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Antidepressant Use in Black and White Populations in the United States

Dr. González is affiliated with the Department of Gerontology and Family Medicine, Wayne State University, Detroit, Michigan, where Mr. Tarraf is also affiliated, and with the Institute of Social Research, University of Michigan, Ann Arbor. Dr. Croghan is with Mathematica Policy Research, Georgetown University School of Medicine, Washington, D.C. Mr. West is with the Center for Statistical Consultation and Research, Dr. Nesse is with the Departments of Psychiatry and Psychology, Dr. Taylor is with the Department of Social Work, and Dr. Neighbors and Dr. Jackson are with the Institute of Social Research, all at the University of Michigan, Ann Arbor. Dr. Williams is with the Department of Society, Human Development, and Health, Harvard School of Public Health, Boston. Dr. Hinton is with the Department of Psychiatry, University of California, Davis. Send correspondence to Dr. González, Department of Gerontology and Family Medicine, Wayne State University, 87 East Ferry St., Detroit, MI 48202 (e-mail: hmgonzalez{at}med.wayne.edu).

OBJECTIVE: The study objective was to estimate the prevalence and correlates of antidepressant use by black and white Americans. METHODS: Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) were analyzed to calculate nationally representative estimates of past-year antidepressant use by black and white Americans ages 18 years and older (N=9,723). RESULTS: Among individuals with depressive and anxiety disorders in the past year (N=516), black respondents (14.6%) had significantly lower (p<.001) antidepressant use than white respondents (32.4%). Depression severity was significantly associated with higher antidepressant use for white but not for black respondents. Psychiatric disorders and vascular disease significantly increased the odds of past-year antidepressant use. The increased prevalence of antidepressant use associated with vascular disease was independent of diagnosable psychiatric disorders. Among respondents not meeting criteria for depressive and anxiety disorders in the past year, lifetime depressive and anxiety disorders and vascular disease significantly increased the odds of antidepressant use. CONCLUSIONS: Few white and fewer black Americans with depressive and anxiety disorders received antidepressant treatment. Higher depression severity was associated with more antidepressant use for white but not for black respondents. Antidepressant use was associated with medical conditions related to vascular disease, and these medical conditions were independent of coexisting psychiatric conditions. The results also indicate that many antidepressants are used for maintenance pharmacotherapy for depressive and anxiety disorders as well as common medical conditions associated with vascular disease.

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