Ethnicity/race and outcome in the treatment of depression: results from STAR*D.

Journal Article (Journal Article)

OBJECTIVES: This secondary analysis of data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study compared rates of remission and response for blacks (n = 495), whites (n = 1853), and Hispanics (n = 327) with nonpsychotic major depressive disorder who were treated with citalopram. METHODS: STAR*D included representative outpatients treated in 23 psychiatric and 18 primary care centers. Participants received flexible doses of citalopram for up to 14 weeks, with dosage adjustments based on routine clinical assessments. Efforts were made to achieve remission, using a measurement-based care approach with adjustments based on symptoms and side effects assessed at each visit. RESULTS: There were significant differences among groups on many baseline demographic, sociocultural, and clinical variables. Blacks and Hispanics were more socially disadvantaged and had more comorbidity than whites. Before adjusting for differences, blacks had lower remission rates than whites, with Hispanics intermediate between the 2. After adjustments, remission rates for groups were not significantly different on the 17-item Hamilton Rating Scale for Depression (HRSD), but remained lower for blacks compared with whites with the 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR). Blacks took longer to achieve remission or response, though this did not remain after adjusting for baseline differences. CONCLUSIONS: Overall, black and to a lesser extent Hispanic participants had a poorer response to citalopram. After adjusting for baseline differences, the remission rates seemed to be more similar on the HRSD, but remained worse for blacks on the QIDS-SR. We discuss the possible biologic and sociocultural factors that may underlie these findings.

Full Text

Duke Authors

Cited Authors

  • Lesser, IM; Castro, DB; Gaynes, BN; Gonzalez, J; Rush, AJ; Alpert, JE; Trivedi, M; Luther, JF; Wisniewski, SR

Published Date

  • November 2007

Published In

Volume / Issue

  • 45 / 11

Start / End Page

  • 1043 - 1051

PubMed ID

  • 18049344

International Standard Serial Number (ISSN)

  • 0025-7079

Digital Object Identifier (DOI)

  • 10.1097/MLR.0b013e3181271462

Language

  • eng

Conference Location

  • United States