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Jeanne Miranda, PhD; Michael Schoenbaum, PhD; Cathy Sherbourne, PhD; Naihua Duan, PhD; Kenneth Wells, MD, MPH

Arch Gen Psychiatry. 2004;61:827-834.

Background  The response of ethnic minorities to mental health care is largely unstudied.

Objective  To determine the effect of appropriate care for depression on ethnic minorities.

Design  Observational analysis of the effects of evidence-based depression care over 6 months on clinical outcomes and employment status is examined for ethnic minorities and nonminorities. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument.

Setting  Six managed care organizations across the United States.

Patients  One thousand three hundred fifty-six depressed adults, including 601 white, 258 Latino, 56 African American, and 24 Asian or Native American patients.

Intervention  Quality improvement interventions aimed at increasing guideline-concordant depression care.

Results  At 6 months, minority patients who received appropriate care, compared with those who did not receive it, had lower rates of probable depressive disorder (20.5% vs 70.5%); the findings were similar for nonminority patients (24.3% vs 71.2%). Nonminority patients who received appropriate care were found to have higher rates of employment than were those who did not receive appropriate care (71.4% vs 52.4%). This was not true of minority patients (68.2% vs 56.5%).

Conclusions  Evidence-based care for depression is equally effective in reducing depressive disorders for minority and nonminority patients. However, functional outcomes of care, such as continued employment, may be more limited for minority than nonminority patients. Because minority members are less likely to get appropriate care, efforts should be made to engage minority members in effective care for depression.

From the University of California, Los Angeles– Neuropsychiatric Institute (Drs Miranda, Duan, and Wells); RAND, Arlington, Va (Dr Schoenbaum); and RAND, Santa Monica, Calif (Drs Sherbourne and Wells).

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