Racial and Ethnic Differences in Minimally Adequate Depression Care Among Medicaid-Enrolled Youth

Objective: To examine racial and ethnic disparities in the receipt of minimally adequate depression treatment in Medicaid-enrolled youth. Method: Medicaid claims data of 2008 through 2011 were used to derive a cohort of youth (5-17 years old) who were diagnosed with a new episode of major depression (N = 45,816) across 9 states. Dichotomous outcomes measured the receipt of minimally adequate psychotherapy (>= 4 psychotherapy visits within 12 weeks of initiation); minimally adequate medication (filled antidepressants for 84 of 144 days); any minimally adequate treatment (psychotherapy or medication); and no psychotherapy or medication. Racial/ethnic disparities in the outcome measures were estimated using logistic regression models that controlled for predisposing, enabling, and need-related factors. Results: Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. Adjusted percentages of black (42.3%; p < .001) and Hispanic (48.2%; p < .001) youth who received minimally adequate treatment were significantly smaller than for non-Hispanic whites (54.7%) because of lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. In addition, adjusted percentages of black (20.2%; p < .001) and Hispanic (15.0%; p < .01) youth who received no treatment were significantly larger than for non-Hispanic white youth (12.9%). Conclusion: The percentage of Medicaid-enrolled youth who receive minimally adequate treatment for depression is small overall and even smaller for racial/ethnic minorities than for whites. Future research is needed to identify strategies that improve the overall quality of depression treatment in Medicaid-enrolled youth and decrease disparities in care.