Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA.
Bureau of Epidemiology, Houston Health Department, Houston, TX, USA.
Child Adolesc Ment Health. 2020 Feb;25(1):28-35. doi: 10.1111/camh.12359. Epub 2019 Dec 5.
To compare the racial/ethnic differences in treatment quality among youth with primary care provider-initiated versus mental health specialist-initiated care for major depressive disorders (MDD).
A retrospective cohort study was conducted using the 2005-2007 Medicaid claims data from Texas. Youth aged 10-20 during the study period were identified if they had two consecutive MDD diagnoses and received either medications for MDD or psychotherapy. Patients who received ≥84 days of medications and/or ≥4 sessions of psychotherapy for MDD treatment during 4 months of follow-up were considered meeting the minimum adequacy of treatment.
The generalized linear multilevel model (MLM) analysis revealed that both Hispanics and Blacks were approximately 30% less likely to receive adequate treatment (Hispanics - OR: 0.67; 95% CI: 0.6-0.8) (Blacks - OR: 0.66; 95% CI: 0.6-0.8) and Hispanic children were 50% more likely to undergo MH-related hospitalization (OR: 1.53; 95% CI: 1.1-2.2) compared to their White counterparts. The odds of meeting the minimum MDD treatment adequacy were comparable between pediatric MDD cases first identified by primary care providers (PCP-I) and psychiatrists (PSY-I) (PCP-I vs. PSY-I: OR: 0.97; 95% CI: 0.8-1.2), and slightly lower in those first identified by social workers/psychologists (SWP-I) as compared to PSY-I (SWP-I vs. PSY-I: OR: 0.81; 95% CI: 0.7-0.9). In all models, the interaction between race/ethnicity and type of provider who initiated MDD care was not statistically significant.
Minority youths received less adequate MDD treatment compared to Whites. Hispanic children had the highest risk of having mental health-related hospitalization. The specialty of provider who initiated MDD care had limited impact on treatment quality and was not associated with the racial/ethnic variations in treatment completion and mental health-related hospitalizations.
比较初级保健提供者发起与心理健康专家发起的青少年重度抑郁症（MDD）治疗质量的种族/民族差异。
使用来自德克萨斯州的 2005-2007 年医疗补助索赔数据进行回顾性队列研究。如果研究期间患者有连续两次 MDD 诊断，并接受 MDD 的药物治疗或心理治疗，则将其确定为患者。在 4 个月的随访期间，如果患者接受 MDD 治疗的药物治疗≥84 天和/或心理治疗≥4 次，则认为符合最低充分治疗标准。
广义线性多层模型（MLM）分析显示，西班牙裔和黑人接受充分治疗的可能性分别降低了约 30%（西班牙裔 - OR：0.67；95%CI：0.6-0.8）（黑人 - OR：0.66；95%CI：0.6-0.8），与白人相比，西班牙裔儿童更有可能接受与心理健康相关的住院治疗（OR：1.53；95%CI：1.1-2.2）。与精神科医生（PSY-I）相比，首先由初级保健提供者（PCP-I）和精神科医生（PSY-I）确定的 MDD 病例达到最低 MDD 治疗充分性的可能性相当（PCP-I 与 PSY-I：OR：0.97；95%CI：0.8-1.2），而与 PSY-I 相比，首先由社会工作者/心理学家（SWP-I）确定的病例的可能性略低（SWP-I 与 PSY-I：OR：0.81；95%CI：0.7-0.9）。在所有模型中，种族/民族与发起 MDD 治疗的提供者类型之间的相互作用均无统计学意义。
与白人相比，少数族裔青少年接受的 MDD 治疗不够充分。西班牙裔儿童有最高的心理健康相关住院风险。发起 MDD 治疗的提供者的专业水平对治疗质量的影响有限，并且与治疗完成和心理健康相关住院治疗的种族/民族差异无关。
