Ethnic differences in the treatment of depression in patients with ischemic heart disease

Abstract

Objective-To examine ethnic differences in depressive symptoms and antidepressant treatment in a cohort of patients undergoing diagnostic coronary angiography.Background-Coronary heart disease (CHD) is the leading cause of mortality in the US, with an excess of mortality in African Americans. Traditional risk factors occur more frequently among African Americans but do not fully account for this increased risk. Elevated depressive symptoms have been shown to be associated with higher morbidity and mortality in CHD patients.

Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice

“…35 Patient's race may influence physicians' recognition and treatment of depression. 36 AfricanAmericans were less likely to be treated with antidepressant medications compared to white patients with similar levels of symptoms of depression. 36 Several causes of this disparity have been suggested, including black patients feeling stigmatized by a mental health disorder, low patient education and recognition of depressive symptoms, inability of black patients to access and pay for treatment, and inability of physicians to recognize symptoms of depression in a minority group.…”

“…36 AfricanAmericans were less likely to be treated with antidepressant medications compared to white patients with similar levels of symptoms of depression. 36 Several causes of this disparity have been suggested, including black patients feeling stigmatized by a mental health disorder, low patient education and recognition of depressive symptoms, inability of black patients to access and pay for treatment, and inability of physicians to recognize symptoms of depression in a minority group. 36 African-Americans with renal cell carcinoma were less likely than whites to be treated with Interleukin 2, after controlling for age, tumour grade, co-morbidities and other relevant clinical variables.…”

“…36 Several causes of this disparity have been suggested, including black patients feeling stigmatized by a mental health disorder, low patient education and recognition of depressive symptoms, inability of black patients to access and pay for treatment, and inability of physicians to recognize symptoms of depression in a minority group. 36 African-Americans with renal cell carcinoma were less likely than whites to be treated with Interleukin 2, after controlling for age, tumour grade, co-morbidities and other relevant clinical variables. 37 Various reasons were suggested, including limited financial resources for AfricanAmericans, and living in rural areas with reduced Journal of the Royal Society of Medicine access to specialized centres.…”

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…198 Future longitudinal research is needed to disentangle psychological mediators of the impact of social and economic circumstances on health and the impact of potential interventions to target depression in the context of its socioeconomic correlates. Understanding of these factors among racial/ethnic minorities is important because conditions such as depression and anxiety are more likely to be underdiagnosed and undertreated among minority patients and are more likely to be chronic, [204][205][206][207][208][209] potentially contributing to an earlier and heavier burden of CVD disparities in these groups. [210][211][212] …”

Waiting for Godot

“…7 Clinicians, confronting this current observational evidence base and set of recommendations, are left to use any of the existing depression identification or treatments for patients with AMI, leading to practice variation and increasing health disparities in care for this prevalent clinical comorbidity. 8 On reading about the large, international, multidecade weight of observational evidence supporting the conjecture that depression portends ill for patients with AMI, many queries may cross one's mind. One logical question to ask, as an interested clinician or scholar, is whether treating depression in these patients would improve these many medical outcomes.…”