Late-life depression in people from ethnic minority backgrounds: Differences in presentation and management

Abstract

Background: An elevated risk of late-life depression has been suggested in older adults from minority ethnic groups, but little is known about ethnic group differences in symptom and treatment profiles. The current study aimed to compare symptoms and types of treatment between ethnic groups in patients with late-life depression.

Methods: Data were extracted from the Clinical Record Interactive Search (CRIS) system , which provides access to the anonymised electronic health records of a large mental health care provider in South London. In total, 5,546 individuals aged 65 years and older, and diagnosed with late-life depression between 2006 and 2017, were included. Patients from ethnic minority backgrounds were compared to White British individuals on the following features recorded at depression diagnosis: mental and physical wellbeing,functional scales, individual depressive symptoms recorded, and treatments administered.

Results: Black Africans and Black Caribbeans more frequently presented with psychotic problems and were significantly less likely to have antidepressant treatment prescribed post diagnosis compared to White British. White Irish had higher rates of substance use and sleep disturbance. Depressive symptoms of hopelessness, guilt feelings, and suicidal thoughts were less common in Black Caribbeans, Black Africans, and South Asians compared to White British.

Limitations: Only patients with depression under a specialist mental health care provider were included in the study.

Conclusions: Ethnic minority elders have significantly different presentations and undertake different types of treatment both across groups and relative to their White British counterparts. These differences need to be taken into consideration to optimise pathways into care and to personalise treatment.

Keywords: Antidepressants; Depression; Depressive symptoms; Ethnic minorities; Health inequalities.