Race/ethnic differences in receipt of evidence based treatment for depression among medicaid enrolled adults in Florida

Objective: The purpose of this study was to examine race/ethnicity differences in receipt of evidence based treatment for depression among Florida's Medicaid enrolled adults over age 18 with Major depressive disorder (MDD). We also examined the relationship between receipt of evidence based treatment, recipient outcomes and Medicaid expenditures.

Methods: This retrospective study used two and a half years of Medicaid claims, involuntary psychiatric commitment, and vital statistics data. We used regression analyses to determine the relative importance of race/ethnicity and other predictive factors for adherence to the APA guidelines for MDD and the relationship of service utilization and cost.

Results: In all, 15,950 persons met inclusion criteria. MDD increased with age. A little over three fourths (75.6 %) of the sample were female. Approximately 37.2% were identified as White, 9% as Black, 42.3% as Hispanic, and 11.5 as “Other”. Only 33% of participants received treatment that conformed to the APA guidelines. Overall, Hispanics were most likely to receive medication treatment that adhered to guidelines, while Whites were least likely. Blacks, Hispanics and those of Other race were likely to receive below APA dosing range of antidepressants when compared to Whites. Whites were more likely to receive polypharmacy (3+ antidepressants) while Blacks had the highest overall monthly healthcare costs.

Conclusions: Nonadherence to APA guidelines for MDD was the norm rather than the exception and race/ethnic disparities were found in treatment of MDD. These findings provide a basis for future research and clinical training initiatives.