Racial differences in the discussion and treatment of depressive symptoms accompanying type 2 diabetes

Abstract

Objective To compare rates of discussion and treatment for depression among African Americans and Whites with diabetes. Methods Measures of diabetes status, depressive symptoms, and history of discussing and being treated for depression were collected from 56 adults with depressive symptoms accompanying diabetes who were drawn from a larger study of type 2 diabetes. Results Analyses adjusted for confounders and multiple tests indicated that relative to Whites, African Americans were 6–12 times less likely to have ever: discussed depression with anyone (p=.007), discussed depression with their primary care physician (p=.008), been prescribed an antidepressant (p=.002), and they were 25 times less likely to have seen a psychiatrist (p=.003). There were no significant differences in discussing depression with clergypersons, or family members/friends. Conclusions Compared to their White counterparts, African Americans with depressive symptoms accompanying diabetes are unlikely to discuss depression with healthcare professionals, be prescribed antidepressant medication, or be seen by a psychiatrist. Minority diabetes patients' medical and psychiatric outcomes may improve if healthcare providers more actively initiate these discussions, provide culturally-tailored education about the nature of depression and its management, incorporate patient preferences into treatment plans, and establish relationships with persons more likely to learn about African American patient symptoms.

Quality of depression treatment in Black Americans with major depression and comorbid medical illness

“…For example, past findings show that physicians are less likely to detect [67] and discuss depression [68] with Black American patients. Additionally, Black American patients may be less likely to disclose their symptoms to physicians [52]. Also, evidence shows that individuals treated by psychiatrists or psychologists are more likely to receive adequate depression treatment relative to those treated by primary care physicians [69].…”

“…Findings are mixed, with some reporting better treatment [4, 44-47], while others have reported worse treatment [14], or null effects [5]. The handful of studies that have investigated these relationships among Blacks report that Blacks with comorbid depression and T2DM are less likely to be diagnosed with [48, 49] and treated for depression [49-52]. One plausible explanation is that Blacks with comorbid T2DM and depression are unlikely to discuss their depression with their physicians, partly as a result medical mistrust, stigma, and cultural beliefs around responding to depression with stoicism [52].…”

“…The handful of studies that have investigated these relationships among Blacks report that Blacks with comorbid depression and T2DM are less likely to be diagnosed with [48, 49] and treated for depression [49-52]. One plausible explanation is that Blacks with comorbid T2DM and depression are unlikely to discuss their depression with their physicians, partly as a result medical mistrust, stigma, and cultural beliefs around responding to depression with stoicism [52]. In fact, Blacks with comorbid depression and T2DM who perceive discrimination in healthcare are less likely to seek depression treatment, even though they may experience more symptoms [48].…”

Correlates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study

“…Co-morbid depression also results in higher utilization for both medical and mental health care, and higher health care costs [15,17,18]. Furthermore, previous studies have shown that co-morbid depression may often be unrecognized and untreated in individuals with diabetes [19–21]. With emerging evidence that depression treatment improves patient outcomes [22–25], it is important to clarify which diabetes patients are at risk for depression, and the relationships between depression, quality of care and outcomes for diabetes.…”

Self-management as a mediator of the relationship between social support and health outcomes of African American adults with type 2 diabetes.

“…Studies showed that persons diagnosed with T2D are at an increased risk of developing depression compared to persons without T2D (Nouwen et al, 2010;Penckofer, Doyle, Byrn, & Lustman, 2014) African Americans with T2D are often unlikely to discuss their depressive symptoms with their health care professionals, to be seen by a psychiatrist, or to be prescribed antidepressants (Wagner et al, 2009).…”