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Articles   |    
Racial-Ethnic Disparities in Use of Antidepressants in Private Coverage: Implications for the Affordable Care Act
Kyoungrae Jung, Ph.D., M.P.H.; Dooyoung Lim, M.H.A.; Yunfeng Shi, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300182
View Author and Article Information

The authors are with the Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania (e-mail: kuj11@psu.edu).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  The objective of this study was to examine racial-ethnic disparities in the use of antidepressants among people with private coverage and people with public insurance or no coverage.

Methods  Data were from Medical Expenditure Panel Surveys (2006–2010), and logistic regression was used for the analysis.

Results  Among persons with depression and private coverage, racial-ethnic minority groups were significantly less likely than non-Hispanic whites to use antidepressants (N=4,468; adjusted odds ratio [AOR]=.50, 95% confidence interval [CI]=.33–.66 for non-Hispanic blacks; AOR=.70, CI=.55–.89 for Hispanics). No significant racial-ethnic disparity in the use of antidepressants was found in Medicare (N=1,944), Medicaid (N=2,125), and uninsured populations (N=1,679). For all racial-ethnic groups, persons with no insurance coverage had much lower rates of antidepressant use than their insured counterparts.

Conclusions  A wide racial-ethnic gap in the use of antidepressants existed in private coverage. As the nation continues to implement the Affordable Care Act, which will increase the number of enrollees from racial-ethnic minority groups in private plans, continuing efforts will be needed to reduce racial-ethnic disparities in the use of antidepressants.

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Figure 1 Proportion (unadjusted) on antidepressant treatment, by racial-ethnic group and insurance coverage

a Includes persons dually eligible for Medicare and Medicaid

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Table 1Sample characteristics, by insurance group, of Medical Expenditure Panel Surveys (MEPS), 2006–2010a
Table Footer Note

a Population weights from MEPS were applied; Ns are in person-years.

Table Footer Note

b Medicare includes persons dually eligible for Medicare and Medicaid.

Table Footer Note

c Linearized standard errors after population weights from MEPS were applied

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Table 2Antidepressant use by race-ethnicity and insurance group, from the 2006–2010 Medical Expenditure Panel Surveys
Table Footer Note

a Includes persons dually eligible for Medicare and Medicaid

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Table 3Results from the logistic regressions of antidepressant use, by insurance coverage, for 10,216 person-years
Table Footer Note

a Includes persons dually eligible for Medicare and Medicaid

Table Footer Note

b Adjusted for clustering within an individual

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Table 4Results from additional analyses on private coverage
Table Footer Note

a FPL, federal poverty level

Table Footer Note

b Adjusted for clustering within an individual

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References

Simon  GE;  VonKorff  M;  Barlow  W:  Health care costs of primary care patients with recognized depression.  Archives of General Psychiatry 52:850–856, 1995
[CrossRef] | [PubMed]
 
Olfson  M;  Marcus  SC:  National patterns in antidepressant medication treatment.  Archives of General Psychiatry 66:848–856, 2009
[CrossRef] | [PubMed]
 
Miranda  J;  Cooper  LA:  Disparities in care for depression among primary care patients.  Journal of General Internal Medicine 19:120–126, 2004
[CrossRef] | [PubMed]
 
Harman  JS;  Mulsant  BH;  Kelleher  KJ  et al:  Narrowing the gap in treatment of depression.  International Journal of Psychiatry in Medicine 31:239–253, 2001
[CrossRef] | [PubMed]
 
Hargraves  JL;  Hadley  J:  The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care.  Health Services Research 38:809–829, 2003
[CrossRef] | [PubMed]
 
Hargraves  JL:  The insurance gap and minority health care, 1997–2001.  Tracking Report 2:1–4, 2002
[PubMed]
 
Akincigil  A;  Olfson  M;  Siegel  M  et al:  Racial and ethnic disparities in depression care in community-dwelling elderly in the United States.  American Journal of Public Health 102:319–328, 2012
[CrossRef] | [PubMed]
 
Melfi  CA;  Croghan  TW;  Hanna  MP  et al:  Racial variation in antidepressant treatment in a Medicaid population.  Journal of Clinical Psychiatry 61:16–21, 2000
[CrossRef] | [PubMed]
 
Crystal  S;  Sambamoorthi  U;  Walkup  JT  et al:  Diagnosis and treatment of depression in the elderly Medicare population: predictors, disparities, and trends.  Journal of the American Geriatrics Society 51:1718–1728, 2003
[CrossRef] | [PubMed]
 
 The Budget and Economic Outlook:  Fiscal Years 2013 to 2023 .  Washington, DC,  Congressional Budget Office, 2013
 
 Health Coverage by Race and Ethnicity: The Potential Impact of the Affordable Care Act .  Washington, DC,  Kaiser Commission on Medicaid and the Uninsured, 2013
 
 Reducing Racial and Ethnic Disparities: A Quality Improvement Initiative in Medicaid Managed Care .  Hamilton, NJ,  Center for Health Care Strategies, 2007
 
Llanos  K;  Palmer  L:  Using Data on Race and Ethnicity to Improve Health Care Quality for Medicaid Beneficiaries .  Hamilton, NJ,  Center for Health Care Strategies, 2006
 
Chen  J;  Rizzo  JA;  Ortega  AN:  Racial and ethnic differences in drug expenditures and access under Medicare Part D.  Journal of Health Care for the Poor and Underserved 22:1059–1074, 2011
[CrossRef] | [PubMed]
 
Baumeister  H:  Inappropriate prescriptions of antidepressant drugs in patients with subthreshold to mild depression: time for the evidence to become practice.  Journal of Affective Disorders 139:240–243, 2012
[CrossRef] | [PubMed]
 
Barbui  C;  Cipriani  A;  Patel  V  et al:  Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis.  British Journal of Psychiatry 198:11–16, 2011
[CrossRef] | [PubMed]
 
Gilberg  K;  Laouri  M;  Wade  S  et al:  Analysis of medication use patterns: apparent overuse of antibiotics and underuse of prescription drugs for asthma, depression, and CHF.  Journal of Managed Care Pharmacy 9:232–237, 2003
[PubMed]
 
Kessler  RC;  Demler  O;  Frank  RG  et al:  Prevalence and treatment of mental disorders, 1990 to 2003.  New England Journal of Medicine 352:2515–2523, 2005
[CrossRef] | [PubMed]
 
Bridge  JA;  Iyengar  S;  Salary  CB  et al:  Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials.  JAMA 297:1683–1696, 2007
[CrossRef] | [PubMed]
 
Dwight-Johnson  M;  Sherbourne  CD;  Liao  D  et al:  Treatment preferences among depressed primary care patients.  Journal of General Internal Medicine 15:527–534, 2000
[CrossRef] | [PubMed]
 
Cooper  LA;  Gonzales  JJ;  Gallo  JJ  et al:  The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients.  Medical Care 41:479–489, 2003
[PubMed]
 
Cooper-Patrick  L;  Powe  NR;  Jenckes  MW  et al:  Identification of patient attitudes and preferences regarding treatment of depression.  Journal of General Internal Medicine 12:431–438, 1997
[CrossRef] | [PubMed]
 
Quiñones  AR;  Thielke  SM;  Beaver  KA  et al:  Racial and ethnic differences in receipt of antidepressants and psychotherapy by veterans with chronic depression.  Psychiatric Services 65:193–200, 2014
[CrossRef] | [PubMed]
 
Ince  BU;  Riper  H;  van ‘t Hof  E  et al:  The effects of psychotherapy on depression among racial-ethnic minority groups: a metaregression analysis.  Psychiatric Services 65:612–617, 2014
[CrossRef] | [PubMed]
 
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