BCBSA report finds racial disparities in diagnosis, treatment of major depression

Undiagnosed and untreated major depression disproportionately affects Black and Hispanic communities, new data show.

The data come from a new report put out by the Blue Cross Blue Shield Association (BCBSA), "Racial Disparities in Diagnosis and Treatment of Major Depression." Its aim was to document the extent of racial and ethnic inequities in mental health. In addition to analyzing 3.1 million medical claims from 2016 to 2020 of members with major depression, BCBSA also surveyed 2,700 adults. 

Among Black and Hispanic communities with greater access to providers, major depression diagnoses increased compared to those with less access. By comparison, there was little change in white communities with fewer or more providers. The spike in diagnosis rates based on widened provider access was up to fourfold higher among nonwhite communities.

The study also found that the overall treatment of major depression declined in Hispanic communities at a higher rate than in Black and white communities from 2018 to 2020. Prescription treatment was 33% lower in Hispanic and 13% lower in Black communities compared to white. Rates of counseling were 21% lower for Hispanic communities than for white and Black communities.

“We cannot heal what we have not identified,” Adam Myers, M.D., chief clinical transformation officer at BCBSA, said in a statement. “It is critical to rigorously prioritize getting people the mental health care they need, when they need it, no matter where they live or their racial, ethnic or linguistic background.”

Black and Hispanic respondents were more likely to wait to make an appointment and more likely to seek information on mental health outside the healthcare system, such as through family, social media or community organizations. This suggests a lack of trust, the report noted. This could be helped by a more diverse workforce and culturally competent methods of care. 

Nonwhite communities also prefer mental health providers of the same race or ethnicity and similar life experiences and believe mental health is stigmatized in their communities.

The report suggested solutions like expanding telehealth services and identifying ways to connect patients with providers of their preference as well as integrating mental and physical healthcare.

“Change must be a collective effort,” the report concluded. “It will require business leaders, policymakers, researchers and community leaders to act with a sense of urgency.”