Objective

To examine racial and ethnic disparities in the receipt of minimally adequate depression treatment in Medicaid-enrolled youth.

Method

Medicaid claims data of 2008 through 2011 were used to derive a cohort of youth (5–17 years old) who were diagnosed with a new episode of major depression (N = 45,816) across 9 states. Dichotomous outcomes measured the receipt of minimally adequate psychotherapy (≥4 psychotherapy visits within 12 weeks of initiation); minimally adequate medication (filled antidepressants for 84 of 144 days); any minimally adequate treatment (psychotherapy or medication); and no psychotherapy or medication. Racial/ethnic disparities in the outcome measures were estimated using logistic regression models that controlled for predisposing, enabling, and need-related factors.

Results

Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. Adjusted percentages of black (42.3%; p < .001) and Hispanic (48.2%; p < .001) youth who received minimally adequate treatment were significantly smaller than for non-Hispanic whites (54.7%) because of lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. In addition, adjusted percentages of black (20.2%; p < .001) and Hispanic (15.0%; p < .01) youth who received no treatment were significantly larger than for non-Hispanic white youth (12.9%).

Conclusion

The percentage of Medicaid-enrolled youth who receive minimally adequate treatment for depression is small overall and even smaller for racial/ethnic minorities than for whites. Future research is needed to identify strategies that improve the overall quality of depression treatment in Medicaid-enrolled youth and decrease disparities in care.

中文翻译：

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参加医疗补助的青少年在最低程度的抑郁症护理方面的种族和民族差异

 客观的

调查参加医疗补助的青少年在接受最低限度抑郁症治疗方面的种族和民族差异。

 方法

使用 2008 年至 2011 年医疗补助索赔数据得出了 9 个州被诊断患有新一期重度抑郁症的青少年（5-17 岁）队列（N = 45,816）。二分结果衡量是否接受了最低限度的充分心理治疗（开始后 12 周内≥4 次心理治疗就诊）；最低限度充足的药物治疗（144 天中的 84 天服用抗抑郁药）；任何最低限度的适当治疗（心理治疗或药物治疗）；并且没有心理治疗或药物治疗。结果测量中的种族/民族差异是使用逻辑回归模型来估计的，该模型控制了诱发因素、促成因素和需求相关因素。

 结果

该队列中不到十分之四 (38.3%) 的人接受了最低限度的充分心理治疗，19.2% 的人接受了最低限度的充分药物治疗，49.9% 的人接受了任何最低限度充分的治疗；相反，16.4% 的人没有接受治疗。接受最低限度充分治疗的黑人 (42.3%; p < .001) 和西班牙裔 (48.2%; p < .001) 青少年的调整后百分比明显低于非西班牙裔白人 (54.7%)，因为接受最低限度治疗的可能性较低充分的心理治疗和/或最低限度的充分药物治疗。此外，调整后未接受治疗的黑人（20.2%； p < .001）和西班牙裔（15.0%； p < .01）青年的百分比显着高于非西班牙裔白人青年（12.9%）。

 结论

参加医疗补助计划的年轻人中，接受最低程度的抑郁症治疗的比例总体来说很小，少数种族/族裔的比例甚至比白人还要低。未来的研究需要确定提高参加医疗补助的青少年抑郁症治疗整体质量并减少护理差异的策略。