Disparities in antidepressant treatment in Medicaid elderly diagnosed with depression

To determine whether there were racial or ethnic disparities in the use of antidepressants in low-income elderly patients insured by Medicaid.

Examination of 1998 Medicaid claims data.

Centers for Medicare and Medicaid Services Medicaid claims data for five U.S. states.

All Medicaid recipients aged 65 to 84 with a diagnosis of depression.

Treatment versus no treatment; in those treated, treatment with drugs was classified as old- or new-generation antidepressants.

In 1998, 7,339 unique individuals aged 65 to 84 had at least one outpatient encounter with depression as the primary diagnosis. Nearly one in four (24.2%) received no antidepressant drug therapy, and 22% received neither psychotherapy nor an antidepressant. African-American individuals were substantially more likely to be untreated (37.1%) than Hispanic (23.6%), white (22.4%), or Asian (13.8%) individuals. In logistic regression models adjusting for sex, state, long-term care status, and age group, African Americans with a primary diagnosis of depression were almost twice as likely as whites not to receive an antidepressant within the study period (odds ratio=1.91, 95% confidence interval=1.62-2.24). Patients in long-term care facilities and those aged 65 to 74 were less likely to receive treatment.

Substantial numbers of elderly Medicaid enrollees with a primary diagnosis of depression did not receive antidepressants or behavioral therapy. This gap in care disproportionately affected African-American patients.