Depression and health-related quality of life in ethnic minorities seekingcare in general medical settings

Background: To examine ethnic groups differences in (a) prevalence of depre ssive disorders and (b) health related quality of life in fee-for-service a nd managed care patients (n = 21 504) seeking care in general medical setti ngs. Methods: Data are from the Medical Outcomes Study, a multi-site observ ational study of outpatient practices. The study screened patients of clini cians (family practice, internal medicine, cardiology, diabetology and endo crinology) for four chronic medical conditions; depression, coronary heart disease, hypertension and diabetes. A brief eight-item depression screener followed by the Diagnostic Interview Schedule-Depression Section (DIS) for screener positives identified depressed patients (n = 2195). The Short Form Health Survey (SF-36) assessed health-related quality of life. Patient sel f-report determined ethnicity. Results: Before adjusting for demographic fa ctors, African-Americans and Hispanics had highest rates of depressive symp toms, Asian-Americans had the lowest. After adjusting for demographics (par ticularly gender and income), we found few statistically significant differ ences in prevalence or severity of depression. However, among the depressed , Whites were the most, and African-Americans the least likely to report su icidal ideation (p < 0.01), and Hispanics and Whites were more likely to ha ve melancholia (p < 0.01). African-Americans reported the poorest quality o f life. Limitations: DSM III criteria (though few changes in DSM IV), and r elatively small sample size of Asian-Americans compared to other groups. Co nclusions: Gender and socioeconomic status are more significant factors tha n ethnicity in determining risk for depressive disorder. However, ethnic di fferences in symptom presentation, and health-related quality of life could have clinical and social consequences, and merit further study. (C) 2000 E lsevier Science B.V. All rights reserved.