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Articles   |    
Differences in Diffusion of FDA Antidepressant Risk Warnings Across Racial-Ethnic Groups
Andrea Elizabeth DePetris, B.A.; Benjamin L. Cook, Ph.D., M.P.H.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200087
View Author and Article Information

Ms. DePetris and Dr. Cook are affiliated with the Cambridge Health Alliance Center for Multicultural Mental Health Research, 120 Beacon St., Somerville, MA 02143 (e-mail: adepetris@wesleyan.edu).
Dr. Cook is also with the Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Numerous articles have identified that medical technologies diffuse more rapidly among non-Latino whites compared with other racial-ethnic groups. However, whether health risk warnings also diffuse differentially across racial-ethnic minority groups is uncertain. This study assessed racial-ethnic variation in children’s antidepressant use before and after the 2004 black-box warning concerning risks of antidepressants for youths.

Methods  Data consisted of responses for white, black, and Latino youths ages five through 17 from the 2002–2008 Medical Expenditure Panel Survey (N=44,422). The dependent variable was any antidepressant use in the prior year. Independent variables were race-ethnicity, year, psychological impairment, income, insurance status, region, and parents’ education level. Logistic regression models were used to assess antidepressant use conditional on race-ethnicity, time, interaction between race-ethnicity and time, need, socioeconomic status, and Institute of Medicine–concordant estimates of disparities in predicted antidepressant use before and after the warning.

Results  The warnings affected antidepressant use differentially for whites, blacks, and Latinos. Usage rates among whites decreased from 3.3 to 2.1 percentage points between prewarning and postwarning, whereas usage rates remained steady among Latinos and increased among blacks. Findings were significant in multiple regression analyses, in which predictions were adjusted for need.

Conclusions  The findings indicate that health safety information on antidepressant usage among children diffused faster among whites than nonwhites, suggesting the need to improve infrastructure for delivering important health messages to racial-ethnic minority populations.

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Table 1Medical Expenditure Panel Survey data on antidepressant usage among youths, 2002–2008, in mean percentagesa
Table Footer Note

a Source: Combined yearly cross-sectional data from the 2002–2008 Medical Expenditure Panel Survey. Calculations for blacks, Latinos, and non-Latino white children ages 5–17 were weighted to be representative of the U.S. population. The test of overall differences between groups was significant at p<.001 for all comparisons except gender and time period.

Table Footer Note

b As measured with the Columbia Impairment Scale. A score ≥16 indicates psychological impairment.

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Table 2Regression analyses of predictors of antidepressant prescription use among white, black, and Latino youths, by race and timea
Table Footer Note

a Source: 2002–2008 Medical Expenditure Panel Survey (MEPS). Logit coefficients and standard errors take into account sampling weights and stratification used to make the MEPS sample representative of the U.S. population.

Table Footer Note

b CIS, Columbia Impairment Scale. A score ≥16 indicates psychological impairment.

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Table 3Trends in disparities in antidepressant use before and after the FDA black-box warning on antidepressant use by youthsa
Table Footer Note

a Source: 2002–2008 Medical Expenditure Panel Survey. FDA, U.S. Food and Drug Administration. Black-white and Latino-white disparities were calculated according to the Institute of Medicine definition of racial-ethnic disparities. Standard errors were calculated with the balanced repeated-replication methodology.

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