identify every study on the evaluation of existing therapeutic tools or delivery interventions for treating depression in adults (and parents); instead, whenever possible, the committee drew on existing meta-analyses and systematic reviews. Whenever possible, the committee limited its review to interventions that have been evaluated in at least one randomized trial and presents a summary of the methodological details, study population demographics, and outcome measures (i.e., depressive symptoms or depression diagnosis) that were used for studies of treatment delivery interventions in a table that is described in the second part of this chapter.

TREATMENT RATES

General Population

More recent nationally representative work has illustrated that those in racial or ethnic minority populations with past-year depressive order are significantly more likely to go without mental health treatment than non-Hispanic whites (64 percent Hispanics, 69 percent Asians, 60 percent of African Americans, compared to 40 percent of non-Hispanic whites) Alegría et al., 2008). Disparities in the likelihood of both having access to and receiving adequate care for depression were significantly different for Asians and African Americans in contrast to non-Hispanic whites. Simply relying on present health care systems without consideration of the unique barriers to quality care that ethnic and racial minority populations face is unlikely to affect the pattern of disparities observed. Populations reluctant to visit a clinic for depression care may have correctly anticipated the limited quality of usual care.

The close association of depression with certain medical conditions (e.g., neurological, cardiovascular, and endocrine disorders) has inspired researchers to explore the feasibility of addressing this mental illness in specialty medical clinics. For example, recent investigations document higher treatment rates and superior outcomes among depressed patients identified at diabetes clinics (Simon et al., 2007).

Mothers with Depression

At the present time, there are no epidemiological data documenting treatment rates among depressed parents, although indirect evidence suggests that these figures are even lower than in the general population. In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial (a large national trial designed to identify depression treatment strategies), for example, only 22 percent of women seeking treatment had children living



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