Disparities in antidepressant treatment in Medicaid elderly diagnosed with depression

J Am Geriatr Soc. 2005 Mar;53(3):456-61. doi: 10.1111/j.1532-5415.2005.53164.x.


Objectives: To determine whether there were racial or ethnic disparities in the use of antidepressants in low-income elderly patients insured by Medicaid.

Design: Examination of 1998 Medicaid claims data.

Setting: Centers for Medicare and Medicaid Services Medicaid claims data for five U.S. states.

Participants: All Medicaid recipients aged 65 to 84 with a diagnosis of depression.

Measurements: Treatment versus no treatment; in those treated, treatment with drugs was classified as old- or new-generation antidepressants.

Results: In 1998, 7,339 unique individuals aged 65 to 84 had at least one outpatient encounter with depression as the primary diagnosis. Nearly one in four (24.2%) received no antidepressant drug therapy, and 22% received neither psychotherapy nor an antidepressant. African-American individuals were substantially more likely to be untreated (37.1%) than Hispanic (23.6%), white (22.4%), or Asian (13.8%) individuals. In logistic regression models adjusting for sex, state, long-term care status, and age group, African Americans with a primary diagnosis of depression were almost twice as likely as whites not to receive an antidepressant within the study period (odds ratio=1.91, 95% confidence interval=1.62-2.24). Patients in long-term care facilities and those aged 65 to 74 were less likely to receive treatment.

Conclusion: Substantial numbers of elderly Medicaid enrollees with a primary diagnosis of depression did not receive antidepressants or behavioral therapy. This gap in care disproportionately affected African-American patients.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antidepressive Agents / classification
  • Antidepressive Agents / therapeutic use*
  • Depression / diagnosis
  • Depression / drug therapy*
  • Depression / therapy
  • Ethnic Groups*
  • Female
  • Health Services for the Aged / statistics & numerical data*
  • Humans
  • Logistic Models
  • Long-Term Care
  • Male
  • Medicaid / statistics & numerical data*
  • Poverty
  • Predictive Value of Tests
  • Psychotherapy
  • United States


  • Antidepressive Agents