Health System Depression Treatment and Outcomes - ABSTRACT Depression will be the greatest source of global disease by 2030, affecting Black, Hispanic, and Asian communities. Our work has shown that compared to White patients, Black, Hispanic, and Asian patients were less likely to receive any depression treatment and if treated, less likely to receive a partial or full course of psychotherapy or medication. If patients do not receive treatment, most will not experience improvement or remission of their depression. However, the evidence is not clear about the benefits of a partial vs full course of treatment because real-world population-based studies rarely include the treatment course in outcome analyses. Two important unanswered questions for implementation research on depression treatment disparities are 1) what factors contribute to patients not receiving treatment and 2) if treated, does a partial course confer similar benefits to a full course? We will address these questions by using 1) the NIMHD Framework adaptation for depression that addresses the role of health systems specifically to establish the determinants of disparities in depression treatment and outcomes and 2) a learning health systems approach to ensure our findings have an impact on practice. The following aims will be accomplished with a sample of Black (N=44,934), Hispanic (N=113,207), Asian (N=16,505), and White (N=179,502) patients in 5 health systems in 7 states (CA,TX,GA,MN,MI,ND,WI): AIM 1. Test the factors in the NIMHD Framework for mental health contributing to racial disparities in treatment (none, partial or full course) for patients with moderate-to-severe symptoms of depression; AIM 2. Examine the mediating effect of treatment on racial disparities in improvement and remission of depression symptoms; AIM 3. Address factors in the NIMHD Framework for mental health that cannot be addressed in models for AIM 1 and AIM 2 by incorporating the lived experiences of Black, Hispanic and Asian patients and their providers; and AIM 4. Combine the findings from AIMS 1 – 3 to create a set of recommendations for research and practice to improve depression care in large health settings.
