Racial Differences in Antidepressant Use among Depressed Nursing Home Residents

Research Objectives: Rates of diagnosis of depression and its treatment with antidepressants have increased in nursing homes (NHs). However, treatment rates remain higher among whites than blacks. We test whether this is due to segregation of blacks into majority-black facilities.

Study Design: We examined effects of resident race and facility racial composition on antidepressant use using data from the 42,864 white residents and 4,016 black residents of Ohio nursing homes diagnosed with depression in the 1999-2000 Long-term Care Minimum Data Set (MDS). Resident-level data were merged with NH facility characteristics from the Online Survey Certification and Reporting (OSCAR) System and Area Resource File (ARF). Logistic regression models controlled for: resident sociodemographics, physical and cognitive limitations, physical and psychiatric comorbidities, and symptom severity; facility ownership structure, size, physician and nurse staffing, quality indicators, and aggregate resident characteristics; and community characteristics.

Principal Findings: Bivariate results indicated that 76.8% of depressed whites and 72.0% of depressed blacks used antidepressants (p<.001). Whites resided in facilities where on average 7.1% of residents were black. Blacks resided in facilities where on average 46.6% of residents were black (p<.001). In multivariate analyses, black race was associated with significantly lower odds (p<.001) of antidepressant use (OR=.878, CI .799-.964), but the proportion of facility residents who were black had no effect on these odds (OR=.803, CI .631-1.020).

Conclusions: Results suggest that while black NH residents were less likely than whites to be treated with antidepressants, this was not due to their segregation in majority black facilities.