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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
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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“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]
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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.”
BackgroundWhitley, D. M., & Fuller‐Thomson, E. (2016) · Journal of Community Health · doi:10.1007/s10900-016-0257-8 · Cited by 29
Jones, A. L., Cochran, S. D., Leibowitz, A. A., Wells, K., Kominski, G. F., & Mays, V. M. (2018) · Healthcare · doi:10.3390/healthcare6020029 · Cited by 28
Jonassaint, C. R., Gibbs, P., Belnap, B. H., Karp, J. F., Abebe, K. Z., & Rollman, B. L. (2017) · BJPsych Open · doi:10.1192/bjpo.bp.116.003657 · Cited by 30
Coombes, B. J., Landi, I., Choi, K. W., Singh, K., Fennessy, B., Jenkins, G. D., Batzler, A. J., Pendegraft, R. S., Núñez, N. A., Gao, Y. N., et al. (2023) · Psychological Medicine · doi:10.1017/s0033291723000983 · Cited by 31
Adams, A., Vail, L., Buckingham, C. D., Kidd, J. M., Weich, S., & ROTER, D. L. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.07.004 · Cited by 31
Njeru, J. W., DeJesus, R. S., Sauver, J. L. S., Rutten, L. J. F., Jacobson, D. J., Wilson, P. M., & Wieland, M. L. (2016) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0044-z · Cited by 26
“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].”
BackgroundCarden, K. D., McDuffie, D. L., Murry, K., Bui, C., & Allen, R. S. (2021) · Aging & Mental Health · doi:10.1080/13607863.2021.1904380 · Cited by 26
The Costs and Benefits of Reducing Racial-Ethnic Disparities in Mental Health Care
Cook, B. L., Liu, Z., Lessios, A. S., Loder, S., & McGuire, T. G. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201400070 · Cited by 25
Chamberlain, P., Goldney, R. D., Taylor, A. W., & Eckert, K. A. (2012) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2012.00109.x · Cited by 26
Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services
Straiton, M. L., Powell, K., Reneflot, A., & Diaz, E. (2016) · Health Care for Women International · doi:10.1080/07399332.2015.1077844 · Cited by 26
Racial Differences in the Effectiveness of Internet-Delivered Mental Health Care
Jonassaint, C. R., Belnap, B. H., Huang, Y., Karp, J. F., Abebe, K. Z., & Rollman, B. L. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05542-1 · Cited by 24
Fassaert, T. J. L., Nielen, M. M. J., Verheij, R. A., Verhoeff, A. P., Dekker, J., Beekman, A. T. F., & de Wit, M. A. S. (2010) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2010.04.010 · Cited by 25
“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].”
BackgroundRamirez, M., Wu, S., Jin, H., Ell, K., Gross-Schulman, S. G., Sklaroff, L. M., & Guterman, J. J. (2016) · JMIR Mental Health · doi:10.2196/mental.4823 · Cited by 25
“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
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
Predisposing, Enabling and Need Correlates of Mental Health Treatment Utilization Among Homeless Men
Rhoades, H., Wenzel, S. L., Golinelli, D., Tucker, J. S., Kennedy, D. P., & Ewing, B. A. (2014) · Community Mental Health Journal · doi:10.1007/s10597-014-9718-7 · Cited by 22
“…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
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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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A Review of the Evidence for Disparities in Child vs Adult Health Care: A Disparity in Disparities
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Parhami, I., FONG, T. W., Siani, A., Carlotti, C., & Khanlou, H. (2012) · AIDS and Behavior · doi:10.1007/s10461-012-0386-8 · Cited by 19
“Some speculation has arisen that lower detection rates of psychiatric disorders in minority populations may be due to disparities in healthcare [35].”
BackgroundSchrier, A. C., de Wit, M. A. S., Coupé, V. M. H., Fassaert, T. J. L., Verhoeff, A. P., Kupka, R., Dekker, J., & Beekman, A. T. F. (2011) · International Journal of Social Psychiatry · doi:10.1177/0020764010390433 · Cited by 19
“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
Mufson, L. H., Morrison, C. A., Shea, E. A., Kluisza, L., Robbins, R. N., Chen, Y., & Mellins, C. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.037 · Cited by 18
Li, C., & West-Strum, D. S. (2010) · Health Services Research · doi:10.1111/j.1475-6773.2010.01113.x · Cited by 18
“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
“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
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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