Citation

Merced K, Imel ZE, Baldwin SA, Fischer H, Yoon T, Stewart C, Simon G, Ahmedani B, Beck A, Daida Y, Hubley S, Rossom R, Waitzfelder B, Zeber JE, Coleman KJ. Psychiatr. Serv. 2020; ePub(ePub): ePub.

Affiliation

Department of Educational Psychology, University of Utah, Salt Lake City (Merced, Imel); Department of Clinical Psychology, Brigham Young University, Provo, Utah (Baldwin); Kaiser Permanente, Pasadena, California (Fischer, Yoon, Coleman), Seattle (Stewart, Simon), Denver (Beck), and Honolulu (Daida, Waitzfelder); Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Ahmedani); University of Colorado School of Medicine, Aurora (Hubley); HealthPartners Institute, Minneapolis (Rossom); Veterans Evidence-Based Research, Dissemination, and Implementation Center, South Texas Veterans Health Care System, San Antonio (Zeber).

Copyright

(Copyright © 2020, American Psychiatric Association)

DOI

10.1176/appi.ps.201800500

PMID

32340593

Abstract

OBJECTIVE: Disparities in diagnosis of mental health problems and in access to treatment among racial-ethnic groups are apparent across different behavioral conditions, particularly in the quality of treatment for depression. This study aimed to determine how much disparities differ across providers.

METHODS: Bayesian mixed-effects models were used to estimate whether disparities in patient adherence to antidepressant medication (N=331,776) or psychotherapy (N=275,095) were associated with specific providers. Models also tested whether providers who achieved greater adherence to treatment, on average, among non-Hispanic white patients than among patients from racial-ethnic minority groups attained lower disparities and whether the percentage of patients from racial-ethnic minority groups in a provider caseload was associated with disparities.

RESULTS: Disparities in adherence to both antidepressant medication and psychotherapy were associated with the provider. Provider performance with non-Hispanic white patients was negatively correlated with provider-specific disparities in adherence to psychotherapy but not to antidepressants. A higher proportion of patients from racial-ethnic minority groups in a provider's caseload was associated with lower adherence among non-Hispanic white patients, lower disparities in adherence to psychotherapy, and greater disparities in adherence to antidepressant medication.

CONCLUSIONS: Adherence to depression treatment among a provider's patients from racial-ethnic minority groups was related to adherence among that provider's non-Hispanic white patients, but evidence also suggested provider-specific disparities. Efforts among providers to decrease disparities might focus on improving the general skill of providers who treat more patients from racial-ethnic minority groups as well as offering culturally based training to providers with notable disparities.

Language: en

Keywords

Bayesian multilevel modeling; adherence; cross-cultural issues; cultural competence; provider effects; racial-ethnic mental health disparities; treatment adherence