Associations of Clinically Relevant Levels of Depressive Symptoms and Antidepressant Use With Mortality in African American Health

Background The Institute of Medicine has highlighted unequal treatment for African American individuals in health care. We examined the association of underuse of antidepressants in African American individuals with increased mortality. Methods We conducted a longitudinal cohort study in Metropolitan St Louis, Missouri, in a population-based study of community-dwelling African American individuals, aged 52 to 68 years. Medication evaluations and clinically relevant levels of depressive symptoms (CRLDS) assessments occurred in 2000 and 2004. The analytic sample included 830 (of 853 total, 97%) participants with complete data. CRLDS was defined as ≥9 on the 11-item Center for Epidemiologic Studies Depression scale. Antidepressant use was determined by in-home medication recording and in-center coding. Participants were placed into 4 exposure categories: persistent CRLDS–no antidepressant (n = 69); intermittent CRLDS–no antidepressant (n = 123); antidepressant treatment (n = 110); and no CRLDS–no antidepressant (n = 528). Logistic regression with backwards elimination of the 9 identified potential confounders was used to examine associations of exposures with all-cause mortality over 6 years (2004–2010). Five sensitivity analyses investigated robustness of the primary findings. Results The antidepressant group was independently associated with reduced mortality compared with the persistent–no antidepressant group (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.08–0.44). Sensitivity analyses showed no substantive differences from the primary model; one indicated that the persistent CRLDS–no antidepressant group experienced significantly increased mortality compared with the no CRLDS–no antidepressant group (OR 2.12, 95% CI 1.10–4.09), whereas the intermittent–no antidepressant group did not (OR 0.83, 95% CI 0.44–1.58). Conclusions These results highlight that underuse of antidepressants in African American individuals is associated with increased mortality.