Racial/Ethnic Disparities in Depression Treatment for Caregivers Investigated by the US Child Welfare System

Hiu fai Fong, Michael A. Lindsey, Mario Cruz-Gonzalez, William Beardslee, Margarita Alegria

Research output: Contribution to journalArticlepeer-review


Objective: To determine whether there are racial/ethnic differences in depression treatment for caregivers investigated by the US child welfare system. Methods: This cross-sectional study used baseline data from the Second National Survey of Child and Adolescent Well-being, a nationally representative sample of children and caregivers investigated by US child welfare agencies (February 2008–April 2009). We included permanent caregivers who met criteria for major depression and had available covariate data (n = 908). In multivariable logistic regression models, we estimated the associations between caregiver race/ethnicity and past-year receipt of: any depression treatment, minimally adequate depression treatment, and depression treatment from 4 sectors (general medical, psychiatry, nonpsychiatry mental health, and human services). We controlled for clinical need and access variables according to the Institute of Medicine's definition of health care disparities. Results: Black caregivers had the lowest rates of treatment receipt of any racial/ethnic group, with 42.2% receiving any depression treatment and 17.2% receiving minimally adequate depression treatment in the past year. In multivariable analyses controlling for clinical need and access variables, Black caregivers were less likely than White caregivers to receive any depression treatment (odds ratio [OR] = 0.49 [95% CI: 0.24–0.97]), minimally adequate depression treatment (OR = 0.37 [95% CI: 0.16–0.85]), and depression treatment from the general medical sector (OR = 0.40 [95% CI: 0.18–0.89]) in the past year (all P< .05). Conclusions: Future research should examine the underlying mechanisms of Black-White disparities in depression treatment for caregivers involved with the US child welfare system and develop targeted interventions to promote equitable mental health care for this highly vulnerable population.

Original languageEnglish (US)
Pages (from-to)1037-1045
Number of pages9
JournalAcademic Pediatrics
Issue number6
StatePublished - Aug 2021


  • caregivers
  • child welfare
  • depression
  • disparities
  • race
  • Caregivers
  • Cross-Sectional Studies
  • Humans
  • Depression/therapy
  • Child Welfare
  • Ethnicity
  • Adolescent
  • Child

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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