Improving Depression Care has Long-lasting Benefits for African Americans and Hispanics

April 5, 2004

Nearly 19 million Americans suffer from a depressive disorder, and the cost in medical care and lost worker productivity is roughly $44 billion a year. Studies have shown that African American and Hispanic patients tend to have poorer quality care for depression and worse outcomes than non-Hispanic whites.

"Reducing racial and ethnic disparities in health care is an important priority across the Department of Health and Human Services," said AHRQ's Director, Carolyn M. Clancy, M.D. "This study shows one promising approach to ensure that all Americans receive high quality mental health care services and achieve lasting improvements in depression care outcomes."

At the start of the program, patients were randomly assigned to either standard primary care depression management or one of two programs which provided provider and patient education plus either practice therapists trained in providing Cognitive Behavioral Therapy, an effective psychotherapy for depression (QI-therapy) or specially trained nurses to help patients manage their medications (QI-meds). These special programs lasted 6 to 12 months. However, under both programs, patients could have either treatment, both treatments, or no treatment, and that choice was left up to the patients and their primary care clinicians. The study involved roughly 1,000 patients in community-based Medicaid and private managed care practices in CA, CO, TX, MD and MN.

When the patients were evaluated 4 years after the programs ended, the researchers found that relative to standard care, the two special programs reduced the overall percentage of patients with a probable depressive disorder by 6.6 percentage points. The QI-therapy program reduced the percentage of African American and Hispanic patients with depression, relative to those who received standard care only, by 20.2 percentage points, but only by 1.7 percentage points for non-Hispanic whites in the same program relative to those in standard care.

The QI-therapy program brought the rate of probable depressive disorder in African American and Hispanic patients down to 35.6 percent, close to the 34.4 percent rate for non-Hispanic whites in the same program. In contrast, while the depression rate of standard care non-Hispanic white patients also reached roughly 36 percent by the end of the study, almost 56 percent of the African American and Hispanic patients who received standard care still suffered from depression. Further, both programs reduced unmet need for treatment, or the percentage of patients who were still depressed but not receiving either medication or psychotherapy 5 years later.

The study's leader, Kenneth Wells, M.D., said, "These findings suggest that better care can have far-reaching consequences for the health and quality of life of depressed African American and Hispanic primary care patients, who otherwise are at high risk for unmet treatment needs and poor long-term health outcomes." Dr. Wells is a senior scientist at RAND and professor of psychiatry and behavioral sciences at the David Geffen School of Medicine and Neuropsychiatric Institute at UCLA.

The AHRQ, which funded the initial treatment phase of the study, supported the development of toolkits and training resources for the program.  Available at www.rand.org/health/partners.care/portweb. The National Institute of Mental Health supported the phase of the research that looked at the long-term depression rates and mental health-related quality of life.

"Five-Year Impact of Quality Improvement for Depression: Results of a Group-Level Randomized Controlled Trial," in the April 2004 issue of the Archives of General Psychiatry.