Health system depression treatment and outcomes

The National Institute for Minority Health and Health Disparities awarded Kaiser Foundation Hospitals (Kaiser Permanente) $10.492 million on September 19, 2025, under the Minority Health and Health Disparities Research program (CFDA 93.307). The award funds a mixed-methods implementation science study examining racial and ethnic disparities in depression treatment and outcomes across five health systems in seven states (California, Texas, Georgia, Minnesota, Michigan, North Dakota, and Wisconsin).

The research addresses two core questions: what factors contribute to patients not receiving depression treatment, and whether a partial course of treatment confers similar benefits to a full course of treatment. The study analyzes data from 354,148 patients (44,934 Black, 113,207 Hispanic, 16,505 Asian, and 179,502 White) and employs the National Institute for Minority Health and Health Disparities framework for mental health to establish determinants of disparities, test mediating effects of treatment on symptom improvement and remission, and incorporate lived experiences of patients and providers through qualitative interviews.

Kaiser Permanente's Division, the Kaiser Foundation Research Institute, serves as the primary research site and administrative lead. The period of performance extends through March 31, 2026, with place of performance in California.

Four sub-recipients deliver components of the research. Henry Ford Health (via Michigan State University Health Sciences) develops interview scripts, conducts patient and provider interviews, extracts electronic medical record data, and provides clinical interpretation of findings. Essentia Institute of Rural Health schedules and conducts interviews, extracts quantitative data from electronic health records using Health Care Systems Research Network Virtual Data Warehouse definitions, and shares transcripts and datasets with lead sites. Georgia State University Research Foundation leads all qualitative data analysis and interpretation as scientific co-lead for qualitative activities, trains interviewers, and oversees patient, provider, and stakeholder interviews. Baylor Research Institute participates in study teleconferences, workgroups, data analyses, and manuscript preparation.

Abstract

Depression will be the greatest source of global disease by 2030, affecting black, hispanic, and asian communities. Our work has shown that compared to white patients, black, hispanic, and asian patients were less likely to receive any depression treatment and if treated, less likely to receive a partial or full course of psychotherapy or medication. If patients do not receive treatment, most will not experience improvement or remission of their depression. However, the evidence is not clear about the benefits of a partial VS full course of treatment because real-world population-based studies rarely include the treatment course in outcome analyses. Two important unanswered questions for implementation research on depression treatment disparities are 1) what factors contribute to patients not receiving treatment and 2) if treated, does a partial course confer similar benefits to a full course? We will address these questions by using 1) the nimhd framework adaptation for depression that addresses the role of health systems specifically to establish the determinants of disparities in depression treatment and outcomes and 2) a learning health systems approach to ensure our findings have an impact on practice. The following aims will be accomplished with a sample of black (n=44,934), hispanic (n=113,207), asian (n=16,505), and white (n=179,502) patients in 5 health systems in 7 states (CA, TX, GA, MN, MI, ND, WI): aim 1. Test the factors in the nimhd framework for mental health contributing to racial disparities in treatment (none, partial or full course) for patients with moderate-to-severe symptoms of depression; aim 2. Examine the mediating effect of treatment on racial disparities in improvement and remission of depression symptoms; aim 3. Address factors in the nimhd framework for mental health that cannot be addressed in models for aim 1 and aim 2 by incorporating the lived experiences of black, hispanic and asian patients and their providers; and aim 4. Combine the findings from aims 1 - 3 to create a set of recommendations for research and practice to improve depression care in large health settings.