Disparities in Antidepressant Use

To the Editor: The article “Racial-Ethnic Disparities in Use of Antidepressants in Private Coverage: Implications for the Affordable Care Act” (1) in the September 2014 issue was timely and interesting. Jung and colleagues provided a good comparison of racial and ethnic disparities in antidepressant use among whites, African Americans, and Hispanics with private insurance, public insurance, and no coverage.

One additional point can be made on this topic. The authors did not note prescriber specialty types in each coverage group. Because the probability of receiving adequate treatment for mental illness increases when patients receive specialty mental health services (2), it would be useful to provide data regarding whether prescription of antidepressants differed by specialty in each coverage group. This information is even more useful when considering gaps in antidepressant use, because African Americans and Hispanics are less likely than whites to utilize specialty services (3,4).

In addition, primary care physicians are less likely to detect mental health problems among African-American and Hispanic patients (3). Therefore, it would be useful to know whether psychiatrists or primary care providers were the majority prescribers in each coverage group. As coverage expands, further research is needed to understand how the differences in prescribing patterns of primary care providers and psychiatrists affect racial and ethnic disparities in antidepressant use.