SAN ANTONIO – Older Mexican American men are significantly less likely than older white non-Hispanic men to be diagnosed or treated for depression, investigators found in an analysis of preliminary data from the Men’s Health and Aging Study.
Among 109 men who screened positive for depressive symptoms or were treated for depression, 35% of the Mexican American men said a physician or other health care professional had suggested to them that they were depressed, compared with 68% of white non-Hispanic men, Dr. Ladson Hinton, professor of psychiatry and behavioral sciences at the University of California, Davis, said at the annual meeting of the American Association for Geriatric Psychiatry.
Photo credit: Courtesy UC Davis Department of Psychiatry
Photo credit:Courtesy UC Davis Department of PsychiatryDr. Ladson Hinton
"They’re not being told that they’re depressed; the diagnosis is actually happening at a much lower frequency among these Mexican American men," he said.
Only 28% of the Mexican American men had received a prescription for depression within the previous year, compared with 68% of white men, and 20% received a prescription for a reported SCID (Structured Clinical Interview for DSM Disorders) depression module, compared with 52% of white non-Hispanics (P less than .001 for both comparisons).
The findings show that significant disparities persist in depression recognition and treatment between older white non-Hispanic men and Hispanic men, Dr. Hinton said. Cultural differences might account for some of the disparity, he said. In fact, the results show that the disparity between non-Hispanic whites and Mexican Americans was similar, whether the latter group spoke primarily Spanish or English.
The Men’s Health and Aging Study (MeHAS) is a cross-sectional primary care–based study designed to identify barriers to, and facilitators of, depression care among depressed older white non-Hispanic and Mexican American men.
Potential participants are screened in primary care practices with a three-item screener, and those with a positive screen, defined as one or more depressive symptoms and/or depression treatment, go on to an in-depth qualitative interview covering major depression within the past year, chronic depression, treatment history, screening for cognitive impairment and psychosis, and demographic questions.
Of 364 men recruited, 49 were identified as depressed without treatment, 40 were depressed and treated, and 20 were identified by virtue of having received depression treatment (treatment-only group).
Among a sample of 338 of the 364 men (151 Mexican American and 187 white non-Hispanics), the frequency of depression was roughly equal, at about 27% for the former and 25% for the latter. But Mexican Americans were significantly less likely to have been treated for depression, at 8% vs. 25% for whites (P less than .01).
When the authors looked at the likelihood of treatment among the 109 patients who screened positive for depression or treatment (46 Mexican American and 63 non-Hispanic whites), they found that the association with ethnicity and lack of treatment held up: Mexican Americans made up a larger proportion of the depressed untreated group, but smaller proportions of both the depressed treated and treatment-only groups.
Looking at correlates of depression treatment, they found that factors significantly associated with not receiving treatment were being Mexican American (P = .001), born in Mexico (P = .005), interviewed in Spanish (P = .001), and having less than a high school education (P = .001).
In a logistic regression analysis controlling for age, education, marital status, and self-rated health, Mexican Americans who preferred English had an odds ratio of .20 (P = .004) for getting depression treatment, compared with white non-Hispanics, and those who preferred Spanish had an odds ratio of .15 (P = .006).
"When we think about disparities in care, policies to improve depression care may not be an effective use of resources without a parallel improvement in quality of care. I think what’s really important from a policy perspective is increasing access for older Hispanics. Simultaneously, once we get people in treatment, we really have to focus on trying to improve the quality of what they get in the primary care setting," Dr. Hinton concluded.
The study is funded by the National Institute of Mental Health. Dr. Hinton said he receives research funding from the NIMH, the Alzheimer’s Foundation, and the Weinberg Foundation.