Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J Natl Med Assoc. 2011 Jul;103(7):576-84. doi: 10.1016/s0027-9684(15)30383-7.
Racial differences in the clinical nature of major depressive disorder (MDD) could contribute to treatment disparities, but national data with large samples are limited. Our objective was to examine black-white differences in clinical characteristics and treatment for MDD from one of the largest, national community samples of US adults.
Non-Hispanic black and white adults (n=32752) from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions produced data on 1866 respondents who met criteria for MDD based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) in the preceding 12 months. Outcome measures were depressive symptoms, comorbid psychiatric and medical disorders, disability, and treatment.
Blacks with MDD had significantly higher odds of initial insomnia, early-morning awakening, and restlessness than whites. Odds of hypertension (odds ratio [OR), 2.16; 95% confidence interval [CI], 1.48-3.14), obesity (OR, 1.98; 95% CI, 1.45-2.69), and liver disease (OR, 3.68; 95% CI, 1.20-11.30) were higher among blacks than whites. In unadjusted models, blacks had greater impairment than whites in social and physical functioning. However, adjusting for sociodemographic characteristics eliminated these differences. Blacks were less likely than whites to receive outpatient services (OR, 0.51; 95% CI, 0.36-0.72) and be prescribed medications for MDD, but were more likely to receive emergency room and inpatient treatment.
We found few racial differences in depressive symptoms, psychiatric comorbidity, and disability after adjusting for sociodemographic factors. Blacks' lower utilization of ambulatory treatment for MDD and greater medical comorbidity, emergency department use, and hospitalization suggests that management of MDD among blacks should be emphasized in primary care or other settings where treatment is more accessible.
重度抑郁症（MDD）的临床表现存在种族差异，这可能导致治疗上的差异，但目前全国范围内的大样本数据有限。我们的目的是从美国最大的成人社区样本之一中，研究非西班牙裔黑人和白人之间 MDD 的临床特征和治疗的差异。
2001-2002 年全国酒精相关状况和流行病学调查的非西班牙裔黑人和白人成年人（n=32752）中，有 1866 名符合 12 个月内 MDD 诊断标准的受访者（基于精神疾病诊断与统计手册第四版）提供了数据。结果测量包括抑郁症状、共病精神和医学疾病、残疾和治疗。
与白人相比，患有 MDD 的黑人出现初始失眠、清晨早醒和不安的几率明显更高。黑人患有高血压的几率（比值比[OR]，2.16；95%置信区间[CI]，1.48-3.14）、肥胖（OR，1.98；95% CI，1.45-2.69）和肝脏疾病（OR，3.68；95% CI，1.20-11.30）的几率高于白人。在未调整的模型中，黑人的社会和身体功能障碍比白人更严重。然而，调整社会人口统计学特征后，这些差异就消失了。黑人接受门诊服务的可能性（OR，0.51；95% CI，0.36-0.72）和 MDD 药物治疗的可能性低于白人，但更有可能接受急诊室和住院治疗。
在调整社会人口统计学因素后，我们发现抑郁症状、精神共病和残疾方面的种族差异很少。黑人对 MDD 的门诊治疗利用度较低，且共病较多，急诊室就诊和住院治疗的几率较高，这表明在初级保健或其他更容易获得治疗的环境中，应加强对黑人 MDD 的管理。
