Racial Differences in Symptoms, Comorbidity, and Treatment for Major Depressive Disorder Among Black and White Adults

Abstract

Objective Racial differences in the clinical nature of major depressive disorder (MDD) could contribute to treatment disparities, but national data with large samples are limited. Our objective was to examine black-white differences in clinical characteristics and treatment for MDD from one of the largest, national community samples of US adults. Methods Non-Hispanic black and white adults (n = 32 752) from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions produced data on 1866 respondents who met criteria for MDD based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) in the preceding 12 months. Outcome measures were depressive symptoms, comorbid psychiatric and medical disorders, disability, and treatment. Results Blacks with MDD had significantly higher odds of initial insomnia, early-morning awakening, and restlessness than whites. Odds of hypertension (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.48–3.14), obesity (OR, 1.98; 95% CI, 1.45–2.69), and liver disease (OR, 3.68; 95% CI, 1.20–11.30) were higher among blacks than whites. In unadjusted models, blacks had greater impairment than whites in social and physical functioning. However, adjusting for sociodemographic characteristics eliminated these differences. Blacks were less likely than whites to receive outpatient services (OR, 0.51; 95% CI, 0.36–0.72) and be prescribed medications for MDD, but were more likely to receive emergency room and inpatient treatment. Conclusions We found few racial differences in depressive symptoms, psychiatric comorbidity, and disability after adjusting for sociodemographic factors. Blacks’ lower utilization of ambulatory treatment for MDD and greater medical comorbidity, emergency department use, and hospitalization suggests that management of MDD among blacks should be emphasized in primary care or other settings where treatment is more accessible.

Long-Term Reciprocal Associations Between Depressive Symptoms and Number of Chronic Medical Conditions: Longitudinal Support for Black–White Health Paradox

“…This is particularly important because the optimal design for studying the reciprocal associations is a longitudinal design [16][17][18]. Second, literature has provided inconsistent [14,15] and even unexpected findings [13,14,19]. If Blacks have more CMCs and with a lower prevalence of depression than Whites, we would expect to observe a stronger association between depressive symptoms and CMCs among Whites than Blacks, with each incremental increase in number of chronic medical conditions associated with a smaller increase in depressive symptoms among Blacks compared to Whites.…”

“…If Blacks have more CMCs and with a lower prevalence of depression than Whites, we would expect to observe a stronger association between depressive symptoms and CMCs among Whites than Blacks, with each incremental increase in number of chronic medical conditions associated with a smaller increase in depressive symptoms among Blacks compared to Whites. However, Hankerson and colleagues documented a stronger association between major depressive disorder (MDD) and hypertension, obesity, and liver disease among Blacks compared to Whites [19], and Assari found a positive cross-sectional association between MDD and cardiovascular diseases among Blacks that could not be replicated for Whites [13]. Further, using the National Survey of American Life (NSAL) data, Watkins, Assari, and JohnsonLawrence (2015) showed that lifetime MDD was associated with at least one CMC among Blacks, but not Whites [15].…”

Connecting Mentally Ill Detainees in Large Urban Jails with Community Care

“…While much is known about racial, ethnic and gender disparities in receipt of communitybased outpatient mental health care [21][22][23][24][25], little is known about whether these same disparities carry-over into jail settings. Some recent studies suggest that racial disparities in mortality rates are smaller in prison populations than in the general community population [26][27][28], for example, but research has yet to establish whether jails mirror similar racial and gender disparities that exist in community treatment for people with severe mental illness.…”

Treatment Disparities among African American Men with Depression: Implications for Clinical Practice

“…1 Depression is associated with high rates of medical and psychiatric comorbidity, 2 poor physical health and functioning, 3 and increased risk of suicide. 4 Lifetime prevalence estimates of MDD range from 14% to 17% in the United States (U.S.).…”