Does minority racial-ethnic status moderate outcomes of collaborative care for depression?

Psychiatr Serv. 2011 Nov;62(11):1282-8. doi: 10.1176/ps.62.11.pss6211_1282.

Abstract

Objective: The authors examined racial differences in response rates to an intervention involving collaborative care and usual care among 360 veterans treated for depression at Department of Veterans Affairs community-based primary care clinics.

Methods: Individuals who screened positive for depression were assigned randomly to usual care (N=200) or to a collaborative care intervention (N=160) that provided phone contact when necessary with a registered nurse and clinical pharmacist to address issues related to compliance with medication and side effect management as well as supervision by a psychiatrist through video chats with the collaborative care team. Data about patients' characteristics, treatment history, and response to treatment were collected by telephone at baseline and after six months.

Results: Seventy-five percent (N=272) of the veterans were Caucasian, and 25% (N=88) belonged to a minority group, including 18% (N=64) who were African American, 3% (N=11) who were Native American, and 3.6% (N=13) who were of other minority groups. There were no significant differences between response rates between the Caucasian and minority group to usual care (18% and 8%, respectively), but the minority group had a higher response rate (42%) than Caucasians (19%) to the intervention (χ²=8.2, df=1, p=.004). Regression analysis indicated that the interaction of minority group status by intervention significantly predicted response (odds ratio [OR]=6.2, 95% confidence interval [CI]=1.6-24.5, p=.009), even after adjustment for other factors associated with minority status (OR=6.0, 95% CI=1.5-24.3, p=.01).

Conclusions: Racial disparities in depression care may be ameliorated through collaborative care programs.

Publication types

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

MeSH terms

  • Adult
  • Antidepressive Agents / therapeutic use*
  • Community Mental Health Services / organization & administration*
  • Cooperative Behavior
  • Depressive Disorder / drug therapy
  • Depressive Disorder / ethnology
  • Depressive Disorder / therapy*
  • Ethnic Groups / psychology
  • Ethnic Groups / statistics & numerical data
  • Female
  • Healthcare Disparities / ethnology*
  • Humans
  • Male
  • Medication Adherence
  • Middle Aged
  • Minority Groups / psychology*
  • Outcome Assessment, Health Care / statistics & numerical data
  • Patient Acceptance of Health Care / ethnology*
  • Patient Acceptance of Health Care / statistics & numerical data
  • Patient Care Team
  • Regression Analysis
  • Rural Population
  • Telemedicine / organization & administration
  • United States
  • Veterans / psychology
  • Veterans / statistics & numerical data

Substances

  • Antidepressive Agents