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Differences by Race and Ethnicity

Laura P. Richardson, MD, MPH; David DiGiuseppe, MSc; Michelle Garrison, MPH; Dimitri A. Christakis, MD, MPH

Arch Pediatr Adolesc Med. 2003;157:984-989.

Background  Racial disparities have previously been noted in antidepressant use among Medicaid-covered youth.

Objective  To determine if racial and ethnic differences are due to dissimilarity in the prevalence of diagnosed depression or disparate treatment patterns.

Methods  Claims were examined for 192 441 youth (5-18 years old) who had been continuously enrolled in Medicaid from July 1, 1997, to December 31, 1998. Diagnosed depression was defined as having been assigned an International Classification of Diseases, Ninth Revision code for a depressive disorder in a medical claim. Logistic regression methods were used to evaluate the association between race/ethnicity and (1) depression diagnosis and (2) depression treatment in the 6 months following a new episode of diagnosed depression. All analyses were controlled for age, sex, and rural or urban residence.

Results  Two percent of the total sample had a depression diagnosis, 25% of which were new episodes of depression. Compared with white youth, Hispanic (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.46-0.57), Asian/Pacific Islander (OR, 0.16; 95% CI, 0.12-0.21), and black (OR, 0.31; 95% CI, 0.26-0.37) youth were less likely to have a depression diagnosis. Following a new diagnosis, Native American (OR, 0.29; 95% CI, 0.18-0.46) and Hispanic (OR, 0.42; 95% CI, 0.30-0.61) youth were less likely than white youth to have received an antidepressant or a mental health specialty visit.

Conclusions  Racial and ethnic disparities exist in both the prevalence and treatment of diagnosed depression. Future studies should examine underlying reasons for these disparities and how they affect the quality of care for depressed Medicaid-covered youth.

From the Child Health Institute (Drs Richardson and Christakis, Mr DiGiuseppe, and Ms Garrison) and Department of Pediatrics (Drs Richardson and Christakis), University of Washington, Seattle.

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