Racial Disparities in the Treatment of Depression in Low-Income Persons With Diabetes

  1. David G. Schlundt, PHD2,3
  1. 1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;
  2. 2Vanderbilt Eskind Diabetes Center, Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, Tennessee;
  3. 3Department of Psychology, Vanderbilt University, Nashville, Tennessee;
  4. 4Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee;
  5. 5International Epidemiology Institute, Rockville, Maryland;
  6. 6Department of Epidemiology, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina.
  1. Corresponding author: Chandra Y. Osborn, chandra.osborn{at}


OBJECTIVE Individuals with diabetes are at higher risk for depression than the general population. Although depression can be treated with antidepressant medications, patients with diabetes and comorbid depression often go untreated. The goal of this study was to examine racial disparities in the treatment of depression with antidepressant medication in the southeastern U.S.

RESEARCH DESIGN AND METHODS Cross-sectional data were collected at baseline from 69,068 participants (71% African American, 60% female, and 82% with incomes <$25,000) recruited from community health centers and enrolled in the Southern Cohort Community Study (SCCS). The SCCS is a prospective epidemiological cohort study designed to explore causes of health disparities in adults aged 40–79 years. Binary logistic regression was used to identify factors associated with antidepressant use among those with diabetes (n = 14,279).

RESULTS Individuals with diagnosed diabetes (14,279) were classified with no depressive symptoms (54.7%), or with mild (24.2%), moderate (12.8%), or severe depressive symptoms (8.3%). After controlling for sex, age, insurance, income, education, BMI, smoking status, alcohol consumption, and level of depression, African Americans with diabetes were much less likely to report taking antidepressant medication than whites (adjusted odds ratio 0.32 [95% CI 0.29–0.35], P < 0.0001).

CONCLUSIONS Antidepressant use is much less common among African Americans than among whites with diabetes. Reasons for racial disparities in treatment of depressive symptoms are unclear but may include a combination of differential diagnosis and treatment by health professionals as well as cultural differences in seeking help for emotional distress.


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    • Received October 16, 2009.
    • Accepted February 8, 2010.

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  1. Diabetes Care vol. 33 no. 5 1050-1054
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