Racial Differences in Antidepressant Treatment Preceding Suicide in a Medicaid Population

Ray, Wayne A.; Hall, Branden; Meador, Marion P.

doi:10.1176/appi.ps.58.10.1317

Cited by 12 publications

(7 citation statements)

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“…Asians not only were much less likely to receive a diagnosis of depression but when diagnosed, were 55% less likely than non-Hispanic whites to receive a medication to treat this condition. In contrast with findings from a decade ago, we found no significant differences in use of psychotropic drugs across racial/ethnic groups with schizophrenia and other psychosis 11, 32, 33 . One reason for this difference may be that the previous studies focused on patients from the Veterans Health Administration 7, 11, 34 or Medicaid 19, 35, 36 which tend to serve the most disadvantaged patients.…”

Section: Discussioncontrasting

confidence: 99%

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

Coleman¹,

Stewart²,

Waitzfelder³

et al. 2016

107

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Objective The objective of this study is to characterize racial/ethnic variation in mental health diagnoses and treatments in large not-for-profit healthcare systems. Method Participating systems were 11 private, not-for-profit healthcare organizations constituting the Mental Health Research Network (MHRN) and had a combined 7,523,956 patients aged 18 years or older, who received care during 2011. Rates of diagnoses, psychotropic medications, and formal psychotherapy sessions received were obtained from insurance claims and electronic medical record databases across all healthcare settings. Results Of the 7,523,956 patients in the study, 1,169,993 (15.6%) received a mental health diagnosis in 2011. This varied significantly by race/ethnicity with Native American/Alaskan Native patients having the highest rates of any diagnosis (20.6%) and Asians having the lowest rates (7.5%). Among patients with a mental health diagnosis, 73% (n = 850,585) received a psychotropic medication. Non-Hispanic white patients were significantly more likely (77.8%) than other racial/ethnic groups (range 61.5% to 74.0%) to receive medication. In contrast, only 34% of patients with a mental health diagnosis (n = 548,837) received formal psychotherapy. Racial/ethnic differences were most pronounced for depression and schizophrenia where non-Hispanic blacks were 20% more likely to receive formal psychotherapy for their depression and 2.64 times more likely to receive formal psychotherapy for their schizophrenia when compared to whites. Conclusions There were significant racial/ethnic differences in diagnosis and treatment of mental health conditions across 11 U.S. healthcare systems. Further study is needed to understand underlying causes of these observed differences and whether processes and outcomes of care are equitable across these diverse patient populations.

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Section: Discussioncontrasting

confidence: 99%

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

Coleman¹,

Stewart²,

Waitzfelder³

et al. 2016

107

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“…Our expectation of relative underdocumentation of comorbidity on the death certificates of the minority suicides is partially supported by a records-based study [ 11 ]. Subjects were adult enrollees in TennCare, Tennessee's Medicaid-waiver managed care program, a public assistance program which offers equal financial access to all low-income groups [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Subjects were adult enrollees in TennCare, Tennessee's Medicaid-waiver managed care program, a public assistance program which offers equal financial access to all low-income groups [ 12 ]. This study found that only 29% of African-American suicides and possible suicides, as compared to 51% of white opposites, used prescribed antidepressants in the year prior to their deaths [ 11 ]. The authors interpreted this differential as indirect evidence that serious mood disorders are underdiagnosed or undertreated in African-Americans.…”

Section: Introductionmentioning

confidence: 99%

Discrepant comorbidity between minority and white suicides: a national multiple cause-of-death analysis

et al. 2009

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“…Although confined to Blacks and Whites (Hispanics not independently presented), data from a Tennessee records-based study addressed discrepant documentation of psychiatric comorbidity between US minority and White suicides [23]. Subjects were adult enrollees in TennCare, Tennessee's Medicaid-waiver managed-care program, which is intended to offer equal financial access to all low-income groups.…”

Section: Introductionmentioning

confidence: 99%

Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox?

et al. 2010

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BackgroundSuicide officially kills approximately 30,000 annually in the United States. Analysis of this leading public health problem is complicated by undercounting. Despite persisting socioeconomic and health disparities, non-Hispanic Blacks and Hispanics register suicide rates less than half that of non-Hispanic Whites.MethodsThis cross-sectional study uses multiple cause-of-death data from the US National Center for Health Statistics to assess whether race/ethnicity, psychiatric comorbidity documentation, and other decedent characteristics were associated with differential potential for suicide misclassification. Subjects were 105,946 White, Black, and Hispanic residents aged 15 years and older, dying in the US between 2003 and 2005, whose manner of death was recorded as suicide or injury of undetermined intent. The main outcome measure was the relative odds of potential suicide misclassification, a binary measure of manner of death: injury of undetermined intent (includes misclassified suicides) versus suicide.ResultsBlacks (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 2.22-2.57) and Hispanics (1.17, 1.07-1.28) manifested excess potential suicide misclassification relative to Whites. Decedents aged 35-54 (AOR, 0.88; 95% CI, 0.84-0.93), 55-74 (0.52, 0.49-0.57), and 75+ years (0.51, 0.46-0.57) showed diminished misclassification potential relative to decedents aged 15-34, while decedents with 0-8 years (1.82, 1.75-1.90) and 9-12 years of education (1.43, 1.40-1.46) showed excess potential relative to the most educated (13+ years). Excess potential suicide misclassification was also apparent for decedents without (AOR, 3.12; 95% CI, 2.78-3.51) versus those with psychiatric comorbidity documented on their death certificates, and for decedents whose mode of injury was "less active" (46.33; 43.32-49.55) versus "more active."ConclusionsData disparities might explain much of the Black-White suicide rate gap, if not the Hispanic-White gap. Ameliorative action would extend from training in death certification to routine use of psychological autopsies in equivocal-manner-of-death cases.

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Racial Differences in Antidepressant Treatment Preceding Suicide in a Medicaid Population

Abstract: Although there are several other potential explanations, the study findings provide indirect evidence that there is underdiagnosis or undertreatment of African Americans with serious mood disorders. Further research on this question in African-American populations is essential.

Cited by 12 publications

References 0 publications

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

Discrepant comorbidity between minority and white suicides: a national multiple cause-of-death analysis

Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox?

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