Despite a high prevalence of depressive symptoms, black and Hispanic patients with type 2 diabetes are significantly less likely to receive antidepressants compared with white patients, according to study results published in The Journal of Diabetes and Its Complications.
The study included baseline data from patients with type 2 diabetes who took part in a randomized trial that evaluated a health literacy intervention for diabetes care in safety net clinics (n=403). The researchers measured depressive symptoms using the Center for Epidemiological Studies Depression Scale. Antidepressant use was abstracted from medication lists.
Multivariable mixed-effect logistic regression analysis was used to evaluate the relationship between antidepressant use and race/ethnicity, adjusting for depressive symptom score, age, sex, income, and health literacy.
Of all patients, 58% were non-Hispanic white, 18% were non-Hispanic black, and 24% were Hispanic. The median age was 51 years and 60% of patients were women. Almost all patients were uninsured and more than half reported an annual income of <$10,000.
The results indicated that 52% of patients screened positively for depression. Of 400 patients with available data for antidepressant use, 18% were prescribed antidepressants.
Compared with white patients, black and Hispanic patients were significantly less likely to be on an antidepressant (adjusted odds ratio [aOR], 0.31; 95% CI, 0.12-0.79; and aOR 0.27; 95% CI, 0.10-0.75, respectively).
Age, income, number of recent clinic visits, and health literacy were not independently associated with the use of an antidepressant. Women, however, were more likely to be on antidepressants compared with men (aOR, 1.92; 95% CI, 1.04-3.55).
The researchers noted that a causal relationship between race and antidepressant use cannot be inferred given the study’s cross-sectional design. However, the results align with previous research that indicates that black and Hispanic patients with diagnosed depression are far less likely to receive antidepressant treatment. The investigators also did not evaluate patients’ attitudes toward antidepressant medication or the duration of care at participating clinics.
“To mitigate downstream effects of depression on outcomes in patients with type 2 diabetes, it is important to assess patients for depression and treat this condition appropriately in vulnerable populations, particularly racial and ethnic minorities,” the researchers wrote.
Presley CA, White RO, Bian A, Schildcrout JS, Rothman RL. Factors associated with antidepressant use among low-income racially and ethnically diverse patients with type 2 diabetes [published online July 15, 2019]. J Diabetes Complications. doi:10.1016/j.jdiacomp.2019.07.002