Navigation Links
Diagnosis, treatment of depression among elderly depend on racial, cultural factors
Date:12/20/2011

NEW BRUNSWICK, N.J. Despite improvements to diagnostic tools and therapies in the two last decades, significant disparities in the diagnosis and treatment of depression remain, according to Rutgers research published online by the American Journal of Public Health; print, February 2012.

In the study "Racial and Ethnic Disparities in Depression Care in Community-Dwelling Elderly in the United States," lead author Ayse Akincigil, an assistant professor in Rutgers' School of Social Work, and colleagues found that African Americans were significantly less likely to receive a depression diagnosis from a health care provider than were non-Hispanic whites. In addition, those diagnosed were less likely to be treated for depression.

"Vigorous clinical and public health initiatives are needed to address this persisting disparity in care," she said.

Depression is a significant public health problem for older Americans about 6.6 percent of elderly Americans experience an episode of major depression each year. "If untreated or undertreated, depression can significantly diminish quality of life," Akincigil said. In addition, depression can complicate such medical conditions commonly found in older populations as congestive heart failure, diabetes and arthritis.

For their study, Rutgers researchers culled data from the U.S. Medicare Current Beneficiary Survey, 2001-2005 obtaining information on health care use and costs, health status, medical and prescription drug insurance coverage, access to care and use of services. Based on a national survey of 33,708 Medicare beneficiaries, depression diagnosis rates were 6.4 percent for non-Hispanic whites, 4.2 percent for African Americans, 7.2 percent for Hispanics and 3.8 percent for others. The heterogeneity of Hispanics makes it difficult to determine why they are undertreated and their treatment preferences, Akincigil said.

"Are there cultural differences or systemic differences regarding health care quality and access for treatment of depression?" Akincigil asked. "If African Americans prefer psychotherapy over drugs, then accessing therapists for treatment in poorer neighborhoods is a lot more difficult than it is for whites, who generally have higher incomes and live in neighborhoods more likely for therapists and doctors to be located.

"Whites use more antidepressants than African Americans. We presume they have better access to doctors and pharmacies, and more money to spend on drugs."

The investigation focused on whether there are racial/ethnic differences in the rate of diagnosis of depression among the elderly, controlling for sociodemographic characteristics and depression symptoms (depressed mood, anhedonia) reported on a two-item screener, and also in treatment provided to those diagnosed with depression by a health care provider. Akincigil said there is evidence that help-seeking patterns differ by race/ethnicity, contributing to the gap in depression diagnosis rates. Stigma, patient attitudes and knowledge also may vary by race and ethnicity.

"African Americans might turn to their pastors or lay counselors in the absence of psychotherapists," she said. "Low-income African Americans who were engaged in psychotherapy reported that stigma, dysfunctional coping behavior, shame and denial could be reasons some African Americans do not seek professional help."

The nature of the patient-physician relationship also might contribute to disparities in depression diagnosis rates. "African Americans reported greater distrust of physicians and poorer patient-physician communication than do white patients," Akincigil explained. "Communication difficulties may contribute to lower rates of clinical detection of depression because the diagnosis of depression depends to a considerable degree on communication of subjective distress."

The researchers also noted that racial and ethnic differences in the clinical presentation of depression may further explain the lower rates of depression detection among African-American patients.

Financial factors may also play a role in the detection rates, according to Akincigil. Among Medicare beneficiaries, African Americans are substantially less likely than non-Hispanic whites to have private supplemental insurance that covers charges larger than standard Medicare-approved amounts. "Differences in provider reimbursement may favor increased clinical detection of depression in white patient groups if higher payment rates result in longer visits," she said.

Akincigil and co-authors Karen A. Zurlo and Stephen Crystal, both from Rutgers' School of Social Work; Mark Olfson, Department of Psychiatry at Columbia University; and Michele Siegel and James T. Walkup from Rutgers' Center for Health Services Research on Pharmacotherapy, Chronic Disease Management and Outcomes, conclude that "efforts are needed to reduce the burden of undetected and untreated depression and to identify the barriers that generate disparities in detection and treatment."

"Promising approaches include providing universal depression screening and ensuring access to care in low-income and minority neighborhoods," they write. "An increase in the reimbursement of case management services for the treatment of depression also may be effective."


'/>"/>
Contact: Steve Manas
smanas@ur.rutgers.edu
732-932-7084 x612
Rutgers University
Source:Eurekalert

Related medicine news :

1. Why do physicians order costly CTs? Ultrasound yields better diagnosis, safer, less costly
2. Black Women Wait Longer for Breast Cancer Diagnosis, Treatment
3. Notable racial disparities in diagnosis, treatment and outcomes of colorectal cancer
4. After Diabetes Diagnosis, Concentrate on Dietary Changes, Study Says
5. New study may lead to quicker diagnosis, improved treatment for fatal lung disease
6. Despite Treatment, Employees with Depression Generate Higher Absentee Costs, According to Thomson Reuters Study
7. Women More Likely to Fail Treatment for Atrial Fibrillation
8. Social Anxiety and Panic - Alternative Treatment to Drugs and Therapy
9. Neuroimaging study may pave way for effective Alzheimers treatments
10. Nanofilm Introduces Clarity Defog It™ Anti Fog Treatment and EcoClens™ Eco-Friendly Lens Cleaner at Vision Expo East
11. Many veterans not getting enough treatment for PTSD
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... (PRWEB) , ... October 13, 2017 , ... Apple ... care services, staged a mock evacuation of the facility as part of a disaster ... Fire Department, Echo Hose EMS and Shelton City Emergency Manager, as well as the ...
(Date:10/13/2017)... , ... October 13, 2017 , ... Global Healthcare Management’s ... Alexandria Park in Milford, NJ. This free event, sponsored by Global Healthcare Management’s ... The fun run is geared towards children of all ages; it is a ...
(Date:10/13/2017)... ... October 13, 2017 , ... “The Journey: From the ... danger possible to save lost souls in the Philippines. “The Journey: From the Mountains ... a dedicated teacher of the Bible. She has taught all ages and currently teaches ...
(Date:10/12/2017)... ... October 12, 2017 , ... Planet Fitness, one of the largest and ... plans to open a flagship location in Covington, LA at 401 N. U.S. Highway ... store next to Office Depot in the Holiday Square shopping center. Its location allows ...
(Date:10/12/2017)... ... 2017 , ... Asante, a nationally recognized health system in ... existing home health joint venture through an agreement, effective October 1, 2017, to ... home health company with Asante, delivering clinically integrated care, for the past eight ...
Breaking Medicine News(10 mins):
(Date:10/10/2017)... -- NDS received FDA 510(k) clearance in May 2017 for its highly ... designed for endoscopy environments. An innovative secondary monitor solution, ZeroWire ... support the improvement of patient outcomes, procedural efficiency, and the lowering ... ... ...
(Date:10/4/2017)... 4, 2017  South Korean-based healthcare product Development Company ... "cprCUBE" on Kickstarter. The device will educate the user ... with better efficiency compared to the dated and pricey ... on efficacy of the compression for a more informed ... goal to raise $5,000. ...
(Date:10/2/2017)... 2017  Eli Lilly and Company (NYSE: ... third quarter of 2017 on Tuesday, October 24, 2017. ... day with the investment community and media to further ... call will begin at 9 a.m. Eastern time. Investors, ... webcast of the conference call through a link that ...
Breaking Medicine Technology: