The association between geographic access to providers and the treatment quality of pediatric depression

Objective: To examine the association of geographic access to providers with racial/ethnic variations in treatment quality among youth with depression. Methods: The geographic access to providers who initiated the depression treatment was measured using the travel distance estimated based on Google Maps® and the provider density within a 5-mile radius of each patient residence. Depression treatment quality was measured as treatment engagement, defined as having ≥2 prescriptions or psychotherapy with 2-month following a new depression diagnosis, and treatment completion defined as having ≥8 sessions of psychotherapy within 12 weeks or received ≥84 days of continuous treatment with antidepressants within 114 days following the treatment initiation. Results: The results of multivariate logistic regression analysis have demonstrated that the travel distance to provider was only negatively associated with the treatment engagement of Hispanics (5.0 - 14.9 vs ≤ 4.9 miles: OR=0.74, 95% CI [0.54–0.88]; ≥15 vs ≤ 4.9 miles: OR=0.82, 95% CI [0.56–0.97]), while a higher mental health specialist density was only positively associated with the treatment engagement of Blacks (1.00–1.99 vs < 1.00: OR=1.63, 95% CI [1.03–4.51]; 2.00–4.99 vs < 1.0: OR=2.28, 95% CI [1.21–7.11]). Among those who have engaged in the treatment, travel distance was associated with a lower likelihood of treatment completion in all racial/ethnic groups. Limitations: The study did not account for types of transportation used by patients. Conclusion: Geographic access barriers had a negative association with treatment quality of pediatric depression. Minority children were more sensitive to the barriers than Whites.