Conference Coverage

Hispanic mothers see better results than non-Hispanic whites in depression trial


 

AT THE AACAP ANNUAL MEETING

References

SAN ANTONIO – Disadvantaged Hispanic mothers in New York enrolled in a medication clinical trial remitted from depression at a faster rate when compared with a more advantaged cohort of non-Hispanic white mothers in Canada.

The Hispanic children also appeared to benefit from their mothers’ remission, seeing levels of psychopathology and impairment significantly improved over the course of the 36-week treatment trial.

These surprising findings, presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, came from the Parental Remission from Depression and Child Psychopathology Study, a randomized, double-blind clinical trial examining the effects of maternal depression treatment on children in two sites: New York and Ottawa (Am J Psychiatry. 2015 May 1;172[5]:450-9).

A previous study of similar design found single mothers to be more likely to drop out of depression treatment and less likely to remit if they remained in treatment. Among those single mothers who remained in treatment, the children were less likely to improve their levels of psychopathology even if their mothers remitted (Soc Psychiatry Psychiatr Epidemiol. 2007;42[12]: 962-71).

For this study, Marivel Davila, Ph.D., of Columbia University in New York and her colleagues, compared results from 33 Hispanic mothers in New York and their children, aged 7-17, with 36 non-Hispanic white mothers in Ottawa and their children, also aged 7-17. All participating mothers were diagnosed with major depressive disorder without psychosis.

Hispanic mothers in New York were more likely to be disadvantaged, compared with their non-Hispanic white counterparts in Ottawa. Seventy percent of Hispanics reported being single mothers, and 44% of the Canadian mothers were. About 71% of the New York group had household incomes under $15,000 a year, compared with 22% of the Canadian women. And nearly two-thirds of the Hispanic mothers reported receiving public assistance, compared with about 8% of the Canadian cohort.

Based on previous findings regarding depression treatment outcomes among single mothers, the study authors hypothesized that Hispanic mothers and their children in New York would not perform as well as their more socially advantaged counterparts in Ottawa.

“When you look at Latinas in the literature, their high rates of disadvantage make them a difficult group to treat,” Dr. Davila said in an interview. “Previous studies have shown that if you are single or disadvantaged, you are more likely to drop out of treatment, you don’t do as well, and your children also don’t do as well, compared to women who are more socially advantaged.”

However, the Hispanic mothers and their children performed well in this trial. After 12 weeks of treatment on escitalopram, bupropion, or a combination of the two, 81.8% of the Hispanic mothers remitted from depression (P less than .05), compared with 55.6% in the Canadian group; at 36 weeks, 90.9% of Hispanic mothers vs. 72% of non-Hispanic mothers had remitted (P less than .05). Hispanic mothers in New York were significantly less likely to drop out of the study over the course of 36 weeks, compared with non-Hispanic Canadian mothers (9.1% vs. 13.9%, respectively, P less than .05).

Among children, while both sites saw improvements in social anxiety and separation/panic disorders, Hispanic children in New York improved their levels of overall anxiety and anxiety with physical symptoms at a faster rate, compared with the children in Canada. They also saw significant improvements in their levels of depressive symptoms and functioning over the course of the 36-week study.

Dr. Davila said the fact that so few of the Hispanic women dropped out of the study points to the therapeutic alliance between the women and those providing their treatment. “Many of the people treating these women at Columbia were Hispanic physicians who spoke Spanish, as many of these women were Spanish dominant. Anyone who receives attentive care has a chance of doing well,” she said, “and in this case the benefits extended to the children.”

Dr. Davila’s study was funded by the National Institute of Mental Health, and its authors declared no conflicts of interest. One coauthor on the study, Myrna Weissman, Ph.D., was the principal investigator on the original study.

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