摘要：Objectives. We investigated racial/ethnic disparities in the diagnosis and treatment of depression among community-dwelling elderly. Methods. We performed a secondary analysis of Medicare Current Beneficiary Survey data (n = 33 708) for 2001 through 2005. We estimated logistic regression models to assess the association of race/ethnicity with the probability of being diagnosed and treated for depression with either antidepressant medication or psychotherapy. Results. Depression diagnosis rates were 6.4% for non-Hispanic Whites, 4.2% for African Americans, 7.2% for Hispanics, and 3.8% for others. After we adjusted for a range of covariates including a 2-item depression screener, we found that African Americans were significantly less likely to receive a depression diagnosis from a health care provider (adjusted odds ratio [AOR] = 0.53; 95% confidence interval [CI] = 0.41, 0.69) than were non-Hispanic Whites; those diagnosed were less likely to be treated for depression (AOR = 0.45; 95% CI = 0.30, 0.66). Conclusions. Among elderly Medicare beneficiaries, significant racial/ethnic differences exist in the diagnosis and treatment of depression. Vigorous clinical and public health initiatives are needed to address this persisting disparity in care. Depression is a significant public health concern for older Americans. 1 It has been estimated that 6.6% of older Americans experience an episode of major depression during 1 year. 2 If untreated or undertreated, depression can significantly diminish quality of life 3 and increase mortality. 4 Depression can complicate several comorbid general medical conditions that are common in older populations, including congestive heart failure, 5,6 diabetes, 7 and arthritis. 8 Antidepressant treatment and psychotherapy have been shown to be effective in increasing rates of remission for depression in older adults. 9 Several studies during the 1990s identified racial/ethnic differences in the diagnosis and treatment of depression, both in the general adult population and among the elderly. 10–14 Although there was a general increase in rates of depression diagnosis and antidepressant use during this period, some studies suggest that these increases are not consistent across racial/ethnic subgroups 15 and that disparities in the treatment of diagnosed depression are persistent. 10,16,17 More recent studies (often combining the nonelderly and elderly adult population rather than considering these groups separately) have provided mixed findings. Some evidence indicates that minority group members with depression continue to receive less mental health care than do non-Hispanic Whites, and some studies suggest that mental health treatment differences by race/ethnicity may have worsened in the early 2000s. 18–21 By contrast, 1 recent national study reported that although overall increases in treatment rates were modest in the 2000s, there were significant increases in treatment rates among African Americans, possibly narrowing the racial/ethnic gap among adults in general. 22 However, this study did not examine disparities in treatment separately among older adults and was founded on household reported conditions that are only modestly related to provider diagnoses. 23 The pattern of diffusion of depression treatment may differ between elderly and nonelderly adults. Consequently, racial/ethnic differences in diagnosis and treatment among the elderly remain a potentially important public health concern. We investigated whether there are racial/ethnic differences (1) in the rate of diagnosis of depression among the elderly, controlling for sociodemographic characteristics and depression symptoms (depressed mood and anhedonia) reported on a 2-item screener; and (2) in the treatment provided to those diagnosed with depression by a health care provider, adjusting for these covariates. In a large, nationally representative sample, we examined whether relationships between race/ethnicity and depression diagnosis or depression treatment are mediated by insurance coverage and perceived access to medical care, depression symptoms, and severity, or by other global measures of health such as self-reported health status and impairment in daily activities.
