Trends in the rate of depressive illness and use of antidepressant pharmacotherapy by ethnicity/race: An assessment of office-based visits in the United States, 1992-1997

Objective: This study was undertaken to determine ethnicity/race-specific ( white, black, and Hispanic) population-adjusted rates of US office-based ph ysician visits in which a diagnosis of a depressive disorder was recorded o r in which a diagnosis of a depressive disorder was recorded and antidepres sant pharmacotherapy was prescribed. Methods: Data from the National Ambulatory Medical Care Survey for 1992 thr ough 1997 were partitioned into three 2-year periods: 1992-1993, 1994-1995, and 1996-1997. For each 2-year period, data from office-based physician vi sits for patients aged 20 to 79 years were extracted to assess, by ethnicit y/race, (1) the number of visits in which a diagnosis of a depressive illne ss was recorded (International Classification of Diseases, Ninth Revision, Clinical Modification codes 296.2-296.36, 300.4, or 311) and (2) the number of visits in which a diagnosis of a depressive illness was recorded and an tidepressant pharmacotherapy was prescribed. We calculated ethnicity/race-s pecific rates (per 100 US population aged 20 to 79 years) of office-based v isits in which a diagnosis of a depressive disorder was recorded and in whi ch a diagnosis of a depressive disorder was recorded and antidepressant pha rmacotherapy was prescribed. The specialty of the reporting physician and t he proportion of patients receiving a selective serotonin reuptake inhibito r (SSRI) were also discerned. Results: From 1992-1993 to 1996-1997, the rate of office-based visits (per 100 US population aged 20 to 79 years) in which a diagnosis of a depressive disorder was recorded increased 3.7% for whites (from 10.9 to 11.3; P = 0. 001), 31.0% for blacks (from 4.2 to 5.5; P = 0.001), and 72.9% for Hispanic s (from 4.8 to 8.3; P = 0.001). The rate of office-based visits in which a diagnosis of a depressive disorder was recorded and antidepressant pharmaco therapy was prescribed increased 18.5% for whites (from 6.5 to 7.7 per 100; P = 0.001), 38.5% for blacks (from 2.6 to 3.6 per 100; P = 0.001), and 106 .7% for Hispanics (from 3.0 to 6.2 per 100; P = 0.001). Between 1992-1993 a nd 1996-1997, use of an SSRI increased among whites and blacks (from 50.0% to 65.8% and from 40.5% to 58.2%, respectively), but declined among Hispani cs (from 51.4% to 48.6%; all comparisons P = 0.001). Conclusion: By 1996-1997, the population-adjusted rates for Hispanics were within a quartile of those observed for whites, whereas the rates for black s remained at less than half those observed in whites. The observed diverge nce in population-adjusted rates by ethnicity/race may reflect the nature o f the patient-physician relationship, sensitivity and specificity of diagno stic techniques and instruments, and the wider social context in which an o ffice-based visit occurs, including access to and type of health insurance and coverage for mental health services.