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Falling through the cracks: gaps in depression treatment among older Mexican-origin and white men

TitleFalling through the cracks: gaps in depression treatment among older Mexican-origin and white men
Publication TypeJournal Article
Year of Publication2012
AuthorsHinton, L, Apesoa-Varano, EC, Gonzalez, HM, Aguilar-Gaxiola, S, Dwight-Johnson, M, Barker, JC, Tran, C, Zuniga, R, Unutzer, J
JournalInt J Geriatr PsychiatryInt J Geriatr Psychiatry
Volume27
Pagination1283-90
Date PublishedDec
ISBN Number1099-1166 (Electronic)<br/>0885-6230 (Linking)
Accession Number22383214
KeywordsAged, California/epidemiology, Cross-Sectional Studies, Delivery of Health Care/ standards, Depressive Disorder/diagnosis/epidemiology/ therapy, Diagnostic and Statistical Manual of Mental Disorders, European Continental Ancestry Group/statistics & numerical data, Humans, Male, Mexican Americans/statistics & numerical data, Middle Aged, Questionnaires
AbstractOBJECTIVES: This study aims (i) to compare depression frequency and self-reported depression treatment in Mexican-origin and white men; (ii) to examine ethnic differences in self-reported prior depression diagnosis and types of treatment; and (iii) to determine whether Mexican-origin men (both English and Spanish language preferring) are less likely than white men to report receiving depression treatment after controlling for potential confounders. METHODS: This is a cross-sectional, observational study of Mexican-origin and white men (60 years old and over) presenting for primary care visits at six outpatient clinics in California's Central Valley. Clinical depression was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), module for past-year major depression and questions for chronic depression. Past year, self-reported prior depression diagnosis and treatment (i.e., medication, psychotherapy, mental health referral) were assessed through a structured questionnaire. RESULTS: The frequency of past-year clinical depression was similar for both ethnic groups, yet Mexican-origin men were significantly less likely than whites to report receiving a prior diagnosis of depression or prior depression treatment. Compared with whites, the odds of untreated depression in Mexican-origin men was 4.35 (95% CI 1.35-14.08) for those interviewed in English and 10.40 (95% CI 2.11-51.25) for those interviewed in Spanish. For both ethnic groups, the majority (i.e., approximately two-thirds) of men receiving depression treatment also met criteria for past-year clinical depression. CONCLUSIONS: Mexican-origin older men in primary care suffer from significant gaps in depression care (i.e., diagnosis and treatment) compared with whites. Delivering effective depression treatment (i.e., so that depression remits) remains elusive for both ethnic groups.