Most Americans with major depression go untreated or under treated using a benchmark of American Psychiatric Association guidelines, according to a national study released this week.
Mexican Americans and African Americans are the least likely to receive treatment, especially treatment consistent with the guidelines, the study found. Those racial and ethnic disparities persisted regardless of health insurance coverage.
"Our findings support the conclusion that the U.S. mental health system is broken," Dr. Hector M. Gonzalez of Wayne State University, Detroit, and first author of the study, told Reuters Health by email.
The findings stem from interviews conducted between 2001 and 2003 with a diverse group of more than 15,000 Americans aged 18 and older.
A little more than 8 percent of the sample suffered from major depression, researchers found, including roughly 8 percent of Mexican Americans, Caribbean blacks, and non-Latino whites, and nearly 12 percent of Puerto Rican Americans.
Overall, only about half of those with depression received some type of treatment in the past year and less than a quarter had received "guideline-based" treatment, according to a report in the Archives of General Psychiatry.
(Earlier this week, a study suggested that mild to severe depression might be better treated with alternatives to antidepressant drugs, which do not help patients much more than an inactive placebo. See Reuters Health report, January 5, 2010.)
While 34 percent of those with depression received an antidepressant in the past year, only about 11 percent received guideline-based antidepressant therapy.
"Surprisingly," said Gonzalez, psychotherapy (talk therapy) was used more commonly by depressed Americans than antidepressant drugs; 44 percent said they had psychotherapy to combat their depression and for about 19 percent of these individuals, psychotherapy conformed to guidelines.
Depressed Mexican Americans and African Americans consistently had lower odds of receiving any type of treatment, let alone guideline-based treatment, in the past year. Depressed Puerto Rican and non-Latino whites were nearly twice as likely as Mexican Americans, Caribbean blacks, and African Americans to get recommended depression care, the authors report.
Having health insurance boosted the odds of depression care but not guideline-based care; this suggests, say the investigators, that while health insurance may equate to better access to depression treatment it does not ensure better care.
"Major depression is a leading cause of disability worldwide and in the U.S. and thus is of high public health importance," Gonzalez told Reuters Health.
On January 1, the Mental Health Parity Act, which promises to boost access to mental health care, took effect. But Gonzalez worries, "Even if patients are identified by clinicians as depressed, isolating or carving out mental health from the rest of medical services ensures that patients will fall between the institutional cracks and not get treatment."
"And that's for those who are 'better off'—who have access to some mental health care. For ethnic and racial minorities, there are cultural, language, and economic barriers to appropriate diagnosis on top of a fragmented mental health care system that leaves the vast majority of African and Mexicans untreated and under treated for depression," Gonzalez said.
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