Racial differences in symptoms, comorbidity, and treatment for major depressive disorder among black and white adults

Funding/Support: Support was provided by grant T32 MH015144 and the APIRE/Program for Minority Research Training in Psychiatry grant T32 MH19126 from the National Institute of Mental Health (NIMH) to (Dr Hankerson), a fellowship from the National Institute on Drug Abuse (NIDA, F31-DA026689) to Dr Keyes, and grant K05 AA014223 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to Dr Hasin. Disclaimer: The NIMH, NIDA, and NIAAA had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Objective: Racial differences in the clinical nature of major depressive disorder (MDD) could contribute to treatment disparities, but national data with large samples are limited. Our objective was to examine black-white differences in clinical characteristics and treatment for MDD from one of the largest, national community samples of US adults. Methods: Non-Hispanic black and white adults (n = 32 752) from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions produced data on 1866 respondents who met criteria for MDD based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) in the preceding 12 months. Outcome measures were depressive symptoms, comorbid psychiatric and medical disorders, disability, and treatment. Results: Blacks with MDD had significantly higher odds of initial insomnia, early-morning awakening, and restlessness than whites. Odds of hypertension (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.48-3.14), obesity (OR, 1.98; 95% CI, 1.45-2.69), and liver disease (OR, 3.68; 95% CI, 1.20-11.30) were higher among blacks than whites. In unadjusted models, blacks had greater impairment than whites in social and physical functioning. However, adjusting for sociode-mographic characteristics eliminated these differences. Blacks were less likely than whites to receive outpatient services (OR, 0.51; 95% CI, 0.36-0.72) and be prescribed medications for MDD, but were more likely to receive emergency room and inpatient treatment. Conclusions: We found few racial differences in depressive symptoms, psychiatric comorbidity, and disability after adjusting for sociodemographic factors. Blacks' lower utilization of ambulatory treatment for MDD and greater medical comorbidity, emergency department use, and hospitalization suggests that management of MDD among blacks should be emphasized in primary care or other settings where treatment is more accessible.