Fatigue, feelings of worthlessness, and recurring thoughts of death: these are some of the symptoms of major depression. It’s a disorder that affects approximately 14.8 million American adults in a given year, according to the National Institute of Mental Health.
Hector Gonzalez, professor of the Institute of Gerontology and the Family Medicine and Public Health Sciences department at the Wayne State School of Medicine, with his team of researchers, conducted a study on major depression care among different ethnic and racial groups in the United States. The Archives of General Psychiatry published their paper in January 2010.
“The surprising part was how few people are getting good or adequate care as we defined it,” Gonzalez said.
According to the study, about half of the population gets some kind of depression care. Among the fewest receiving treatment were African-Americans and Mexican-Americans.
Not only were differences between minorities and the rest of population noted, but differences within the minorities, too.
Gonzalez’s study, which included researchers from universities like Harvard University, the University of California, Los Angeles and the University of Michigan, looked at discreet ethnic subgroups, which he said hadn’t been done before.
“I think that’s a good question why folks haven’t looked at subgroups, Latinos in particular,” he said. “That’s where we found the most interesting findings, because what we’ve seen in the past is that when you compare Latinos as a group to whites, they look about the same.”
This happens because not all Latino groups get the same depression treatment. For example, Gonzalez said, Puerto Ricans in the study had better treatment rates than whites.
“So, if you average them up together they look about the same. You break them out and you get to see the important differences,” he said. “It really makes no sense to lump people together.”
The purpose of the study was to understand who is getting adequate major depression care, who is not getting the care and how to fix the division.
“Pretty straightforward,” Gonzalez said. “Nothing fancy.”
In addition to the low numbers receiving care, researchers found new information on treatment method trends.
“I was very surprised … that antidepressant use was lower than psychotherapy use,”
Gonzalez said. “What was interesting, too, but not surprising, was that the psychotherapy use among African-Americans and Mexican-Americans, in particular, was proportionally higher than it was for whites.”
In general, people in the study did not prefer prescription psychotropic or mind-altering drugs — including antidepressants.
“We didn’t know what the distributions were in the U.S. between psychotherapy use and antidepressant use among people with depression,” Gonzalez said.
Results showing psychotherapy being used alone to treat depression worries clinical psychologists, like Gonzalez, that people are not getting the proper care.
“People say disparities, disparities, disparities,” he said. “That was another objective: try to define disparities. And, yes, we did, as opposed to other studies that say disparities without being careful about how they define those terms.”
Gonzalez said that the Institute of Medicine defines disparities as differences that are due to access to care, called enabling factors, not preferences. In the study, these enabling factors such as income, education and health insurance did not explain the disparities.
“What seems to be the driving difference is ethnic racial differences,” he said. “It’s to say that maybe there are some communication problems or cultural differences that contribute to under-diagnosis and under-treatment.”
A part of these differences is the weighty stigma often attached to depression.
“I think that explains some of it. And that’s really hard to fix,” Gonzalez said. “But I think really the crux of the issue is the healthcare system. That’s something we can fix.”
Gonzalez said the behavioral-health system is not integrated well into general medicine, which is part one of the solution to reduce hurdles to healthcare. The healthcare structures are much easier to fix than attitudes, he said.
President Barack Obama’s health care plan promises to do just that: reform the health care structure by providing affordable and accessible healthcare to all.
“Is that the solution?” Gonzalez asked. “I think that’s a good step in the right direction.”
He said it’s always important to look at demographic shifts, whether you’re in the business of shoes, cars or healthcare. He said U.S. census results show that from 2000 to 2008 the Latino population grew from 14 to 16 percent.
“I think my research will be useful,” he said. “And I think this is the main point that let’s be ready for what’s going to happen in the coming years.”
There isn’t a focus on Latino health at WSU now, Gonzalez said, but it will be necessary if they want to look to the future of healthcare.
“If they don’t they’ll be caught off guard just like the rest of the country will be caught off guard,” he said. “If we want to maintain a healthy population let’s start planning for the future. And the future is the Latinization, as folks have called it, of America. Plain and simple.”
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