Racial Disparities in Prescription of Antidepressants Among US Veterans Referred to Behavioral Health Care

Objective: Antidepressants are often prescribed in primary care to treat veterans who have depression. An evaluation of current racial disparities in integrated primary care is war-ranted. This study examined the association between race and prescription of antidepressants among veterans in pri-mary care. Methods: Veterans in primary care (Black, N=4,120; White, N=4,372) who were referred from primary care to a col-laborative care program completed an assessment of de-mographic characteristics and clinical symptoms, including of current antidepressant prescription before the referral, verified by chart review. Patient data were collected from January 1, 2015, to December 22, 2020. Logistic regression analyses were conducted to examine the relationships be-tween patient race and both depression symptoms and antidepressant prescription. Analyses were also stratified by severity of depression symptoms to understand the results in the context of clinical guidelines. Results: White patients were almost two times (odds ratio=1.96, 95% confidence interval [CI]=1.75-2.19, p<0.001) more likely than Black patients to receive an antidepressant prescription, after the analysis was controlled for depression symptoms, demographic characteristics, and other clinical symptoms. Among patients with severe depression, for whom prescrip-tion of antidepressants is clinically indicated, White patients were 1.87 times more likely than Black patients to receive an antidepressant prescription (95% CI=1.40-2.50, p<0.001). Conclusions: The findings reveal racial disparities in anti-depressant prescription for veterans in primary care. Regular clinical review of antidepressant prescription is recom-mended to identify disparities in individual clinics. Future research should aim to identify drivers of racial disparities and provide recommendations for health care systems, providers, and patients.