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Lumping ethnic groups in mental health leaves many untreated 

By Paul Kleyman

New America Media, News Report

Jan 24, 2010

The conventional practice of lumping ethnic groups together as Latinos, African Americans or Asian/Pacific Islanders makes it nearly impossible for researchers to determine key factors for improving the effectiveness of care among racial or ethnic subgroups, according to a new study of depression care in the United States.

“Most Americans with recent major depression go untreated or undertreated,” say the study authors, led by Hector Gonzalez, PhD, of the Gerontology Institute at Wayne State University in Detroit.

Gonzalez and his colleagues found that the failure of national studies to distinguish ethnic or racial groups “obscures depression care research, especially for the largest and fastest-growing segment of the U.S. population, Latino individuals and especially Mexican American individuals.”

The researchers examined national data for almost 16,000 people ages 18 or older, who were Mexican American, Puerto Rican, African American, Caribbean black and non-Hispanic white. Gonzalez and his coauthors raised the kinds of questions only group-specific studies can answer if care is to be effective across cultures.

Poor mental health treatment, Gonzalez said, has serious consequences for patients’ ability to recover from physical illness – and for subsequent costs. The study stresses that depression is “a leading cause of disability among major ethnic and racial groups” in the United States.

In an e-mail interview he observed, “We know that depression co-occurs with about half of all patients with diabetes and heart disease,” especially for members of disadvantaged groups.

Gonzalez added that earlier studies found those with both depression and medical illnesses “are less likely to engage in self-care and are sicker overall. As these adults age (assuming they survive), they experience more devastating complications that cost a lot in pain, suffering, and healthcare use.”

Previous studies of Hispanics, Gonzalez said, masked that Mexican Americans--two-thirds of Latinos in the United States--consistently receive less depression care than non-Latino whites and some other Hispanic groups.

The new study, published in the January 2010 issue of the Archive of General Psychiatry, shows that Puerto Ricans, who reported experiencing depression in the previous year, actually had slightly more care than whites. The researchers speculated that Puerto Ricans’ wider use of English and lack of immigrant status probably enhance their ability to access mental-health care more than Mexican Americans.

Also, fewer Mexican Americans had health insurance. But the study emphasized that only more research can determine group differences that can lead to improving their care.

Gonzalez and his colleagues also looked at the kinds of care intervention groups received—psychotherapy, antidepressant drugs or a combination of the two—and determined whether groups obtained therapy meting American Psychiatric Association guidelines.

Overall, Mexican Americans and African Americans were the least likely groups in the study to receive any depression care. And only those with higher levels of education beyond high school, especially whites, had greater odds of obtaining therapy approved under the guidelines.

African Americans and Caribbean blacks who did seek help received more psychotherapy than antidepressant-drug treatment. But neither lack of health insurance nor other factors studied explained why.

The study suggests that unmet needs for some groups may stem from “separate and unequal” sources of care imbedded in the system. The researchers also call for greater scrutiny of perceived discrimination among blacks and Latinos, who may have experienced racial bias in U.S. health care, or may fear prescribed mental health drugs because of past experiments on ethnic patients without their consent.

Although the study looked at people ages 18 or older, Gonzalez noted that older Americans use less depression care compared to younger adults. Targeting undertreated groups will become increasingly important with the aging of the diverse boomer generation, he said.

“We are already experiencing demographic shift shock with the healthcare system ill-prepared for the browning of America,” Gonzalez said. He noted the large influxes of immigrants in unsafe and poor-paying jobs without healthcare benefits in southern states.

Gonzalez commented that the U.S. health care system is “not well-equipped to meet the population’s needs. What this means is continued health care spending increases without requisite precision to get the most for taxpayer dollars, especially for a progressively diverse population.”