The response of ethnic minorities to mental health care is largely unstudied.
To determine the effect of appropriate care for depression on ethnic
Observational analysis of the effects of evidence-based depression care
over 6 months on clinical outcomes and employment status is examined for ethnic
minorities and nonminorities. Selection into treatment is accounted for using
instrumental variables techniques, with randomized assignment to the quality
improvement intervention as the identifying instrument.
Six managed care organizations across the United States.
One thousand three hundred fifty-six depressed adults, including 601
white, 258 Latino, 56 African American, and 24 Asian or Native American patients.
Quality improvement interventions aimed at increasing guideline-concordant
At 6 months, minority patients who received appropriate care, compared
with those who did not receive it, had lower rates of probable depressive
disorder (20.5% vs 70.5%); the findings were similar for nonminority patients
(24.3% vs 71.2%). Nonminority patients who received appropriate care were
found to have higher rates of employment than were those who did not receive
appropriate care (71.4% vs 52.4%). This was not true of minority patients
(68.2% vs 56.5%).
Evidence-based care for depression is equally effective in reducing
depressive disorders for minority and nonminority patients. However, functional
outcomes of care, such as continued employment, may be more limited for minority
than nonminority patients. Because minority members are less likely to get
appropriate care, efforts should be made to engage minority members in effective
care for depression.