Wassim Tarraf

Depression care in the United States: too little for too few.

OBJECTIVE To determine the prevalence and adequacy of depression care among different ethnic and racial groups in the United States. DESIGN Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of depression care. SETTING The 48 coterminous United States. PARTICIPANTS Household residents 18 years and older (N = 15 762) participated in the study. MAIN OUTCOME MEASURES Past-year depression pharmacotherapy and psychotherapy using American Psychiatric Association guideline-concordant therapies. Depression severity was assessed with the Quick Inventory of Depressive Symptomatology Self-Report. Primary predictors were major ethnic/racial groups (Mexican American, Puerto Rican, Caribbean black, African American, and non-Latino white) and World Mental Health Composite International Diagnostic Interview criteria for 12-month major depressive episode. RESULTS Mexican American and African American individuals meeting 12-month major depression criteria consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies despite depression severity ratings not significantly differing between ethnic/racial groups. All groups reported higher use of any past-year psychotherapy and guideline-concordant psychotherapy compared with pharmacotherapy; however, Caribbean black and African American individuals reported the highest proportions of this use. CONCLUSIONS Few Americans with recent major depression have used depression therapies and guideline-concordant therapies; however, the lowest rates of use were found among Mexican American and African American individuals. Ethnic/racial differences were found despite comparable depression care need. More Americans with recent major depression used psychotherapy over pharmacotherapy, and these differences were most pronounced among Mexican American and African American individuals. This report underscores the importance of disaggregating ethnic/racial groups and depression therapies in understanding and directing efforts to improve depression care in the United States.

The epidemiology of major depression and ethnicity in the United States

OBJECTIVES To determine the prevalence, age of onset, severity, associated disability, and treatment of major depression among United States ethnic groups, national survey data were analyzed. METHODS National probability samples of US household residents aged 18-years and older (n=14,710) participated. The main outcomes were past-year and lifetime major depression (World Mental Health Composite International Diagnostic Interview). Major depression prevalence estimates, age of onset, severity, associated disability, and disaggregated treatment use (pharmacotherapy and psychotherapy) and treatment guideline concordant use were examined by ethnicity. RESULTS The prevalence of major depression was higher among US-born ethnic groups compared to foreign-born groups, but not among older adults. African Americans and Mexicans had significantly higher depression chronicity and significantly lower depression care use and guideline concordant use than Whites. DISCUSSION We provide concise and detailed guidance for better understanding the distribution of major depression and related mental healthcare inequalities and related morbidity. Inequalities in depression care primarily affecting Mexican Americans and African Americans may relate to excesses in major depression disease burden.

Health care quality perceptions among foreign-born Latinos and the importance of speaking the same language.

Objectives: To examine the relationship between patients’ English proficiency, patient-provider language concordance, and health care quality among foreign-born Latinos in the United States. Methods: National probability sample data (from the Pew Hispanic Center/Robert Wood Johnson Foundation Latino Health Survey) were analyzed from telephone interviews with foreign-born Latino adults (n = 2921; aged 18 years and older). There were 3 main outcomes related to clinical experiences using self-reports of confusion, frustration, and perception of poor quality of care received because of English-speaking ability and accent bias, as well as an overall rating of care quality. Patients’ English proficiency and patient-provider language concordance were the chief predictors. Results: Patients’ English proficiency was not significantly associated with the 3 clinical experiences measures and marginally so with overall care quality ratings. Language concordance was significantly associated with a lower likelihood of confusion, frustration, and language-related poor quality ratings, and was positively associated with patient-reported overall quality of care. In addition, providers’ language concordance attenuated the statistical significance of the effects of patients’ English proficiency when both were modeled simultaneously. Conclusion: Patient-provider language concordance plays an important role in communication barriers among foreign-born Latino patients. Our findings indicate that although patients’ language proficiency is important to health care quality ratings, what may matter more is when patient and provider speak the same language.

The health of older Mexican Americans in the long run.

OBJECTIVES We compared risk for several medical illnesses between immigrant and US-born older Mexican Americans to determine the relationship between functional health and years of US residency among immigrants. METHODS Cross-sectional, multistage probability sample data for 3050 Mexican Americans aged 65 years or older from 5 US southwestern states were analyzed. Self-rated health, medical illnesses, and functional measures were examined in multivariate regression models that included nativity and years of US residency as key predictors. RESULTS Self-rated health and medical illnesses of immigrant and US-born groups did not differ significantly. Immigrants with longer US residency had significantly higher cognitive functioning scores and fewer problems with functional activities after adjustment for predisposing and medical need factors. CONCLUSIONS Among older Mexican Americans, immigrant health advantages over their US-born counterparts were not apparent. Immigrants had better health functioning with longer US residency that may derive from greater socioeconomic resources. Our findings suggest that the negative acculturation-health relationship found among younger immigrant adults may become a positive relationship in later life.

Antidepressant use in black and white populations in the United States

OBJECTIVE The study objective was to estimate the prevalence and correlates of antidepressant use by black and white Americans. METHODS Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) were analyzed to calculate nationally representative estimates of past-year antidepressant use by black and white Americans ages 18 years and older (N=9,723). RESULTS Among individuals with depressive and anxiety disorders in the past year (N=516), black respondents (14.6%) had significantly lower (p<.001) antidepressant use than white respondents (32.4%). Depression severity was significantly associated with higher antidepressant use for white but not for black respondents. Psychiatric disorders and vascular disease significantly increased the odds of past-year antidepressant use. The increased prevalence of antidepressant use associated with vascular disease was independent of diagnosable psychiatric disorders. Among respondents not meeting criteria for depressive and anxiety disorders in the past year, lifetime depressive and anxiety disorders and vascular disease significantly increased the odds of antidepressant use. CONCLUSIONS Few white and fewer black Americans with depressive and anxiety disorders received antidepressant treatment. Higher depression severity was associated with more antidepressant use for white but not for black respondents. Antidepressant use was associated with medical conditions related to vascular disease, and these medical conditions were independent of coexisting psychiatric conditions. The results also indicate that many antidepressants are used for maintenance pharmacotherapy for depressive and anxiety disorders as well as common medical conditions associated with vascular disease.

Breast cancer screening and ethnicity in the United States: implications for health disparities research

Ethnic and racial minority women within the U.S. are less likely to use breast cancer screening (BCS) procedures than non-Latina White women, and are more likely to be diagnosed with cancer at later stages of disease. Previous studies examining Latina rates of screening and disease have used aggregated populations for comparison, possibly attenuating important ethnic healthcare disparities and yielding misleading findings. The purpose of this study was to examine if ethnicity matters in understanding current estimates of BCS patterns among U.S. women; to test if healthcare disparities in BCS are present, and if any ethnic/racial groups are primarily affected. The authors used multivariate multinomial regression to examine self-reported mammogram and clinical breast exam in the 2007 full-year U.S. Medical Expenditure Panel Survey. Mexican origin women reported the lowest rates of past-year mammograms and clinical breast examination. Factors enabling healthcare moderated the group’s lower likelihood of mammograms and clinical breast examination. Some breast cancer screening parity appears to have been achieved in 2007 for Black and some Latina groups; however, those rates lag behind for the largest Latino ethnic group, Mexican. Factors enabling healthcare access, such as education, income and insurance, attenuated the BCS inequalities found for Mexican origin women. Findings suggest that successful efforts to reduce BCS disparities be strategically redirected to include women of Mexican origin in addition to other underserved populations.

Neurocognitive Function Among Middle-aged and Older Hispanic/Latinos: Results from the Hispanic Community Health Study/Study of Latinos

We sought to examine and describe neurocognitive function among middle-aged and older Hispanic/Latino Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants. We analyzed baseline cross-sectional data from the middle-aged and older (ages 45-74 years old) participants (n = 9,063) to calculate neurocognitive function scores and their correlates. Older age and higher depressive symptoms scores were associated with lower average neurocognitive performance, whereas greater educational attainment and household income were associated with higher neurocognitive performance. Hispanic/Latino heritage groups significantly varied in neurocognitive performances. Some neurocognitive differences between Hispanics/Latinos were maintained after controlling for language preference, education, household income, and depressive symptoms. We found notable differences in neurocognitive scores between Hispanic/Latino heritage groups that were not fully explained by the cultural and socioeconomic correlates examined in this study. Further investigations into plausible biological and environmental factors contributing to the Hispanic/Latino heritage group differences in neurocognitive found in the HCHS/SOL are warranted.

Diabetes Awareness and Knowledge Among Latinos: Does a Usual Source of Healthcare Matter?

ObjectiveTo provide national prevalence estimates of usual source of healthcare (USHC), and examine the relationship between USHC and diabetes awareness and knowledge among Latinos using a modified Andersen model of healthcare access.ParticipantsThree thousand eight hundred and ninety-nine Latino (18-years or older) participants of the Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic/Latino Health survey from the 48 contiguous United States.DesignCross-sectional, stratified, random sample telephone interviews.MethodsSelf-reported healthcare service use was examined in regression models that included a past-year USHC as the main predictor of diabetes awareness and knowledge. Anderson model predisposing and enabling factors were included in additional statistical models.ResultsSignificant differences in USHC between Latino groups were found with Mexican Americans having the lowest rates (59.7%). USHC was associated with significantly higher diabetes awareness and knowledge (OR=1.24; 95%CI=1.05-1.46) after accounting for important healthcare access factors. Men were significantly (OR=0.64; 95%CI=0.52-0.75) less informed about diabetes than women.ConclusionWe found important and previously unreported differences between Latinos with a current USHC provider, where the predominant group, Mexican Americans, are the least likely to have access to a USHC. USHC was associated with Latinos being better informed about diabetes; however, socioeconomic barriers limit the availability of this potentially valuable tool for reducing the risks and burden of diabetes, which is a major public health problem facing Latinos.

Comorbid cardiovascular disease and major depression among ethnic and racial groups in the United States

BACKGROUND To describe and examine the distribution, disability, and treatment associated with comorbid cardiovascular disease and major depressive disorder (CVD/MDD) among middle-aged and older ethnic/racial groups in the United States. METHODS Cross-sectional data from a national probability sample of household resident adults (18 years and older; N = 16,423) living in the 48 coterminous United States were analyzed. We defined comorbid CVD/MDD as the presence of CVD (e.g. diabetes, hypertension, heart disease, and stroke) among adults who met MDD criteria at or after age 50 years. RESULTS Two-thirds of middle-aged and older American adults meeting criteria major depression at or after age 50 years also reported a diagnosis of comorbid CVD. Blacks were most likely to meet our comorbid CVD/MDD (74.4%) criteria. The disease burden of depression was also highest among Black respondents. Differences in treatment due to race/ethnicity and comorbidity were not statistically significant. CONCLUSIONS Our findings indicate that among middle-aged and older US adults meeting MDD criteria more than half would also report a comorbid CVD. Comorbid CVD/MDD rates varied between the considered ethnic/race groups. Functional impairment associated with comorbid CVD/MDD was higher than MDD alone; however, depression care rates did not differ remarkably. Among middle-aged and older adults meeting MDD criteria, comorbid CVD may be the rule rather than the exception.

Obstructive sleep apnea and neurocognitive function in a Hispanic/Latino population

Objective: We evaluated the association between obstructive sleep apnea (OSA) and neurocognitive function among community-dwelling Hispanic/Latino individuals in the United States. Methods: Cross-sectional analysis of the Hispanic Community Health Study/Study of Latinos middle-aged and older adults, aged 45 to 74 years, with neurocognitive test scores at baseline measurements from 2008 to 2011. Neurocognitive scores were measured using the Word Fluency (WF) Test, the Brief–Spanish English Verbal Learning Test (SEVLT), and the Digit Symbol Substitution (DSS) Test. OSA was defined by the apnea-hypopnea index (AHI). Multivariable linear regression models were fit to evaluate relations between OSA and neurocognitive scores. Results: The analysis consisted of 8,059 participants, mean age of 56 years, 55% women, and 41% with less than high school education. The mean AHI was 9.0 (range 0–142; normal AHI <5/h). There was an association between the AHI and all 4 neurocognitive test scores: Brief-SEVLT–sum (β = −0.022) and –recall (β = −0.010), WF (β = −0.023), and DSS (β = −0.050) at p < 0.01 that was fully attenuated by age. In the fully adjusted regression model, female sex was a moderating factor between the AHI and WF (β = −0.027, p < 0.10), SVELT-sum (β = −0.37), SVELT-recall (β = −0.010), and DSS (β = −0.061) at p < 0.01. Conclusion: OSA was associated with worse neurocognitive function in a representative sample of Hispanic/Latino women in the United States.