Racial Disparities in Antidepressant Treatment After a Psychiatric Consultation

NCT06799078 | Active Not Recruiting

• 1 other identifier: 2023-174
• Study Type: observational
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Patients from black, indigenous, and people of color (BIPOC) communities are reported to have lower rates of antidepressant adherence and response. The investigators have a limited understanding of why this disparity exists. The majority of outpatient psychiatric consultations are one-time assessments that provide treatment recommendations to the primary care provider. It is important to identify whether there are racial differences in accessing and adhering to recommended treatment plans to provide more equitable care. To the investigators' knowledge, there are no studies that examined racial differences in access and barriers to receiving antidepressant treatment after a one-time psychiatric assessment. This study focuses on patients who were diagnosed with major depressive disorder during a psychiatric consultation 3 months prior. We are examining whether there are racial differences in being a) recommended an antidepressant, b) started/switched to a recommended antidepressant, c) treated at a therapeutic dosage, d) adherence to treatment, and e) whether sociodemographic factors, discrimination in medical settings, and patient perception of depression and antidepressant treatment moderate these differences. This study will inform the development of treatment strategies that minimize racial disparities in the treatment of depression.

Conditions

Depression - Major Depressive Disorder; Depression Disorders

Keywords

antidepressant; consultation; depression; major depressive disorder; Race

Outcome Measures

Primary Outcomes (1)

• Psychotropic medication initiation or change after psychiatric consultation

  This information will be obtained during the first and second online surveys

  From the psychiatric consultation to three months after the consultation

Other Outcomes (6)

• Patient Health Questionnaire (PHQ-9)

  Upon enrolment and 3 months after enrolement

• GAD-7

  Upon enrolment and 3 months after enrolement

• Brief Medication Questionnaire (BMQ)

  Upon enrolment and 3 months after enrolement

Study Arms (2)

Participants that self-identify as being BIPOC

Participants that self-identify as being White

Other: Observation while participants receive treatment by their primary care provider

Interventions

Observation while participants receive treatment by their primary care provider OTHER

Participants complete a consultation with a psychiatrist who makes some recommendations for the treatment of their depression. The participant's primary care provider decides whether to implement some of these recommendations.

Participants that self-identify as being White

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients who received an outpatient psychiatric consultation at CAMH within the past 3 months and received a diagnosis of depression, after which they were discharged to the care of their primary care provider

You may qualify if:

• Able and willing to sign and date the informed consent form
• Stated willingness to comply with all study procedures
• Age 18 years and older
• Diagnosis of depression in a psychiatric consultation at CAMH in the last 3 months
• Not currently followed by a psychiatrist
• Able to complete the REDCap questionnaire in English using the internet

You may not qualify if:

• Presence of a life-time diagnosis of bipolar disorder or schizophrenia
• Potential participants with a suicidal plan or intent whose consulting psychiatrist determined are in need of immediate clinical attention (e.g., referral to CAMH ED, voluntary or involuntary hospitalization)
• Acute psychosis (e.g., MDD with psychotic features)

Sponsors & Collaborators

• Centre for Addiction and Mental Health: lead
• The Physicians' Services Incorporated Foundation: collaborator

Study Sites (1)

Centre for Addiction and Mental Health

Toronto, Ontario, M5S 2S1, Canada

Location

Related Publications (15)

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  PMID: 14528539 BACKGROUND

• Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. doi: 10.1001/archinte.166.10.1092.

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  PMID: 11256718 BACKGROUND

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  PMID: 26352783 BACKGROUND

• Rossom RC, Shortreed S, Coleman KJ, Beck A, Waitzfelder BE, Stewart C, Ahmedani BK, Zeber JE, Simon GE. ANTIDEPRESSANT ADHERENCE ACROSS DIVERSE POPULATIONS AND HEALTHCARE SETTINGS. Depress Anxiety. 2016 Aug;33(8):765-74. doi: 10.1002/da.22532. Epub 2016 Jun 20.

  PMID: 27320786 BACKGROUND

• Peek ME, Nunez-Smith M, Drum M, Lewis TT. Adapting the everyday discrimination scale to medical settings: reliability and validity testing in a sample of African American patients. Ethn Dis. 2011 Autumn;21(4):502-9.

  PMID: 22428358 BACKGROUND

• Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, Gupta A, Kelaher M, Gee G. Racism as a Determinant of Health: A Systematic Review and Meta-Analysis. PLoS One. 2015 Sep 23;10(9):e0138511. doi: 10.1371/journal.pone.0138511. eCollection 2015.

  PMID: 26398658 BACKGROUND

• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x.

  PMID: 11556941 BACKGROUND

• Kales HC, Nease DE Jr, Sirey JA, Zivin K, Kim HM, Kavanagh J, Lynn S, Chiang C, Neighbors HW, Valenstein M, Blow FC. Racial differences in adherence to antidepressant treatment in later life. Am J Geriatr Psychiatry. 2013 Oct;21(10):999-1009. doi: 10.1016/j.jagp.2013.01.046. Epub 2013 Feb 6.

  PMID: 23602306 BACKGROUND

• Ishrat Husain M, Rodie DJ, Perivolaris A, Sanches M, Crawford A, Fitzgibbon KP, Levinson A, Geist R, Kurdyak P, Mitchell B, Oslin D, Sunderji N, Mulsant BH; PARTNERs Study Group. A Collaborative-Care Telephone-Based Intervention for Depression, Anxiety, and at-Risk Drinking in Primary Care: The PARTNERs Randomized Clinical Trial. Can J Psychiatry. 2023 Oct;68(10):732-744. doi: 10.1177/07067437231156243. Epub 2023 Feb 28.

  PMID: 36855791 BACKGROUND

• Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med. 2022 Jan;292:114523. doi: 10.1016/j.socscimed.2021.114523. Epub 2021 Nov 2.

  PMID: 34785096 BACKGROUND

• Fortuna LR, Alegria M, Gao S. Retention in depression treatment among ethnic and racial minority groups in the United States. Depress Anxiety. 2010 May;27(5):485-94. doi: 10.1002/da.20685.

  PMID: 20336808 BACKGROUND

• Donneyong M, Reynolds C, Mischoulon D, Chang G, Luttmann-Gibson H, Bubes V, Guilds M, Manson J, Okereke O. Protocol for studying racial/ethnic disparities in depression care using joint information from participant surveys and administrative claims databases: an observational cohort study. BMJ Open. 2020 Jan 7;10(1):e033173. doi: 10.1136/bmjopen-2019-033173.

  PMID: 31915172 BACKGROUND

• Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res. 2006 Jun;60(6):631-7. doi: 10.1016/j.jpsychores.2005.10.020.

  PMID: 16731240 BACKGROUND

• Breslau J, Cefalu M, Wong EC, Burnam MA, Hunter GP, Florez KR, Collins RL. Racial/ethnic differences in perception of need for mental health treatment in a US national sample. Soc Psychiatry Psychiatr Epidemiol. 2017 Aug;52(8):929-937. doi: 10.1007/s00127-017-1400-2. Epub 2017 May 26.

  PMID: 28550518 BACKGROUND

Related Links

• Hayes, A. F. (2022). Introduction to Mediation, Moderation, and Conditional Process Analysis. A Regression-Based Approach (Tgurd ed.). New York: Guilford Press
• Rosner, B. (2011). Fundamentals of Biostatistics (7th Ed. ed.): Brooks/Cole.

MeSH Terms

Conditions

Depression; Depressive Disorder, Major

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior; Depressive Disorder; Mood Disorders; Mental Disorders

Study Officials

• Benoit H Mulsant, MD, MS

  Centre for Addiction and Mental Health

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Scientist

Study Record Dates

• First Submitted: January 23, 2025
• First Posted: January 29, 2025
• Study Start: March 4, 2024
• Primary Completion: August 31, 2025
• Study Completion (Estimated): December 31, 2026
• Last Updated: April 13, 2026

Record last verified: 2026-04

Locations

CA (1)