0000131 · Cited by 23 · see citing works
Bedoya, C. A., Traeger, L. N., Trinh, N., Chang, T. E., Brill, C. D., Hails, K. A., Hagan, P. N., Flaherty, K., & Yeung, A. (2014) · Psychiatric Services · doi:10.1176/appi.ps.201300088 · Cited by 22 · see citing works
Predisposing, Enabling and Need Correlates of Mental Health Treatment Utilization Among Homeless Men
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“…the more typical legacy of race-based disparity that continues to affect health care access and quality in the United States (Simpson et al. 2007; Stockdale et al. 2008), further research is critical to understand how improved access to care can be had for all African Americans while also…”
BackgroundSadock, E., Perrin, P. B., Grinnell, R. M., Rybarczyk, B. D., & Auerbach, S. M. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22459 · Cited by 22 · see citing works
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“10,68,69 To achieve equity in mental health treatment for currently underserved populations, accessible and acceptable evidence-based depression treatment options must be made widely available in community-based settings.”
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“Some speculation has arisen that lower detection rates of psychiatric disorders in minority populations may be due to disparities in healthcare [35].”
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“In the USA, decline in ethnic disparities in detection and treatment of these common mental disorders has also been noticed (Stockdale et al., 2008).”
Screening for depression with the PHQ-9 in young adults affected by HIV
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“Medically underserved populations are those with diminished access to health services (Chang et al. 2004) and lower quality of care when they do have access (Reschovsky and O’Malley 2008; Stockdale et al. 2008).”
BackgroundCook, B. L., McGuire, T. G., Alegria, M. M., & Normand, S. T. (2011) · Health Services Research · doi:10.1111/j.1475-6773.2011.01253.x · Cited by 17 · see citing works
“For example, in regression equations that assess the significance of the race coefficients, Stockdale et al. (2008) adjust for the Charlson–Deyo comorbidity index, McGuire et al. (2006) adjust for a list of 17 chronic conditions, the PCS SF-12, and activity limitation, and Alegria et al. (2008)…”
BackgroundMethodInfluential
- Authors
- Stockdale, S. E., Lagomasino, I. T., Siddique, J., McGuire, T., & Miranda, J.
- Affiliations
- University of California, Los Angeles (US)
- University of Southern California (US)
- University of Chicago (US)
- Harvard University (US)
- Corresponding author
- Stockdale, Susan E.
- Miranda, Jeanne
- Venue
- Medical Care
- Published
- 2008-07
- Volume
- 46
- Issue
- 7
- Pages
- 668-677
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC3956700
- OpenAlex
- W2041096161
- Cited by
- 197
- References
- 37
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 3 · 2023: 12 · 2022: 11 · 2021: 17 · 2020: 9 · 2019: 14 · 2018: 9 · 2017: 11 · 2016: 12 · 2015: 11 · 2014: 13 · 2013: 12 · 2012: 14
- FWCI
- 18.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5p30mh068639-05, 5p20md000148-05)
- National Institute on Aging (3P0 3AG021684, P30AG021684)
- National Institute of Mental Health (MH068639-01, P30-MH068639)
- National Institute on Minority Health and Health Disparities (1 P20 MD00148-01, P20-MD000148)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Keywords
- racial and ethnic disparities, depression, anxiety, access to mental health care, primary care, psychiatric nursing, African Americans, Hispanic Americans, antidepressant prescribing, counseling referral, temporal trends, language and cultural barriers
- MeSH terms
- Anxiety, Black or African American, Depression, Female, Hispanic or Latino, Humans, Male, Mental Health Services, Middle Aged, Office Visits, Primary Health Care, United States, Health Care Surveys, White People, Healthcare Disparities
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