Racial/Ethnic Disparities in Depression Treatment for Caregivers Investigated by the US Child Welfare System |
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| Affiliation: | 1. Division of General Pediatrics (H-f Fong), Boston Children''s Hospital, Boston, Mass;2. Department of Pediatrics (H-f Fong), Harvard Medical School, Boston, Mass;3. McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work (MA Lindsey), New York, NY;4. Department of Medicine (M Cruz-Gonzalez, M Alegria), Harvard Medical School, Boston, Mass;5. Disparities Research Unit, Department of Medicine (M Cruz-Gonzalez, M Alegria), Massachusetts General Hospital, Boston, Mass;6. Department of Psychiatry (W Beardslee), Boston Children''s Hospital, Boston, Mass;7. Department of Psychiatry (W Beardslee, M Alegria), Harvard Medical School, Boston, Mass;1. Pediatric Residency Training Program, Cincinnati Children''s Hospital Medical Center (JJ Petosa), Cincinnati, Ohio;2. Division of General Pediatrics and Community Pediatrics, Cincinnati Children''s Hospital Medical Center (M Klein), Cincinnati, Ohio;3. Division of Pediatric Emergency Medicine, Cincinnati Children''s Hospital Medical Center (A Martini and D Schumacher), Cincinnati, Ohio;4. University of Cincinnati College of Medicine (M Klein and D Schumacher), Cincinnati, Ohio;1. Department of Pediatrics, University of Minnesota School of Medicine & Masonic Children''s Hospital (MB Pitt), Minneapolis, Minn;2. Division of General and Community Pediatrics, Cincinnati Children''s Hospital Medical Center, University of Cincinnati College of Medicine (MD Klein), Cincinnati, Ohio;1. Division of General Pediatrics, Department of Pediatrics, Boston Children''s Hospital (JL Wilder, EW Pingree, CM Hark, CH Marcus, and AS Winn), Boston, Mass;2. Harvard Medical School (JL Wilder, EW Pingree, CM Hark, CH Marcus, EC Rabinowitz, and AS Winn), Boston, Mass;3. Division of Pulmonary Medicine, Department of Pediatrics, Boston Children''s Hospital (EC Rabinowitz), Boston, Mass;4. Department of Pediatrics, Boston Medical Center (CD Michelson), Boston, Mass;5. Boston University School of Medicine (CD Michelson), Boston, Mass;1. University of Pittsburgh and Children''s Hospital of Pittsburgh of UPMC (MI Ragavan), Pittsburgh, Pa;2. University of Florida College of Medicine (EA Zenni), Jacksonville, Fla;3. Baylor College of Medicine and Texas Children''s Hospital (TL Turner), Houston, Tex;4. Cincinnati Children''s Hospital Medical Center and University of Cincinnati College of Medicine (M Klein), Cincinnati, Ohio |
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| Abstract: | ObjectiveTo determine whether there are racial/ethnic differences in depression treatment for caregivers investigated by the US child welfare system.MethodsThis cross-sectional study used baseline data from the Second National Survey of Child and Adolescent Well-being, a nationally representative sample of children and caregivers investigated by US child welfare agencies (February 2008–April 2009). We included permanent caregivers who met criteria for major depression and had available covariate data (n = 908). In multivariable logistic regression models, we estimated the associations between caregiver race/ethnicity and past-year receipt of: any depression treatment, minimally adequate depression treatment, and depression treatment from 4 sectors (general medical, psychiatry, nonpsychiatry mental health, and human services). We controlled for clinical need and access variables according to the Institute of Medicine's definition of health care disparities.ResultsBlack caregivers had the lowest rates of treatment receipt of any racial/ethnic group, with 42.2% receiving any depression treatment and 17.2% receiving minimally adequate depression treatment in the past year. In multivariable analyses controlling for clinical need and access variables, Black caregivers were less likely than White caregivers to receive any depression treatment (odds ratio [OR] = 0.49 [95% CI: 0.24–0.97]), minimally adequate depression treatment (OR = 0.37 [95% CI: 0.16–0.85]), and depression treatment from the general medical sector (OR = 0.40 [95% CI: 0.18–0.89]) in the past year (all P< .05).ConclusionsFuture research should examine the underlying mechanisms of Black-White disparities in depression treatment for caregivers involved with the US child welfare system and develop targeted interventions to promote equitable mental health care for this highly vulnerable population. |
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