Racial variation in antidepressant treatment in a Medicaid population

Background: Many stydies have found racial and socioeconomic variation in medical care for a variety of conditions. Undertreatment of depression for individuals of all races is a concern, but especially may affecy vulnerable populations such asMedical recipients and minorities. With this study, we examine racial differences in the antide-pressent usage in a Medicaid population. Methods: Treatment of 13,065 depressed patients (ICD-9-CM criteria) was examined in a state Medicaid database covering the years 1989 through 1994. Treatment differences were assessed in terms of whether an antidepression was recieved at the time of the initial depression diagnosis and the type of antidepressant prescribed (tricyclic antidepressants [TCAs] vs. selective serotonin reuptake inhibitors [SSRIs]), using logistic regression technique. Results: African Americans were less likely than whites to recieve an antidepressant at the time of thier initial depression diagnosis (27.2% vs. 44.0%, p < .001). Of those recieving an anti-depressant, whites were more likely than African Americans to recieve SSRIs versus TCAs. These findings remained even after adjusting for other covarties. Conclusion: Despite the easy availability of effective treatments, we found that only a small portion of depressed Medicaid recipients recieve adequate usage of antidepressants. Within this Medicated population, limited access to treatment was especially pronounced amoung African American. Racial differences existed in terms of whether an antidepressant was recieved and the type of medication used.