Rollins School of Public Health, Emory University, Atlanta, GA.
Rollins School of Public Health, Emory University, Atlanta, GA.
J Am Acad Child Adolesc Psychiatry. 2019 Jan;58(1):128-138. doi: 10.1016/j.jaac.2018.04.025. Epub 2018 Oct 17.
To examine racial and ethnic disparities in the receipt of minimally adequate depression treatment in Medicaid-enrolled youth.
Medicaid claims data of 2008 through 2011 were used to derive a cohort of youth (5-17 years old) who were diagnosed with a new episode of major depression (N = 45,816) across 9 states. Dichotomous outcomes measured the receipt of minimally adequate psychotherapy (≥4 psychotherapy visits within 12 weeks of initiation); minimally adequate medication (filled antidepressants for 84 of 144 days); any minimally adequate treatment (psychotherapy or medication); and no psychotherapy or medication. Racial/ethnic disparities in the outcome measures were estimated using logistic regression models that controlled for predisposing, enabling, and need-related factors.
Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. Adjusted percentages of black (42.3%; p < .001) and Hispanic (48.2%; p < .001) youth who received minimally adequate treatment were significantly smaller than for non-Hispanic whites (54.7%) because of lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. In addition, adjusted percentages of black (20.2%; p < .001) and Hispanic (15.0%; p < .01) youth who received no treatment were significantly larger than for non-Hispanic white youth (12.9%).
The percentage of Medicaid-enrolled youth who receive minimally adequate treatment for depression is small overall and even smaller for racial/ethnic minorities than for whites. Future research is needed to identify strategies that improve the overall quality of depression treatment in Medicaid-enrolled youth and decrease disparities in care.
研究医疗补助计划中接受青少年接受轻度足够抑郁治疗的种族和民族差异。
使用 2008 年至 2011 年的医疗补助索赔数据，从 9 个州中得出了一个患有新发作的重度抑郁症（N=45816 名 5-17 岁的青少年）队列。二项结果衡量了接受轻度足够的心理治疗（在开始后的 12 周内接受≥4 次心理治疗）的情况；轻度足够的药物治疗（在 144 天内服用 84 天抗抑郁药）；任何轻度足够的治疗（心理治疗或药物治疗）；以及没有接受心理治疗或药物治疗。使用逻辑回归模型估计种族/民族差异，该模型控制了倾向、使能和与需求相关的因素。
不到十分之四（38.3%）的队列接受了轻度足够的心理治疗，19.2%接受了轻度足够的药物治疗，49.9%接受了任何轻度足够的治疗；相反，16.4%的人没有接受治疗。调整后的黑人（42.3%；p<.001）和西班牙裔（48.2%；p<.001）青少年接受轻度足够治疗的比例明显低于非西班牙裔白人（54.7%），因为他们接受轻度足够心理治疗和/或轻度足够药物治疗的可能性较低。此外，调整后的黑人（20.2%；p<.001）和西班牙裔（15.0%；p<.01）青少年未接受治疗的比例明显高于非西班牙裔白人青少年（12.9%）。
总体而言，接受医疗补助计划的青少年接受轻度足够的抑郁症治疗的比例很小，少数民族的比例甚至比白人青少年更小。需要进一步研究以确定可提高医疗补助计划中接受青少年的抑郁症整体治疗质量并减少护理差异的策略。
