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Too Little for Too Few

Hector M. González, PhD; William A. Vega, PhD; David R. Williams, PhD; Wassim Tarraf, MA; Brady T. West, MA; Harold W. Neighbors, PhD

Arch Gen Psychiatry. 2010;67(1):37-46.

Objective  To determine the prevalence and adequacy of depression care among different ethnic and racial groups in the United States.

Design  Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of depression care.

Setting  The 48 coterminous United States.

Participants  Household residents 18 years and older (N = 15 762) participated in the study.

Main Outcome Measures  Past-year depression pharmacotherapy and psychotherapy using American Psychiatric Association guideline-concordant therapies. Depression severity was assessed with the Quick Inventory of Depressive Symptomatology Self-Report. Primary predictors were major ethnic/racial groups (Mexican American, Puerto Rican, Caribbean black, African American, and non-Latino white) and World Mental Health Composite International Diagnostic Interview criteria for 12-month major depressive episode.

Results  Mexican American and African American individuals meeting 12-month major depression criteria consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies despite depression severity ratings not significantly differing between ethnic/racial groups. All groups reported higher use of any past-year psychotherapy and guideline-concordant psychotherapy compared with pharmacotherapy; however, Caribbean black and African American individuals reported the highest proportions of this use.

Conclusions  Few Americans with recent major depression have used depression therapies and guideline-concordant therapies; however, the lowest rates of use were found among Mexican American and African American individuals. Ethnic/racial differences were found despite comparable depression care need. More Americans with recent major depression used psychotherapy over pharmacotherapy, and these differences were most pronounced among Mexican American and African American individuals. This report underscores the importance of disaggregating ethnic/racial groups and depression therapies in understanding and directing efforts to improve depression care in the United States.

Author Affiliations: Institute of Gerontology and Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit (Dr González and Mr Tarraf), and Institute of Social Research, Program for Research on Black Americans (Drs González and Neighbors), and Center for Statistical Consultation and Research (Mr West), University of Michigan, Ann Arbor; Department of Family Medicine, University of California, Los Angeles (Dr Vega); and Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts (Dr Williams).

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