Effects of primary care depression treatment on minority patients' clinical status and employment
Effects of primary care depression treatment on minority patients' clinical status and employment
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DOI：
10.1001/archpsyc.61.8.827
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发表时间：
2004-08-01
影响因子：
--
通讯作者：
Wells, K
中科院分区：
文献类型：
--
作者：
Miranda, J;Schoenbaum, M;Wells, K
背景资料：少数民族对精神卫生保健的反应主要是unstudied.Objective：要确定适当的照顾抑郁症对ethnic minorities.Design的影响：观察分析的影响，以证据为基础的抑郁症护理超过6个月的临床结果和就业状况的少数民族和非少数民族。使用工具变量技术，随机分配到质量改善干预作为识别工具，对治疗进行选择。设置：美国六个管理式护理组织。患者：1356五十六例抑郁症成人，包括601例白色患者，258例拉丁美洲患者，56例非洲裔美国人和24例亚洲或美洲土著患者。干预：结果：在6个月时，接受适当护理的少数患者与未接受适当护理的患者相比，可能患抑郁症的比率较低（26.5% vs; 70.5%）;非少数民族患者的结果相似（24.3% vs 71.2%）。接受适当护理的非少数民族患者的就业率高于未接受适当护理的患者（71.4% vs 52.4%）。这是不正确的少数民族患者（68.2%比56.5%）。结论：抑郁症的循证护理是同样有效的，减少抑郁症的少数民族和非少数民族患者。然而，护理的功能结果，如继续就业，可能比非少数民族患者的少数民族更有限。由于少数民族成员不太可能得到适当的照顾，应努力使少数民族成员有效地照顾抑郁症。
Background: The response of ethnic minorities to mental health care is largely unstudied.Objective: To determine the effect of appropriate care for depression on ethnic minorities.Design: Observational analysis of the effects of evidence-based depression care over 6 months on clinical outcomes and employment status is examined for ethnic minorities and nonminorities. Selection into treatment is accounted for using instrumental variables techniques, with randomized assignment to the quality improvement intervention as the identifying instrument.Setting: Six managed care organizations across the United States.Patients: One thousand three hundred fifty-six depressed adults, including 601 white, 258 Latino, 56 African American, and 24 Asian or Native American patients.Intervention: Quality improvement interventions aimed at increasing guideline-concordant depression care.Results: At 6 months, minority patients who received appropriate care, compared with those who did not receive it, had lower rates of probable depressive disorder (26.5% vs; 70.5%); the findings were similar for nonminority patients (24.3% vs 71.2%). Nonminority patients who received appropriate care were found to have higher rates of employment than were those who did not receive appropriate care (71.4% vs 52.4%). This was not true of minority patients (68.2% vs 56.5%).Conclusions: Evidence-based care for depression is equally effective in reducing depressive disorders for minority and nonminority patients. However, functional outcomes of care, such as continued employment, may be more limited for minority than nonminority patients. Because minority members are less likely to get appropriate care, efforts should be made to engage minority members in effective care for depression.