There were some significant differences in sociodemographic characteristics of the racial/ethnic groups. African Americans were, on average, older and Latinos were younger compared to the other racial/ethnic groups (see ), while African American, Latino and Filipino subgroups had relatively higher proportions of women versus men compared to Asians and whites. Education also varied; Latinos were the least likely to have completed high school while Filipinos, Asians, and whites were the most likely to report having a college degree. There were no significant racial/ethnic differences in the distribution of depression symptom severity based on the self-reported screener (PHQ-8). There were significant differences in the number of medical visits across racial/ethnic groups. On average, African Americans had the highest number of visits during the follow-up period and Asians had the fewest number of visits. This utilization pattern tracked the significant differences in comorbidity burden, with the highest levels in African Americans, lowest in Asians, and intermediate and similar in Filipinos, Latinos, and Whites.
Sociodemographic Characteristics among survey respondents meeting depression criteria on the screener and not clinically recognized in the previous 12 months, by Race/Ethnicity* n= 910
Our first finding concerns the rate of CRD during the 12 months after self-reporting moderate to severe depressive symptoms (PHQ-8 ≥10) on our survey, among those whose depression was not currently recognized in the medical system (i.e., no CRD in the prior 12 months). In this sample, 12% (110/910) overall (12%, 8%, 8%, 14%, and 15% of African American, Asian, Filipino, Latino, and white patients, respectively), were clinically recognized (i.e. diagnosed, referred or treated for depression) within 12 months of each individual's survey date. The second finding concerns the relative differential in rates of clinical recognition across racial/ethnic groups (). In the unadjusted model, patients from each of the four racial/ethnic minority groups were less likely than whites to be clinically recognized for depression within 12 months, although the absolute differences in rates were small and was statistically significant only for Filipinos (RR: 0.33; CI: 0.17 to 0.65). Across all models, Filipinos remained significantly less likely to have CRD compared to whites. While Asians were less likely to have CRD compared to whites, these differences were not significant in any model. For Latinos and African Americans, differences were evident in some models but not others. Latinos were less likely than whites to have CRD when adjusted for age and sex in Model 2 (RR: 0.58; CI: 0.36 to 0.95) and for age, sex, depression severity and limitations on English proficiency in Model 3 (0.53; CI: 0.29 to 0.97), but was not significant either in the initial unadjusted model or when further adjusted for medical visits in Model 4 (RR: 0.57; CI:0.31 to 1.04) and Charlson index in Model 5 (RR: 0.57; CI:0.31 to 1.05). Differences in CRD between African Americans and whites were not significant in Models 1-3, but became significant once analyses were further adjusted for medical visits in Model 4 (RR= 0.58; CI: 0.35 to 0.97) and remained significant in Model 5 after adjusting for the Charlson index (RR= 0.58; CI: 0.35 to 0.97).
Adjusted Relative Risk Estimates of being diagnosed or treated for depression by clinician among survey respondents meeting depression criteria on the screener and not clinically recognized in the previous 12 months
Finally, we tested whether the race/ethnic differences in CRD were modified by sex but we found no statistically significant interactions between race/ethnicity and gender in our models of CRD, indicating that the patterns of clinical recognition variation across racial/ethnic groups were similar for men and women (analysis not shown).