Racial Variation in Antidepressant Treatment in a Medicaid Population

Background: Many studies have found racial and
socioeconomic variation in medical care for a variety of
conditions. Undertreatment of depression for individuals of all
races is a concern, but especially may affect vulnerable
populations such as Medicaid recipients and minorities. With this
study, we examine racial differences in the antidepressant usage
in a Medicaid population.

Method: Treatment of 13,065 depressed patients
(ICD-9-CM criteria) was examined in a state Medicaid database
covering the years 1989 through 1994. Treatment differences were
assessed in terms of whether an antidepressant was received at
the time of the initial depression diagnosis and the type of
antidepressant prescribed (tricyclic antidepressants [TCAs] vs.
selective serotonin reuptake inhibitors [SSRIs]), using logistic
regression techniques.

Results: African Americans were less likely than
whites to receive an antidepressant at the time of their initial
depression diagnosis (27.2% vs. 44.0%, p < .001). Of those
receiving an antidepressant, whites were more likely than African
Americans to receive SSRIs versus TCAs. These findings remained
even after adjusting for other covariates.

Conclusion: Despite the easy availability of
effective treatments, we found that only a small portion of
depressed Medicaid recipients receive adequate usage of
antidepressants. Within this Medicaid population, limited access
to treatment was especially pronounced among African Americans.
Racial differences existed in terms of whether an antidepressant
was received and the type of medication used.