Falling through the cracks: gaps in depression treatment among older Mexican-origin and white men

Abstract

Objectives: This study aims (i) to compare depression frequency and self-reported depression treatment in Mexican-origin and white men; (ii) to examine ethnic differences in self-reported prior depression diagnosis and types of treatment; and (iii) to determine whether Mexican-origin men (both English and Spanish language preferring) are less likely than white men to report receiving depression treatment after controlling for potential confounders.

Methods: This is a cross-sectional, observational study of Mexican-origin and white men (60 years old and over) presenting for primary care visits at six outpatient clinics in California's Central Valley. Clinical depression was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), module for past-year major depression and questions for chronic depression. Past year, self-reported prior depression diagnosis and treatment (i.e., medication, psychotherapy, mental health referral) were assessed through a structured questionnaire.

Results: The frequency of past-year clinical depression was similar for both ethnic groups, yet Mexican-origin men were significantly less likely than whites to report receiving a prior diagnosis of depression or prior depression treatment. Compared with whites, the odds of untreated depression in Mexican-origin men was 4.35 (95% CI 1.35-14.08) for those interviewed in English and 10.40 (95% CI 2.11-51.25) for those interviewed in Spanish. For both ethnic groups, the majority (i.e., approximately two-thirds) of men receiving depression treatment also met criteria for past-year clinical depression.

Conclusions: Mexican-origin older men in primary care suffer from significant gaps in depression care (i.e., diagnosis and treatment) compared with whites. Delivering effective depression treatment (i.e., so that depression remits) remains elusive for both ethnic groups.

Figure 1

Men’s Health and Aging Study Depression Screening Results from Primary Care Clinics in the California Central Valley.

Figure 2. Frequency of past year clinical depression and depression treatment among Mexican- origin (n=152) and white men (n=183) screened in primary care

*Cross-ethnic comparison do depression treatment, X² = 15.74, p <.001 (df=1)

Figure 3. Comparison of the proportion of Mexican-origin and white men in three depression-treatment subgroups (n=108)*

*Cross-ethnic comparison, X² = 24.47, p <.001 (df=2)