Insurance status, race, ethnicity and access to antidepressant medications

Prescription drugs are instrumental to the treatment of many illnesses, including depression. Drug treatment for depression underwent a significant change with the introduction of selective serotonin reuptake inhibitors (SSRIs) and other newer agents in the late 1980s and early 1990s. This study investigates overall access to antidepressants, and access to SSRIs and other newer agents as compared to the older tricyclic antidepressants (TCAs). Using data from the 1996 Medical Expenditure Panel Survey (MEPS), outpatient access to antidepressant prescription drugs among the adult, non-elderly population based on insurance coverage, particularly as it relates to race and ethnicity, was explored.;Compared to those with insurance, the uninsured were 47% less likely to receive any antidepressant and black patients were 47% less likely than white patients to receive an antidepressant, after controlling for other factors. Additionally, older age, female sex, unemployment and fair to poor perceived mental health were all associated with 41–55% increases in receipt of antidepressant medication after adjustment. When SSRI use was compared to TCA use, blacks were 65% less likely than whites, the older group was 40% less likely than the younger group and women were 67% more likely than men to receive an SSRI. Adding other newer agents to the analysis did not change most findings significantly, but patient sex no longer had an effect on drug type access. Hispanic/Latino ethnicity was not significant at the p = 0.05 level in any of the adjusted models.;These findings indicate that there are sometimes large differences in access to antidepressant drugs, and in access to preferred drug types, by factors for which there are no clinical justifications, including insurance coverage, race and other demographic characteristics, raising issues of treatment quality and distributional equity. This study adds to the literature documenting the importance of health insurance to health care access. It also provides further evidence of disparities in health care quality and treatment by race, and of the effects that non-clinical characteristics can have on the diffusion of advances in medical care.