Health Disparities
Differences in initial clinical prescription of antidepressant mediations among sexual minority and heterosexual populations with major depressive disorder Frank M. Wolf* Frank Wolf Wolf Wolf Wolf Wolf Wolf Department of Epidemiology and Biostatistics, University of California, San Francisco
Introduction: Major depressive disorder (MDD) is more prevalent among sexual minority individuals (SM), likely due to the stigma and discrimination they experience per the minority stress model. Scarce literature on the utilization and effectiveness of pharmacotherapy treatments for MDD among SM exists to inform care delivery.
Methods: De-identified clinical records for patients with MDD (F32 or F33 ICD-9 or ICD-10) who initiated MDD-directed pharmacotherapy at UCSF Health between January 1, 2018 and December 31, 2023 (index date: date of first pharmacotherapy) were analyzed. Patients with ≥1 UCSF encounter 12 months prior to index and complete sexual orientation data were eligible for inclusion. Frequency of antidepressant medication orders at index were described for SM and heterosexual patients. Mixed-effect Poisson regression models were fit to compare the count of unique medications among MDD medication orders received for SM vs. heterosexual patients during follow-up (1 year).
Results: 6,416 patients were eligible. SM (1,291 [20.1%]) were more likely to identify as Latinx, multi-race/ethnicity, White, and gender minority than heterosexual patients. The three most prescribed first-line antidepressants for SM and heterosexual patients were escitalopram (Lexapro; SM: 21%; Heterosexual: 23%), sertraline (Zoloft; SM: 19%; Heterosexual: 20%), and bupropion (Wellbutrin; SM: 17%; Heterosexual: 12%). Models adjusted for age at index and gender identity indicated an increased count of unique antidepressant medications ordered for SM vs. heterosexual populations. The fully adjusted model indicated a 3% increase (RR 1.03; 95% CI 0.99-1.07) and was of borderline statistical significance.
Discussion: Similar initial medication utilization and 3% greater medication diversity during follow-up may indicate reduced effectiveness or less tolerable side effect profiles of guideline-concordant MDD treatment among SM. Investigation of antidepressant effectiveness among SM is merited.
