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Serious mood disorders may be underdiagnosed or undertreated among impoverished blacks

Nearly all adults who commit suicide suffer from major psychiatric illness, predominantly serious mood disorders such as bipolar disorder. Yet, in the year preceding their suicide, blacks insured by Tennessee's Medicaid program (TennCare) were less likely than their white counterparts to have been treated for mood disorders, reveals a new study. These findings suggest underdiagnosis or undertreatment of blacks with serious mood disorders, notes Wayne Ray, Ph.D., of the Vanderbilt Center for Education and Research on Therapeutics.

Dr. Ray and colleagues examined the medical records of adults who had committed suicide between 1986 and 2004. The researchers also examined their use of antidepressants in the year prior to their suicide. All patients were insured by TennCare.

Overall, 29 percent of blacks had filled an antidepressant prescription compared with 51 percent of whites. In contrast, there was no significant difference between the two groups in filled prescriptions for antipsychotic medications (Figure 2). These findings persisted after accounting for other problems linked to suicide, such as alcohol or substance abuse, seizure disorders, borderline personality disorder, and serious neurological conditions.

Blacks who completed suicide were younger (mean age of 33 vs. 42 years) and were more likely to live in urban areas and in low-income neighborhoods. Both black and white suicide victims had substantial physical problems. Nearly one-half of blacks and whites who committed suicide were enrolled in TennCare because of disability. In the 3 months preceding the suicide, 56 percent of blacks and 73 percent of whites were either hospitalized or had an outpatient visit. Also, 37 percent of blacks and 49 percent of whites had inpatient admissions or outpatient visits indicating psychiatric disorders. The study was supported in part by the Agency for Healthcare Research and Quality (HS10384).

See "Racial differences in antidepressant treatment preceding suicide in a Medicaid population," by Dr. Ray, Kathi Hall, B.S., and Keith G. Meador, M.D., M.P.H., in the October 2007 Psychiatric Services 58(10), pp. 1317-1323.

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