Major depressive episode persistence, severity differ by race/ethnicity

Researchers have identified racial and ethnic disparities in major depressive episode persistence and severity, according to study results in a research letter published in JAMA Psychiatry.

“Research using the National Comorbidity Survey (fielded 1990 to 1992) showed that while lifetime and past-year rates of major depressive disorder were lower among individuals from minoritized racial and ethnic groups compared with white adults, major depressive disorder persistence was greater for Black and Latino adults,” Michael William Flores, PhD, MPH, of the Health Equity Research Lab, Cambridge Health Alliance, in Massachusetts, and colleagues wrote.

“Analysis of the National Survey of American Life (fielded 2001 to 2003) found similar or lower major depressive disorder prevalence among Black adults compared with white adults but greater major depressive disorder chronicity, severity and disability,” the authors wrote. “We provide an update of these findings, analyzing nationally representative data to estimate differences in major depressive episode (MDE) prevalence, persistence and severity among racial and ethnic groups.”

The researchers pooled cross-sectional data of 203,295 adults (Black, n = 27,081; Latino, n = 37,015; Asian, n = 10,275; white, n = 128,924) aged 18 years or older between the years 2015 to 2019 from the National Survey on Drug Use and Health, a nationally representative survey of noninstitutionalized U.S. civilians that allows for identification of mental illness via validated DSM-based diagnostics. They defined persistence as experiencing lifetime and past-year major depressive episode and severity as experiencing past-year major depressive episode with very severe impairment, with the latter based on Sheehan Disability Scale scores.

Further, the researchers used age- and sex-adjusted logistic regression models to evaluate racial and ethnic differences in major depressive episode outcomes.

Results showed lower rates of lifetime and past-year major depressive episode among Black, Latino and Asian individuals compared with white individuals. However, Black individuals had higher rates of major depressive episode persistence and severity, Latino adults had higher rates of persistence and comparable rates of severity, and Asian adults had comparable rates of persistence and lower rates of severity. The researchers observed noticeable differences in age and sex distributions between racial and ethnic groups.

Moreover, Black adults had higher risk for major depressive episode persistence and severity, Latino adults had comparable risk for persistence and severity, and Asian adults had similar risk for persistence and lower risk for severity compared with white adults.

“Clinicians practicing patient-centered treatment that support active patient participation and openness to understanding patient experiences with and interpretation of mental illness can improve mental health care,” Flores and colleagues wrote. “It is important that clinicians acknowledge and be sensitive to patients’ prior experiences with discrimination and trauma stemming from medical system interactions, which may contribute to treatment nonadherence and exacerbation of mental illness.

“These considerations are especially salient as we continue to endure the COVID-19 pandemic, which has disproportionately affected minoritized racial and ethnic groups and elevated their need for mental health treatment,” they added.