Protocol for studying racial/ethnic disparities in depression care using joint information from participant surveys and administrative claims databases: an observational cohort study

IntroductionCurrent evidence indicates that older racial/ethnic minorities encounter disparities in depression care. Because late-life depression is common and confers major adverse health consequences, it is imperative to reduce disparities in depression care. Thus, the primary objectives of this protocol are to: (1) quantify racial/ethnic disparities in depression treatment and (2) identify and quantify the magnitude of these disparities accountable for by a multifactorial combination of patient, provider and healthcare system factors.Methods and analysisData will be derived from the Vitamin D and Omega-3 Trial-Depression Endpoint Prevention (VITAL-DEP) study, a late-life depression prevention ancillary study to the VITAL trial. A total of 25 871 men and women, aged 50+ and 55+ years, respectively, were randomised in a 2×2 factorial randomised trial of heart disease and cancer prevention to receive vitamin D and/or fish oil for 5 years starting from 2011. Most participants were aged 65+ years old at randomisation. Medicare claims data for over 19 000 VITAL/VITAL-DEP participants were linked to conduct our study.The major study outcomes are depression treatment (antidepressant use and/or receipt of psychotherapy services) and adherence to medication treatment (antidepressant adherence and acceptability). The National Academy of Medicine framework for studying racial disparities was leveraged to select patient-level, provider-level and healthcare system-level variables and to address their potential roles in depression care disparities. Blinder-Oaxaca regression decomposition methods will be implemented to quantify and identify correlates of racial/ethnic disparities in depression treatment and adherence.Ethics and disseminationThis study received Institutional Review Board (IRB) approval from the Partners Healthcare (PHS) IRB, protocol# 2010P001881. We plan to disseminate our results through publication of manuscripts patient engagement activities, such as study newsletters regularly sent out to VITAL participants, and presentations at scientific meetings.Trial registration numberNCT01696435.

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Geographic Regional Variation in Patterns of Racial and Ethnic Disparities in Late-Life Depression

Innovation in Aging ◽

10.1093/geroni/igaa057.545 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 168-168

Author(s):

Chirag Vyas ◽

Charles Reynolds ◽

David Mischoulon ◽

Grace Chang ◽

Olivia Okereke

Keyword(s):

Native American ◽

Ethnic Differences ◽

Ethnic Disparities ◽

Late Life ◽

Geographic Region ◽

Omega 3 ◽

Late Life Depression ◽

Item Level ◽

Racial Ethnic ◽

Hispanic White

Abstract There is evidence of racial/ethnic disparities in late-life depression (LLD) burden and treatment in the US. Geographic region may be a novel social determinant; yet, limited data exist regarding the interplay of geographic region with racial/ethnic differences in LLD severity, item-level symptom burden and treatment. We conducted a cross-sectional study among 25,503 men aged 50+ years and women aged 55+ years in VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary study to the VITAL trial. Racial/ethnic groups included Non-Hispanic White, Black, Hispanic, Asian, and other groups (Native American/Alaskan Native and other/multiple/unspecified-race/ethnicity). We assessed depression status using: the Patient Health Questionnaire-8 (PHQ-8); self-reported clinician/physician diagnosis of depression; medication and/or counseling treatment for depression. In the full sample, Midwest region was significantly associated with 12% lower severity of LLD, compared to Northeast region (rate ratio (RR) (95% confidence interval (CI)): 0.88 (0.83-0.93)). However, racial/ethnic differences in LLD varied by region. For example, in the Midwest, Blacks and Hispanics had significantly higher depression severity compared to non-Hispanic Whites (RR (95% CI): for Black, 1.16 (1.02-1.31); for Hispanic, 2.03 (1.38-3.00)). Furthermore, in multivariable-adjusted logistic regression models, minority vs. non-Hispanic White adults had 2- to 3-fold significantly higher odds of several item-level symptoms across all regions, especially in the Midwest and Southwest. Finally, among those endorsing PHQ-8≥10, Blacks had 60-80% significantly lower odds of depression treatment, compared to non-Hispanic Whites, in all regions. In summary, we observed significant geographic variation in patterns of racial/ethnic disparities in LLD outcomes. This requires further longitudinal investigation.

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Geographic region, racial/ethnic disparities and late-life depression: results from a large US cohort of older adults

American Journal of Geriatric Psychiatry ◽

10.1016/j.jagp.2021.11.010 ◽

2021 ◽

Author(s):

Chirag M. Vyas ◽

Charles F. Reynolds ◽

Macarius Donneyong ◽

David Mischoulon ◽

Grace Chang ◽

...

Keyword(s):

Older Adults ◽

Ethnic Disparities ◽

Late Life ◽

Geographic Region ◽

Late Life Depression ◽

Racial Ethnic

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Comment on Vitamin D serum levels are cross-sectionally but not prospectively associated with late-life depression

Acta Psychiatrica Scandinavica ◽

10.1111/acps.12798 ◽

2017 ◽

Vol 136 (5) ◽

pp. 527-528 ◽

Cited By ~ 2

Author(s):

T. C. Griffen

Keyword(s):

Vitamin D ◽

Late Life ◽

Serum Levels ◽

Late Life Depression

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Preventing late-life depression: a clinical update

International Psychogeriatrics ◽

10.1017/s1041610210000864 ◽

2010 ◽

Vol 22 (8) ◽

pp. 1216-1224 ◽

Cited By ~ 25

Author(s):

Robert C. Baldwin

Keyword(s):

Risk Factors ◽

Primary Prevention ◽

Depressive Disorder ◽

Functional Limitation ◽

Late Life ◽

Current Evidence ◽

Secondary Outcome ◽

Late Life Depression ◽

Current Evidence Base ◽

The Impact

ABSTRACTBackground: Achieving remission in late-life depressive disorder is difficult; it is far better to prevent depression. In the last ten years there have been a number of clinical studies of the feasibility of prevention.Methods: A limited literature review was undertaken of studies from 2000 specifically concerning the primary prevention of late-life depressive disorder or where primary prevention is a relevant secondary outcome.Results: Selective primary prevention (targeting individuals at risk but not expressing depression) has been shown to be effective for stroke and macular degeneration but not hip fracture. It may also prove effective for the depression associated with caregiving in dementia. Emerging evidence finds effectiveness for indicated prevention (in those identified with subthreshold depression often with other risk factors such as functional limitation). Despite a number of promising risk factors (for example, diet, exercise, vascular risk factors, homocysteine and insomnia), universal prevention of late-life depression (acting to reduce the impact of risk factors at the population level) has no current evidence base, although a population approach might mitigate suicide.Conclusion: Interventions which work in preventing late-life depression include antidepressant medication in standard doses and Problem-Solving Treatment. When integrated into a care model, such as collaborative care, prevention is feasible but more economic studies are needed.

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Racial/Ethnic Disparities in Young Adulthood and Midlife Cardiovascular Risk Factors and Late-life Cognitive Domains

Alzheimer Disease & Associated Disorders ◽

10.1097/wad.0000000000000436 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Rachel L. Peterson ◽

Kristen M. George ◽

Paola Gilsanz ◽

Sarah Ackley ◽

Elizabeth R. Mayeda ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Young Adulthood ◽

Ethnic Disparities ◽

Late Life ◽

Cognitive Domains ◽

Racial Ethnic

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STRENGTHENING LATE-LIFE DEPRESSION COLLABORATIVE CARE THROUGH COMMUNITY ENGAGEMENT: CARE PARTNERS INITIATIVE

Innovation in Aging ◽

10.1093/geroni/igz038.2120 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S572-S573

Author(s):

Ladson Hinton ◽

Theresa J Hoeft ◽

Stuart Henderson ◽

Melissa M Gosdin ◽

Laura Rath ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Collaborative Care ◽

Late Life ◽

Lessons Learned ◽

Successful Implementation ◽

Depression Care ◽

Late Life Depression ◽

Primary Care Clinics ◽

Care Partners

Abstract Despite the availability of effective treatments for late life depression, many older adults with depression either do not access or fully engage in treatment. The goal of this study was to examine the feasibility and two-year outcomes from an Archstone Foundation funded Care Partners Initiative to strengthen depression care for adults 65 years of age and older. Seven sites throughout California implemented evidence-based collaborative care through partnerships between primary care organizations, community-based organizations (CBOs), and families of older adults with depression. Evaluation used a mixed-methods approach incorporating both qualitative and quantitative data. Of the seven sites, six formed partnerships between primary care clinics and CBOs and one site only focused on engaging family members in treatment. In the first two years, 274 patients were enrolled and rates of depression improvement were comparable to prior depression care effectiveness trials. Overall, 49% of patients at CBO sites interacted 3+ times with CBO staff/clinicians, while at the family site, 79% of patients had 3+ contacts including a family member. Using data from key informant interviews, focus groups, and site progress documents, seven core components were identified that facilitated successful implementation and delivery of partnered collaborative care, including three foundational components: strong stakeholder buy-in, effective patient engagement, and the promotion of depression treatment as a core value across organizations. Multiple complexities of partnering between primary care clinics and CBOs or families were identified. Challenges and lessons learned from this initiative will also be discussed.

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