Ethnicity, insurance status may affect access to antidepressants

African-American and Hispanic patients diagnosed with depression are prescribed antidepressants less frequently than similarly diagnosed white patients, finds a study by Washington State University researchers.

In addition to ethnicity, the study found that age, gender and lack of private insurance coverage may further impede a patient's access to antidepressants. The study was published in the May/June 1999 issue of Harvard Review of Psychiatry (Vol. 7, p. 29-36).

An estimated 11 million Americans suffer from some form of depression each year. But nearly two-thirds don't receive treatment, says the study's author, David Sclar, professor of health policy and administration in the College of Pharmacy at Washington State University. Many of those who don't receive treatment are African-American and Hispanic, says Sclar, who is also director of the Pharmocoeconomics and Pharmocoepidemiology Research Unit.

Sclar and his colleagues used data from the National Ambulatory Medical Care Survey for the years 1992 through 1995 to conduct their study. Specifically, they looked at data from physician office visits among patients, ages 20 to 79, between 1992 and 1993 and between 1994 and 1995.

Although the number of office-based visits documenting a diagnosis of a depressive disorder increased for whites, African-Americans and Hispanics during those years, more white patients than African-American or Hispanic patients were prescribed antidepressants. According to Sclar, for every 100 people, a diagnosis of depression and the prescribing of an antidepressant increased during that time from 6.7 to 7.7 for whites, from 2.6 to 3.4 for blacks and from 3.0 to 3.2 for Hispanics. Sclar attributes this difference to potential language barriers, depression-screening methods that might not be culturally sensitive and public insurance, such as Medicaid or Medicare, which often doesn't cover outpatient prescriptions. Physicians often prescribe medications based on what the patient's insurance will cover, he says.

In a separate study, the authors looked at factors that influence a physician's decision to prescribe an antidepressant. They reviewed data from more than 18 million physician office visits from the 1995 National Ambulatory Medical Care Survey and found that physicians were more likely to prescribe antidepressants to patients who were younger (18 to 49 years old), female and who self-reported depression as their reason for scheduling an office visit.

Further, physicians were more likely to prescribe one of the newer antidepressants, such as Paxil, Prozac or Zoloft, if the patient also had private insurance. In comparison, physicians were more likely to prescribe older antidepressants-- which are more likely to cause side effects--to patients on Medicaid or Medicare. These side effects might cause the patient to stop taking his or her medication, says Sclar. The results of this study were published in the December 1998 issue of the International Journal of Psychiatry in Medicine (Vol. 28, p. 407-419).

--L. Rabasca



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