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Protocol for studying racial/ethnic disparities in depression care using joint information from participant surveys and administrative claims databases: an observational cohort study
  1. Macarius Donneyong1,
  2. Charles Reynolds2,
  3. David Mischoulon3,
  4. Grace Chang4,5,
  5. Heike Luttmann-Gibson6,7,
  6. Vadim Bubes6,
  7. McKenna Guilds8,
  8. Joann Manson6,9,
  9. Olivia Okereke10,11
  1. 1 Pharmacy Practice and Science, College of Pharmacy, The Ohio University State University, Columbus, Ohio, USA
  2. 2 Psychiatry, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  3. 3 Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4 Psychiatry, Harvard University, Cambridge, Massachusetts, USA
  5. 5 Psychiatry, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
  6. 6 Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  7. 7 Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  8. 8 Pharmacy, Ohio State University, Columbus, Ohio, USA
  9. 9 Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  10. 10 Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  11. 11 Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Macarius Donneyong; donneyong.1{at}


Introduction Current evidence indicates that older racial/ethnic minorities encounter disparities in depression care. Because late-life depression is common and confers major adverse health consequences, it is imperative to reduce disparities in depression care. Thus, the primary objectives of this protocol are to: (1) quantify racial/ethnic disparities in depression treatment and (2) identify and quantify the magnitude of these disparities accountable for by a multifactorial combination of patient, provider and healthcare system factors.

Methods and analysis Data will be derived from the Vitamin D and Omega-3 Trial-Depression Endpoint Prevention (VITAL-DEP) study, a late-life depression prevention ancillary study to the VITAL trial. A total of 25 871 men and women, aged 50+ and 55+ years, respectively, were randomised in a 2×2 factorial randomised trial of heart disease and cancer prevention to receive vitamin D and/or fish oil for 5 years starting from 2011. Most participants were aged 65+ years old at randomisation. Medicare claims data for over 19 000 VITAL/VITAL-DEP participants were linked to conduct our study.

The major study outcomes are depression treatment (antidepressant use and/or receipt of psychotherapy services) and adherence to medication treatment (antidepressant adherence and acceptability). The National Academy of Medicine framework for studying racial disparities was leveraged to select patient-level, provider-level and healthcare system-level variables and to address their potential roles in depression care disparities. Blinder-Oaxaca regression decomposition methods will be implemented to quantify and identify correlates of racial/ethnic disparities in depression treatment and adherence.

Ethics and dissemination This study received Institutional Review Board (IRB) approval from the Partners Healthcare (PHS) IRB, protocol# 2010P001881. We plan to disseminate our results through publication of manuscripts patient engagement activities, such as study newsletters regularly sent out to VITAL participants, and presentations at scientific meetings.

Trial registration number NCT01696435.

  • depression
  • antidepressants
  • racial disparities
  • Medicare

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Twitter @Macarius@DonMacarius

  • Contributors All authors read and approved the manuscript. MD and OO led the design and writing of this manuscript. CR, DM, GC, HL-G, VB, MKG and JM all contributed significantly to the writing of this manuscript.

  • Funding This study is externally funded by National Institutes of Health (NIH) awards R01 MH091448 and 3R01 MH091448-08S1. The VITAL trial is funded by NIH awards R01 CA138962 and U01 CA138962. NIH had no role in the writing of this protocol and will have no ultimate authority over any of the planned activities described in the protocol. The views expressed in this protocol are those of the authors and do not necessarily represent the views of the NIH.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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