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Joseph J. Gallo, MD, MPH; Hillary R. Bogner, MD, MSCE; Knashawn H. Morales, ScD; Daniel E. Ford, MD, MPH

Arch Intern Med. 2005;165:1962-1968.

Background  Black Americans are more likely to obtain mental health care from a primary care physician than from a mental health specialist. We investigated the association of ethnicity with the identification and active management of depression among older patients.

Methods  Cross-sectional survey of 355 older adults with and without significant depressive symptoms. At the index visit, the physician’s ratings of depression and reports of active management were obtained on 341 of the 355 patients who completed in-home interviews.

Results  Older black patients were less likely than older white patients to be identified as depressed (unadjusted odds ratio [OR], 0.40; 95% confidence interval [CI], 0.25-0.63) and their depression was less likely to be actively managed in the 6 months before the interview (unadjusted OR, 0.63; 95% CI, 0.19-2.16). In multivariate models that controlled for potentially influential characteristics such as patient age, sex, marital status, level of education, functional status, physical health, severity of depressive symptoms, severity of anxiety symptoms, attitudes about depression, number of office visits in the last 6 months, and the physician’s rating of how well they knew the patient, the associations of identification (OR, 0.25; 95% CI, 0.17-0.39) and management (OR, 0.57; 95% CI, 0.19-1.77) with patient ethnicity remained substantially unchanged.

Conclusion  Our study calls attention to the role ethnicity may play in the identification and active management of depression among older primary care patients.

Author Affiliations: Department of Family Practice and Community Medicine (Drs Gallo and Bogner) and Center for Clinical Epidemiology and Biostatistics (Dr Morales), School of Medicine, University of Pennsylvania, Philadelphia; and Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md (Dr Ford).

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