Does being a member of a minority ethnicity put you at risk of being overlooked for depression? Black & Hispanic patients have lower treatment rates of depression.
Depression is often seen as a taboo subject in many cultures and societies. This is increasingly problematic in the African-American and Hispanic populations, as data shows that both populations are less likely to seek medical attention for Major Depressive Disorder and other mental health conditions. Although the causes of the increased prevalence and incidence of depression among African Americans and Hispanics is multifaceted, it cannot go without being said that discrimination, racism, and intolerance are major causes of the condition. There is a certain stigma that is perceived regarding mental health in society, especially among the Hispanic and African American populations. When a patient is diagnosed with diabetes, hyperglycemia is not the only condition that is treated. Around a quarter of those diagnosed with type 2 diabetes also suffer from a form of depression. With such a high incidence rate, the data on patient characteristics is lacking, says Caroline A. Presley, MD, assistant professor at the University of Alabama at Birmingham. Without patient characteristics, it is difficult to spot trends in patient populations, increasing the potential for clinicians to miss important trends in therapy. The researchers set out to examine the medical records of participants in the Partnership to Improve Diabetes Education study.
Using the medical records and questionnaires of 403 participants, 60% of whom were women, researchers mapped out the different ethnicities, medication uses, and HbA1C levels of the participants. The medication uses included antidepressants like Effexor, Wellbutrin, and Prozac, and the eligible A1C level of the patients needed to be at least 7.5%. 4% of the study had health insurance, and around 54% of the participants made less than $10,000 in yearly income. 52% of the patient questionnaires indicated a positive diagnosis of depression, but of the 210 participants, only 73 participants were taking an antidepressant. It is a staggering statistic because the majority of this cohort are not taking medications that may help their mood and life, in addition to the fact that there are approximately 422 million patients with diabetes worldwide who may be suffering. As noted by the wealth data above, it shows that diabetes heavily affects the poorer populations of the world. This is due to the lack of diabetes education, lack of resources to adopt a healthier lifestyle, and the increased secretion of cortisol from the stress of not having money.
Presley and her colleagues found that the likelihood of white patients seeking antidepressant treatment versus that of their black and Hispanic counterparts was significant. The data illustrated a trend that showed 26% of white adults sought medical treatment for their depression, versus 8% of African Americans and 6% of Hispanics (P<.001). Black and Hispanic adults were 69% and 73% less likely to seek medical treatment when compared to white adults, respectively [(OR=0.31; 95% CI, 0.12-0.79), (OR = 0.27; 95% CI, 0.1-0.75)]. This study found that women were 92% more likely to receive an antidepressant versus their male counterparts (OR = 1.92; 95% CI, 1.04-3.55). As illustrated by the statistics, the results mentioned above show that there is an overwhelming disparity in the type 2 Diabetes population, and more specifically, in the black and Hispanic populations. Previous studies have shown that there is a link between untreated depression and worsened glycemic control. This leaves the minorities of the United States underserved and more susceptible to worsening of their diabetes.
The results that Presley and her colleagues found on the disproportionate treatment of people with diabetes and their depression is quite staggering. Patients with diabetes often go untreated in the context of depression. Previous studies have pointed to a worsening of glycemic control in patients with diabetes and untreated depression. It is increasingly important to evaluate patients with diabetes for possible mental health conditions and to break down the barrier of the stigma that often impedes their road to a healthier life.
- Patients with diabetes suffer from depression at high rates, but there is little action taken to reverse such a trend.
- Patients who are black or Hispanic often forgo depression treatment and are less likely to receive antidepressant therapy when compared to their white counterparts.
- The next trial on this issue should include more patients, and the regular screening of patients with diabetes for mental health conditions should become the gold standard in therapy.
References for “Lower Treatment Rates of Depression For Some Type 2 Patients”:
Holt, Richard I. G., et al. “Diabetes and Depression.” Current Diabetes Reports, vol. 14, no. 6, 2014, doi:10.1007/s11892-014-0491-3.
Presley, Caroline A., et al. “Factors Associated with Antidepressant Use among Low-Income Racially and Ethnically Diverse Patients with Type 2 Diabetes.” Journal of Diabetes and Its Complications, 2019, doi: 10.1016/j.jdiacomp.2019.07.002.
Usif Darwish, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences