Depression Care in the United States

Too Little for Too Few

Depression is a leading cause of disability among all major ethnic and racial groups in the United States. Even though guidelines suggest pharmacotherapy and psychotherapy to treat depression, most Americans with 12-month major depression go untreated. Are there disparities in depression treatment with some ethnic groups having lower rates of treatment than others?

Using the National Institute of Mental Health Collaborative Psychiatric Epidemiology Surveys, researchers examined depression care among five major ethnic groups: Mexican American, Puerto Rican, Caribbean Black, African American and non-Latino White. The mean level of depression severity did not differ among groups relative to Whites, indicating that there was the same need for treatment among all ethnicities.

Overall, one in three depressed respondents used an antidepressant in the last year—highest for Puerto Ricans and Whites and lowest for Mexican Americans, Caribbean Blacks and African Americans. Similarly, psychotherapy use was higher for Puerto Ricans and Whites and lowest for the other three groups. Half the respondents received some form of care, following the same pattern. Puerto Ricans and Whites used concordant therapies at twice the rate of the other three groups.

Important patterns of therapy use for depression can only be revealed by disaggregating ethnicity.