Among adolescents with MDE, only 38% received any MDE treatment, 17% took prescription medication for MDE, 30% received MDE treatment from a mental health specialist, and 11% received MDE treatment from a medical provider (). When examining measures of past year mental health treatment across settings, 5% had an inpatient stay, 36% had an outpatient visit, and 25% received counseling in a school setting. When comparing these measures across racial/ethnic groups using Wald tests, results indicate that Blacks, Hispanics, and Asians are significantly less likely than non-Hispanic Whites to receive any MDE treatment (p<0.01), use prescription medication for MDE (p<0.001), receive MDE treatment from a mental health specialist (p<0.01), receive MDE treatment from a medical professional (p<0.001), and have a mental health visit in an outpatient setting (p<0.001). Blacks, Hispanics, and Asians also have lower family incomes (p<0.001) and are less likely to have private health insurance (p<0.05) than non-Hispanic Whites.
Weighted descriptive statistics for pooled sample of U.S. adolescents with past year major depression (2004–2008)
Controlling for demographics and health status (, Model 1), the absolute percentage of racial/ethnic minorities who received any MDE treatment is between 7.6 (Blacks: 95% CI=−12.3%, −3.0%) and 21.0 percentage points lower (Asians: 95% CI= −29.1%, −12.9%) than among non-Hispanic Whites. In other words, the adjusted percentages of those who received any MDE treatment are 31.9% for blacks, 31.0% for Hispanics, and 18.5% for Asians, compared to 39.5% for non-Hispanic whites. These adjusted percentages for each racial/ethnic group are depicted graphically in , where the height difference between the bars corresponds to the adjusted risk differences estimated in this model. After including family income and insurance status, these risk differences are slightly reduced for each group but remain statistically significant (, Model 2).
Racial/ethnic differences in the receipt of any treatment and prescription medication for major depression among U.S. adolescents
Figure 1 Adjusted percentage of U.S. adolescents who received treatment for major depression by race/ethnicity. Note: N=7,618. Results from multivariate probit models adjusting for age, gender, family status, depression-related impairment, substance abuse/dependence, (more ...)
Results examining racial/ethnic differences in the use of prescription medication yield a similar pattern (, Model 3). Among racial/ethnic minorities, the absolute percentage of adolescents who use prescription medication for MDE is between 11.2 (Hispanics: 95% CI=−13.9%, −8.6%) and 16.0 percentage points lower (Asians: 95% CI= −19.3%, −12.7%) relative to non-Hispanic Whites. Consequently, the adjusted percentages of adolescents who received prescription medication for MDE are 19.8% for non-Hispanic whites, 6.7% for blacks, 8.6% for Hispanics, and 3.8% for Asians (). As before, the inclusion of family income and insurance status slightly accounts for these differences, but the findings remain statistically significant (Model 4).
Blacks, Hispanics, and Asians are also significantly less likely than non-Hispanic whites to receive MDE treatment from a mental health professional or a medical provider (: Model 1, Model 3). Once again, the risk differences are largest for Asians. The adjusted percentage of non-Hispanic whites with MDE who received treatment from a mental health professional and a medical provider are 31.5% and 12.4%, respectively, compared to only 15.6% (RD=−16.0, 95% CI=−23.2%,−8.7%) and 2.2% (RD=−10.2, 95% CI=−12.8%,−7.5%) of Asians with MDE (). Although the inclusion of family income and insurance status slightly reduces these differences, they remain statistically significant (Model 2, Model 4).
Racial/ethnic differences in the receipt of treatment for major depression across provider types among U.S. adolescents
Results examining racial/ethnic differences in past year mental health treatment across settings among adolescents with MDE, irrespective of the problem that was treated, are presented in . Although there are no racial/ethnic differences in the likelihood of having an inpatient stay, there are significant differences in the likelihood of having an outpatient visit and receiving counseling in a school setting. Findings from Model 3 indicate that 39.7% (model based prediction not shown) of non-Hispanic whites received an outpatient mental health visit during the year, compared to only 27.9% of blacks (RD=−11.7%, 95% CI=−15.8%, −7.6%), 28.7% of Hispanics (RD=−11.0%, 95% CI=−14.9%,−7.0%), and 23.1% of Asians (RD=−16.5%, 95% CI=−25.5%,−7.5%). These differences are slightly reduced, but remain significant, after accounting for family income and insurance status (Model 4). Lastly, results from Model 5 show that the percentage of Hispanics (RD= −3.7%; 95% CI= −7.1%, −0.2%) and Asians (RD= −7.6%; 95% CI= −13.7%, −1.5%) who received counseling in a school setting is significantly lower than among non-Hispanic whites (24.5%; Model based prediction not shown).
Racial/ethnic differences in the receipt of past-year mental health treatment across settings among U.S. adolescents with major depression
Supplemental analyses further explored racial/ethnic differences in the number of outpatient visits among those who received any outpatient treatment. Among adolescents who received any outpatient visit, results from a negative binomial regression model indicated that Hispanics have approximately 2.8 fewer visits per year (95% CI = −5.0, −0.6) than non-Hispanic whites, who have approximately 13.6 visits per year. This difference was slightly reduced to 2.5 fewer visits among Hispanics after adjusting for family income and insurance status. Blacks and Asians, however, did not differ significantly from non-Hispanic whites in their number of outpatient visits. Lastly, supplemental models that also included language of interview and population density were virtually unchanged across all outcome measures.