CNSPulse
T109

RACIAL DIFFERENCES IN ANTIDEPRESSANT INITIATION AND OUTCOMES AFTER A ONE-TIME PSYCHIATRIC CONSULTATION: A MIXED-METHODS STUDY

Helena Kim — Ishrat Husain2, Stefan Kloiber1, Benoit H. Mulsant3 1Centre for Addiction and Mental Health, University of Toronto, 2Centre for Addiction and Mental Health, 3University of Toronto

2026 ASCP Annual Meeting

Background

Many patients with major depressive disorder (MDD) access psychiatric care through a one-time psychiatric consultation and are referred back to their primary care provider (PCP) for treatment. Racial disparities in antidepressant outcomes are well documented, but it is unclear whether inequities emerge within this transition.

Methods

Adults diagnosed with MDD at a large urban academic mental health hospital were followed for three months after a one-time psychiatric consultation. The primary outcome was implementation of at least one recommended antidepressant initiation or change. Secondary outcome was symptom improvement. Pre-specified moderators included gender, income, discrimination in medical settings, beliefs about depression care, and adherence. Logistic and linear regression analyses were conducted. Categorical principal component analysis (CATPCA) was conducted to identify unsupervised clustering of variables (loadings ≥|0.4| considered meaningful; Cronbach α > 0.7 indicating acceptable internal consistency). Qualitative analysis of interview transcripts was conducted using constructivist grounded theory and mapped onto the Capability, Opportunity, Motivation–Behavior (COM-B) framework.

Results

Fifty-six participants (28 BIPOC; 28 Caucasian) completed questionnaires and chart review. Of the 56, 24 completed semi-structured interviews. Overall, 75% implemented at least one recommended antidepressant initiation or change; 93% of these changes occurred within one month. This did not differ by race (χ²=1.0, p=0.31). Mean PHQ-9 decreased by 2.8±6.6 points (N=51), which also did not differ by race (F1,49=0.6, p=0.43). Moderation analyses were negative. CATPCA identified four dimensions, of which 2 were associated with race: first dimension clustered Caucasian identity with higher socioeconomic status, older age, and perceiving depression as impactful; second dimension clustered Caucasian identity with following treatment recommendations, adherence, interest in medication, positive consultation experience, and more comprehensive documentation. The primary outcome did not cluster with race. Qualitative analysis identified capability barriers (limited mental health literacy), opportunity barriers (rushed encounters, misalignment with providers), and motivation barriers (perceived harm, stigma, doubts about effectiveness) in both groups. Racialized participants more frequently described systemic misalignment and internalized stigma, while Caucasian participants more frequently described financial barriers.

Conclusions

Although no racial differences were observed in early antidepressant uptake or treatment outcomes, unsupervised machine learning analysis and qualitative findings reveal structural and experiential inequities.