Major depression often emerges in adolescence, and a new study finds serious inequities in treatment for depression between adolescents of different racial and ethnic backgrounds. White teens were found to still more likely get depression treatment than other racial groups of adolescents — in some cases more than double.
In a study in the February 2011 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), researchers from the Rollins School of Public Health at Emory University in Atlanta analyzed five years of data (2004-2008) collected from the National Survey of Drug Use and Health (NSDUH).
The study evaluated a national representative sample of 7,704 adolescents, from 12 to 17 years of age, who were diagnosed with major depression within the past year. Researchers studied the differences in treatment for depression across four racial/ethnic groups of adolescents with major depression (i.e., non-Hispanic whites, blacks, Hispanics, and Asians).
The NSDUH samples non-institutionalized individuals 12 years and older from all 50 states and the District of Columbia. The survey is conducted annually, in both English and Spanish, and is sponsored by the Substance Abuse and Mental Health Services Administration.
In the article titled “Racial/Ethnic Differences in Mental Health Service Use Among Adolescents With Major Depression,” Janet R. Cummings, Ph.D., and Benjamin G. Druss, M.D., reported that after adjusting for demographics and health status, the percentage of non-Hispanic whites who received any major depression treatment was 40 percent compared with 32 percent in blacks, 31 percent in Hispanics, and 19 percent in Asians.
The study could not say what is causing the discrepancy — access to care, professionals not making the appropriate referrals, or a greater stigma associated with receiving mental health treatment amongst different racial groups.
Black, Hispanic, and Asian adolescents were also significantly less likely than non-Hispanic whites to receive treatment for major depression from mental health professionals, to receive treatment for major depression from medical providers, and to have any mental health outpatient visits, with Asians exhibiting the lowest rate of service use on each measurement.
The adjustment for socioeconomic status and health insurance status accounted for only a small portion of the estimated differences in major depression treatment measurements and outpatient utilization across racial/ethnic groups. Other factors, such as stigma and limited proficiency in English, possibly contributed to the lower rates of service use in Hispanics and Asians.
Notably, one-fourth of all adolescents with major depression received school-based counseling. According to Cummings and Druss, “Investment in quality improvement programs implemented in primary care settings as well as school-based mental health services may reduce unmet need for mental health services in all adolescents with major depression and reduce the sizeable differences in service use across racial/ethnic groups.”
Furthermore, the researchers reported, “Unlike treatment in outpatient settings, we did not find any significant racial/ethnic differences in the receipt of inpatient treatment.”
In a related editorial, Harvard psychiatrist Dr. Nicholas J. Carson stated, “Given the serious consequences of depression, which are not limited to suicide, substance abuse, and academic failure, these low rates are tragic.”
Carson said, “Future research will also need to clarify how a disproportionately low supply of mental health providers in minority communities affects disparities in access to services.”