Male, Minority Patients Less Frequently Screened for Depression by Primary Care Providers

Patients who are male, non-White, or who primarily speak a non-English language are significantly less likely to be screened for depression in a primary care setting, according to new data.

In a poster presented at the American Academy of Physician Associates (AAPA) 2024 Conference & Expo in Houston, TX, this weekend, a team of investigators from University of Utah Health reported findings from their clinic showing significant disparities in depression screening based on patient sex, race, ethnicity, language and insurance status. The data highlight a continued trend of disparate prioritization of mental health-related screening among US male and minority patients in particular.

Led by Sonora George, PA-S, a physician assistant student at University of Utah, the team conducted a retrospective data analysis of depression screening rates at the university’s Sugar House Health Clinic, a primary care center that first implemented a universal depression screening protocol in 2019. As George and colleagues noted, Utah residents report an approximate 17% greater prevalence of lifetime depression than the US average.

“Annual screening using validated questionnaires is an effective way of detecting depression and initiating treatment,” investigators wrote. “Members of marginalized groups are often screened less than their White peers, which may worsen mental health outcomes.”

Indeed, data from the last decade has elucidated a reduced rate of men and patients of minority race/ethnicity being screened for depression via the Patient Health Questionnaire 9 (PHQ-9), a commonly used screening tool at the primary care level.

George and colleagues posited whether the Sugar House Health Clinic’s universal depression screening protocol would result in differences based on patient sex, race, language preferences and insurance coverage. Their analysis included patients ≥12 years old seen at any University of Utah Health location from June 2021 - December 2022 who had been assigned a Sugarhouse-based primary care provider.

The analysis’ outcomes included depression screening in the last 12 months as well as screening rates between patient demographic groups via prevalence percentages and odds ratios (ORs). The comparator reference group included female, White, English-speaking patients with private insurance.

Their final assessment included 12,428 patients; a majority (59.9%) were female, followed by male (40.0%) and gender-diverse (n = 8 [0.1%]) patients. Three-fourths of patients were White and carried private insurance (75.0% for each). A significant majority (97.2%) of patients spoke English.

Investigators found that male patients were 21% less likely to be screened for depression by their primary care provider than female patients (adjusted OR [aOR], 0.79; 95% CI, 0.73 - 0.86; P <.001). Patients who were uninsured were 43% less likely to be screened than those with private insurance (aOR, 0.57; 95% CI, 0.43 - 0.76; P <.001).

Additionally, patients who were non-White were 23% less likely to be screened for depression than White patients (aOR, 0.77; 95% CI, 0.67 -0.87; P <.001), and patients who spoke Spanish were 48% less likely to be screened than those who spoke English (aOR, 0.52; 95% CI, 0.49 - 0.85; P = .002).

In reviewing the findings, George and colleagues noted that racial and ethnic minority groups are also disproportionately affected by chronic diseases than White patients. “We may see lower rates of depression screening in non-White patients because depression screening is a lower priority for providers in more medically complex patients,” they wrote.

Additionally, while the PHQ-9 has been effectively utilized in some Spanish-speaking countries, a Spanish-language version of the screening tool has not been adequately adopted in the US.

All the same, they concluded their findings supported evidence that male, non-White, non-English speakers and uninsured patients are being screened for depression at the primary care level—despite even their clinic’s protocol. They advocated for research-informed interventions that tailor screening and timely care for these groups of US patients with depression who may be missed at the frontline of care.

References

1. ^{George S, Goetz PJ, Johnson B, Ure S, et al. Disparities in depression screening after implementing a universal screening process. Paper presented at: American Academy of Physician Associates (AAPA) 2024 Conference & Expo. Houston, TX. May 18 - 22, 2024.}
2. ^{Gingerich CP. Depression Screening Less Common for Men and Minorities. HCPLive. Published September 12, 2018. https://www.hcplive.com/view/depression-screening-less-common-for-men-and-minorities}