Coyne, J.C.

de Jonge, P.

English

Coyne, James C.

de Jonge, Peter

University of Groningen Research Database

  
 University of Groningen
Should African Americans be overtreated for depression the same as whites are?
Commentary on Waldman et al (2009)
Coyne, James C.; de Jonge, Peter
Published in:
American Heart Journal
DOI:
10.1016/j.ahj.2009.03.004
IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from
it. Please check the document version below.
Document Version
Publisher's PDF, also known as Version of record
Publication date:
2009
Link to publication in University of Groningen/UMCG research database
Citation for published version (APA):
Coyne, J. C., & de Jonge, P. (2009). Should African Americans be overtreated for depression the same as
whites are? Commentary on Waldman et al (2009). American Heart Journal, 157(5), -e31. [ARTN 157:e31].
DOI: 10.1016/j.ahj.2009.03.004
Copyright
Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the
author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).
Take-down policy
If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately
and investigate your claim.
Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the
number of authors shown on this cover page is limited to 10 maximum.
Download date: 10-02-2018
Should African Americans be overtreated for
depression the same as whites are?
Commentary on Waldman et al (2009)
Contrary to the interpretation that Waldman et al1
provide, we believe that their data point to carelessness
with which antidepressants (ADs) are currently being
prescribed to both African Americans and whites. These
authors examined charts of 864 of 8,028 available
patients who had undergone left heart cardiac catheter-
ization. Apparently, records of AD prescriptions and self-
report depression inventories were available, but no
formal diagnoses of depression. Furthermore, data were
available for only 137 African American patients, with
only 16 of them receiving an AD. Multivariate regression
and subgroup analyses are thus not valid.2
The authors report that 27% of the sample had
elevated scores (≥10) on the depression inventory and
that an additional 10% of the patients with lower scores
on the depression inventory received an AD. From these
figures, the authors infer that 38% of the sample had
significant depression. However, an elevated score on a
self-report depression scale is not itself an indication of
the need for AD treatment. In fact, between one tenth
and one fifth of patients with scores ≥10 would be found
to have major depression,3 suggesting a much lower
estimate of the patients appropriate to receive antide-
pressants. There is thus evidence of gross nonspecific
prescribing and overtreatment with ADs in this sample.
That 10% of the sample with low depression scores have
received an AD is also troubling. Given the poor quality of
routine care for depression in general medical settings4
and modest reductions in depression this care is likely to
yield,2 it is unlikely that many of these patients were
depressed when prescribed an AD or that their low
depression scores represent a reduction in symptoms.
Undoubtedly, much depression in medical patients
remains undetected and undertreated, but the problem
of AD overtreatment is substantial and growing.5
Perhaps, steps could be made to ensure that African
Americans have greater access to overtreatment and
poor quality depression care. However, we believe it
would be much more important that better quality,
more nuanced data than what were mustered by
Waldman should be gathered to identify breakdowns in
the delivery of appropriate prescription of AD and
adequacy of follow-up care for depression among all
patients, white and minority.
Am Heart J 2009;157:e31.
0002-8703/$ - see front matter
doi:10.1016/j.ahj.2009.03.004
James C. Coyne, PhD
Department of Psychiatry
University of Pennsylvania School of Medicine
Philadelphia, PA
Peter de Jonge, PhD
Interdisciplinary Center for Psychiatric Epidemiology
Departments of Psychiatry and Internal Medicine
University Medical Center Groningen
University of Groningen, Netherlands
CoRPS-Center of Research on Psychology in
Somatic Diseases
Department of Medical Psychology
Tilburg University
Tilburg, Netherlands
References
1. Waldman SV, Blumenthal JA, Babyak MA, et al. Ethnic differences in
the treatment of depression in patients with ischemic heart disease. Am
Heart J 2009;157:77-83.
2. Babyak M. What you see may not be what you get: a brief,
nontechnical introduction to overfitting in regression-type models.
Psychosom Med 2004;66:411-21.
3. Thombs BD, de Jonge P, Coyne JC, et al. Depression screening and
patient outcomes in cardiovascular care: a systematic review. JAMA
2008;300:2161-71.
4. Seelig MD, Katon W. Gaps in depression care: why primary care
physicians should hone their depression screening, diagnosis, and
management skills. J Occup Environm Med 2008;50:451-8.
5. Jureidini J, Tonkin A. Overuse of antidepressant drugs for the treatment
of depression. Cns Drugs 2006;20:623-32.


Should African Americans be overtreated for depression the same as whites are? Commentary on Waldman et al (2009)

ARTS repository - University of Groningen

   University of GroningenShould African Americans be overtreated for depression the same as whites are?Commentary on Waldman et al (2009)Coyne, James C.; de Jonge, PeterPublished in:American Heart JournalDOI:10.1016/j.ahj.2009.03.004IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2009Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Coyne, J. C., & de Jonge, P. (2009). Should African Americans be overtreated for depression the same aswhites are? Commentary on Waldman et al (2009). American Heart Journal, 157(5), -e31. Article ARTN157:e31. https://doi.org/10.1016/j.ahj.2009.03.004CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Should African Americans be overtreated fordepression the same as whites are?Commentary on Waldman et al (2009)Contrary to the interpretation that Waldman et al1provide, we believe that their data point to carelessnesswith which antidepressants (ADs) are currently beingprescribed to both African Americans and whites. Theseauthors examined charts of 864 of 8,028 availablepatients who had undergone left heart cardiac catheter-ization. Apparently, records of AD prescriptions and self-report depression inventories were available, but noformal diagnoses of depression. Furthermore, data wereavailable for only 137 African American patients, withonly 16 of them receiving an AD. Multivariate regressionand subgroup analyses are thus not valid.2The authors report that 27% of the sample hadelevated scores (≥10) on the depression inventory andthat an additional 10% of the patients with lower scoreson the depression inventory received an AD. From thesefigures, the authors infer that 38% of the sample hadsignificant depression. However, an elevated score on aself-report depression scale is not itself an indication ofthe need for AD treatment. In fact, between one tenthand one fifth of patients with scores ≥10 would be foundto have major depression,3 suggesting a much lowerestimate of the patients appropriate to receive antide-pressants. There is thus evidence of gross nonspecificprescribing and overtreatment with ADs in this sample.That 10% of the sample with low depression scores havereceived an AD is also troubling. Given the poor quality ofroutine care for depression in general medical settings4and modest reductions in depression this care is likely toyield,2 it is unlikely that many of these patients weredepressed when prescribed an AD or that their lowdepression scores represent a reduction in symptoms.Undoubtedly, much depression in medical patientsremains undetected and undertreated, but the problemof AD overtreatment is substantial and growing.5Perhaps, steps could be made to ensure that AfricanAmericans have greater access to overtreatment andpoor quality depression care. However, we believe itwould be much more important that better quality,more nuanced data than what were mustered byWaldman should be gathered to identify breakdowns inthe delivery of appropriate prescription of AD andadequacy of follow-up care for depression among allpatients, white and minority.Am Heart J 2009;157:e31.0002-8703/$ - see front matterdoi:10.1016/j.ahj.2009.03.004James C. Coyne, PhDDepartment of PsychiatryUniversity of Pennsylvania School of MedicinePhiladelphia, PAPeter de Jonge, PhDInterdisciplinary Center for Psychiatric EpidemiologyDepartments of Psychiatry and Internal MedicineUniversity Medical Center GroningenUniversity of Groningen, NetherlandsCoRPS-Center of Research on Psychology inSomatic DiseasesDepartment of Medical PsychologyTilburg UniversityTilburg, NetherlandsReferences1. Waldman SV, Blumenthal JA, Babyak MA, et al. Ethnic differences inthe treatment of depression in patients with ischemic heart disease. AmHeart J 2009;157:77-83.2. Babyak M. What you see may not be what you get: a brief,nontechnical introduction to overfitting in regression-type models.Psychosom Med 2004;66:411-21.3. Thombs BD, de Jonge P, Coyne JC, et al. Depression screening andpatient outcomes in cardiovascular care: a systematic review. JAMA2008;300:2161-71.4. Seelig MD, Katon W. Gaps in depression care: why primary carephysicians should hone their depression screening, diagnosis, andmanagement skills. J Occup Environm Med 2008;50:451-8.5. Jureidini J, Tonkin A. Overuse of antidepressant drugs for the treatmentof depression. Cns Drugs 2006;20:623-32.

Tilburg University Repository

   University of GroningenShould African Americans be overtreated for depression the same as whites are?Commentary on Waldman et al (2009)Coyne, James C.; de Jonge, PeterPublished in:American Heart JournalDOI:10.1016/j.ahj.2009.03.004IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2009Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Coyne, J. C., & de Jonge, P. (2009). Should African Americans be overtreated for depression the same aswhites are? Commentary on Waldman et al (2009). American Heart Journal, 157(5), -e31. [ARTN 157:e31].https://doi.org/10.1016/j.ahj.2009.03.004CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Should African Americans be overtreated fordepression the same as whites are?Commentary on Waldman et al (2009)Contrary to the interpretation that Waldman et al1provide, we believe that their data point to carelessnesswith which antidepressants (ADs) are currently beingprescribed to both African Americans and whites. Theseauthors examined charts of 864 of 8,028 availablepatients who had undergone left heart cardiac catheter-ization. Apparently, records of AD prescriptions and self-report depression inventories were available, but noformal diagnoses of depression. Furthermore, data wereavailable for only 137 African American patients, withonly 16 of them receiving an AD. Multivariate regressionand subgroup analyses are thus not valid.2The authors report that 27% of the sample hadelevated scores (≥10) on the depression inventory andthat an additional 10% of the patients with lower scoreson the depression inventory received an AD. From thesefigures, the authors infer that 38% of the sample hadsignificant depression. However, an elevated score on aself-report depression scale is not itself an indication ofthe need for AD treatment. In fact, between one tenthand one fifth of patients with scores ≥10 would be foundto have major depression,3 suggesting a much lowerestimate of the patients appropriate to receive antide-pressants. There is thus evidence of gross nonspecificprescribing and overtreatment with ADs in this sample.That 10% of the sample with low depression scores havereceived an AD is also troubling. Given the poor quality ofroutine care for depression in general medical settings4and modest reductions in depression this care is likely toyield,2 it is unlikely that many of these patients weredepressed when prescribed an AD or that their lowdepression scores represent a reduction in symptoms.Undoubtedly, much depression in medical patientsremains undetected and undertreated, but the problemof AD overtreatment is substantial and growing.5Perhaps, steps could be made to ensure that AfricanAmericans have greater access to overtreatment andpoor quality depression care. However, we believe itwould be much more important that better quality,more nuanced data than what were mustered byWaldman should be gathered to identify breakdowns inthe delivery of appropriate prescription of AD andadequacy of follow-up care for depression among allpatients, white and minority.Am Heart J 2009;157:e31.0002-8703/$ - see front matterdoi:10.1016/j.ahj.2009.03.004James C. Coyne, PhDDepartment of PsychiatryUniversity of Pennsylvania School of MedicinePhiladelphia, PAPeter de Jonge, PhDInterdisciplinary Center for Psychiatric EpidemiologyDepartments of Psychiatry and Internal MedicineUniversity Medical Center GroningenUniversity of Groningen, NetherlandsCoRPS-Center of Research on Psychology inSomatic DiseasesDepartment of Medical PsychologyTilburg UniversityTilburg, NetherlandsReferences1. Waldman SV, Blumenthal JA, Babyak MA, et al. Ethnic differences inthe treatment of depression in patients with ischemic heart disease. AmHeart J 2009;157:77-83.2. Babyak M. What you see may not be what you get: a brief,nontechnical introduction to overfitting in regression-type models.Psychosom Med 2004;66:411-21.3. Thombs BD, de Jonge P, Coyne JC, et al. Depression screening andpatient outcomes in cardiovascular care: a systematic review. JAMA2008;300:2161-71.4. Seelig MD, Katon W. Gaps in depression care: why primary carephysicians should hone their depression screening, diagnosis, andmanagement skills. J Occup Environm Med 2008;50:451-8.5. Jureidini J, Tonkin A. Overuse of antidepressant drugs for the treatmentof depression. Cns Drugs 2006;20:623-32.

University of Groningen Digital Archive

Should African Americans be overtreated for
depression the same as whites are?
Commentary on Waldman et al (2009)
Contrary to the interpretation that Waldman et al
1
provide, we believe that their data point to carelessness
with which antidepressants (ADs) are currently being
prescribed to both African Americans and whites. These
authors examined charts of 864 of 8,028 available
patients who had undergone left heart cardiac catheter-
ization. Apparently, records of AD prescriptions and self-
report depression inventories were available, but no
formal diagnoses of depression. Furthermore, data were
available for only 137 African American patients, with
only 16 of them receiving an AD. Multivariate regression
and subgroup analyses are thus not valid.
2
The authors report that 27% of the sample had
elevated scores (≥10) on the depression inventory and
that an additional 10% of the patients with lower scores
on the depression inventory received an AD. From these
figures, the authors infer that 38% of the sample had
significant depression. However, an elevated score on a
self-report depression scale is not itself an indication of
the need for AD treatment. In fact, between one tenth
and one fifth of patients with scores ≥10 would be found
to have major depression,
3 suggesting a much lower
estimate of the patients appropriate to receive antide-
pressants. There is thus evidence of gross nonspecific
prescribing and overtreatment with ADs in this sample.
That 10% of the sample with low depression scores have
received an AD is also troubling. Given the poor quality of
routine care for depression in general medical settings
4
and modest reductions in depression this care is likely to
yield,
2 it is unlikely that many of these patients were
depressed when prescribed an AD or that their low
depression scores represent a reduction in symptoms.
Undoubtedly, much depression in medical patients
remains undetected and undertreated, but the problem
of AD overtreatment is substantial and growing.
5
Perhaps, steps could be made to ensure that African
Americans have greater access to overtreatment and
poor quality depression care. However, we believe it
would be much more important that better quality,
more nuanced data than what were mustered by
Waldman should be gathered to identify breakdowns in
the delivery of appropriate prescription of AD and
adequacy of follow-up care for depression among all
patients, white and minority.
Am Heart J 2009;157:e31.
0002-8703/$ - see front matter
doi:10.1016/j.ahj.2009.03.004
James C. Coyne, PhD
Department of Psychiatry
University of Pennsylvania School of Medicine
Philadelphia, PA
Peter de Jonge, PhD
Interdisciplinary Center for Psychiatric Epidemiology
Departments of Psychiatry and Internal Medicine
University Medical Center Groningen
University of Groningen, Netherlands
CoRPS-Center of Research on Psychology in
Somatic Diseases
Department of Medical Psychology
Tilburg University
Tilburg, Netherlands
References
1. Waldman SV, Blumenthal JA, Babyak MA, et al. Ethnic differences in
the treatment of depression in patients with ischemic heart disease. Am
Heart J 2009;157:77-83.
2. Babyak M. What you see may not be what you get: a brief,
nontechnical introduction to overfitting in regression-type models.
Psychosom Med 2004;66:411-21.
3. Thombs BD, de Jonge P, Coyne JC, et al. Depression screening and
patient outcomes in cardiovascular care: a systematic review. JAMA
2008;300:2161-71.
4. Seelig MD, Katon W. Gaps in depression care: why primary care
physicians should hone their depression screening, diagnosis, and
management skills. J Occup Environm Med 2008;50:451-8.
5. Jureidini J, Tonkin A. Overuse of antidepressant drugs for the treatment
of depression. Cns Drugs 2006;20:623-32.

Depression screening and patient outcomes in cardiovascular care: a systematic review.

Ethnic differences in the treatment of depression in patients with ischemic heart disease.

Gaps in depression care: why primary care physicians should hone their depression screening, diagnosis, and management skills.

Overuse of antidepressant drugs for the treatment of depression.

What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models.

University of Groningen

   University of GroningenShould African Americans be overtreated for depression the same as whites are?Commentary on Waldman et al (2009)Coyne, James C.; de Jonge, PeterPublished in:American Heart JournalDOI:10.1016/j.ahj.2009.03.004IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2009Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Coyne, J. C., & de Jonge, P. (2009). Should African Americans be overtreated for depression the same aswhites are? Commentary on Waldman et al (2009). American Heart Journal, 157(5), -e31. [ARTN 157:e31].https://doi.org/10.1016/j.ahj.2009.03.004CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 12-11-2019Should African Americans be overtreated fordepression the same as whites are?Commentary on Waldman et al (2009)Contrary to the interpretation that Waldman et al1provide, we believe that their data point to carelessnesswith which antidepressants (ADs) are currently beingprescribed to both African Americans and whites. Theseauthors examined charts of 864 of 8,028 availablepatients who had undergone left heart cardiac catheter-ization. Apparently, records of AD prescriptions and self-report depression inventories were available, but noformal diagnoses of depression. Furthermore, data wereavailable for only 137 African American patients, withonly 16 of them receiving an AD. Multivariate regressionand subgroup analyses are thus not valid.2The authors report that 27% of the sample hadelevated scores (≥10) on the depression inventory andthat an additional 10% of the patients with lower scoreson the depression inventory received an AD. From thesefigures, the authors infer that 38% of the sample hadsignificant depression. However, an elevated score on aself-report depression scale is not itself an indication ofthe need for AD treatment. In fact, between one tenthand one fifth of patients with scores ≥10 would be foundto have major depression,3 suggesting a much lowerestimate of the patients appropriate to receive antide-pressants. There is thus evidence of gross nonspecificprescribing and overtreatment with ADs in this sample.That 10% of the sample with low depression scores havereceived an AD is also troubling. Given the poor quality ofroutine care for depression in general medical settings4and modest reductions in depression this care is likely toyield,2 it is unlikely that many of these patients weredepressed when prescribed an AD or that their lowdepression scores represent a reduction in symptoms.Undoubtedly, much depression in medical patientsremains undetected and undertreated, but the problemof AD overtreatment is substantial and growing.5Perhaps, steps could be made to ensure that AfricanAmericans have greater access to overtreatment andpoor quality depression care. However, we believe itwould be much more important that better quality,more nuanced data than what were mustered byWaldman should be gathered to identify breakdowns inthe delivery of appropriate prescription of AD andadequacy of follow-up care for depression among allpatients, white and minority.Am Heart J 2009;157:e31.0002-8703/$ - see front matterdoi:10.1016/j.ahj.2009.03.004James C. Coyne, PhDDepartment of PsychiatryUniversity of Pennsylvania School of MedicinePhiladelphia, PAPeter de Jonge, PhDInterdisciplinary Center for Psychiatric EpidemiologyDepartments of Psychiatry and Internal MedicineUniversity Medical Center GroningenUniversity of Groningen, NetherlandsCoRPS-Center of Research on Psychology inSomatic DiseasesDepartment of Medical PsychologyTilburg UniversityTilburg, NetherlandsReferences1. Waldman SV, Blumenthal JA, Babyak MA, et al. Ethnic differences inthe treatment of depression in patients with ischemic heart disease. AmHeart J 2009;157:77-83.2. Babyak M. What you see may not be what you get: a brief,nontechnical introduction to overfitting in regression-type models.Psychosom Med 2004;66:411-21.3. Thombs BD, de Jonge P, Coyne JC, et al. Depression screening andpatient outcomes in cardiovascular care: a systematic review. JAMA2008;300:2161-71.4. Seelig MD, Katon W. Gaps in depression care: why primary carephysicians should hone their depression screening, diagnosis, andmanagement skills. J Occup Environm Med 2008;50:451-8.5. Jureidini J, Tonkin A. Overuse of antidepressant drugs for the treatmentof depression. Cns Drugs 2006;20:623-32.

University of GroningenShould African Americans be overtreated for depression the same as whites are?Commentary on Waldman et al (2009)Coyne, James C.; de Jonge, PeterPublished in:American Heart JournalDOI:10.1016/j.ahj.2009.03.004IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2009Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Coyne, J. C., & de Jonge, P. (2009). Should African Americans be overtreated for depression the same aswhites are? Commentary on Waldman et al (2009). American Heart Journal, 157(5), -e31. Article ARTN157:e31. https://doi.org/10.1016/j.ahj.2009.03.004CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 30-12-2025Should African Americans be overtreated fordepression the same as whites are?Commentary on Waldman et al (2009)Contrary to the interpretation that Waldman et al1provide, we believe that their data point to carelessnesswith which antidepressants (ADs) are currently beingprescribed to both African Americans and whites. Theseauthors examined charts of 864 of 8,028 availablepatients who had undergone left heart cardiac catheter-ization. Apparently, records of AD prescriptions and self-report depression inventories were available, but noformal diagnoses of depression. Furthermore, data wereavailable for only 137 African American patients, withonly 16 of them receiving an AD. Multivariate regressionand subgroup analyses are thus not valid.2The authors report that 27% of the sample hadelevated scores (≥10) on the depression inventory andthat an additional 10% of the patients with lower scoreson the depression inventory received an AD. From thesefigures, the authors infer that 38% of the sample hadsignificant depression. However, an elevated score on aself-report depression scale is not itself an indication ofthe need for AD treatment. In fact, between one tenthand one fifth of patients with scores ≥10 would be foundto have major depression,3 suggesting a much lowerestimate of the patients appropriate to receive antide-pressants. There is thus evidence of gross nonspecificprescribing and overtreatment with ADs in this sample.That 10% of the sample with low depression scores havereceived an AD is also troubling. Given the poor quality ofroutine care for depression in general medical settings4and modest reductions in depression this care is likely toyield,2 it is unlikely that many of these patients weredepressed when prescribed an AD or that their lowdepression scores represent a reduction in symptoms.Undoubtedly, much depression in medical patientsremains undetected and undertreated, but the problemof AD overtreatment is substantial and growing.5Perhaps, steps could be made to ensure that AfricanAmericans have greater access to overtreatment andpoor quality depression care. However, we believe itwould be much more important that better quality,more nuanced data than what were mustered byWaldman should be gathered to identify breakdowns inthe delivery of appropriate prescription of AD andadequacy of follow-up care for depression among allpatients, white and minority.Am Heart J 2009;157:e31.0002-8703/$ - see front matterdoi:10.1016/j.ahj.2009.03.004James C. Coyne, PhDDepartment of PsychiatryUniversity of Pennsylvania School of MedicinePhiladelphia, PAPeter de Jonge, PhDInterdisciplinary Center for Psychiatric EpidemiologyDepartments of Psychiatry and Internal MedicineUniversity Medical Center GroningenUniversity of Groningen, NetherlandsCoRPS-Center of Research on Psychology inSomatic DiseasesDepartment of Medical PsychologyTilburg UniversityTilburg, NetherlandsReferences1. Waldman SV, Blumenthal JA, Babyak MA, et al. Ethnic differences inthe treatment of depression in patients with ischemic heart disease. AmHeart J 2009;157:77-83.2. Babyak M. What you see may not be what you get: a brief,nontechnical introduction to overfitting in regression-type models.Psychosom Med 2004;66:411-21.3. Thombs BD, de Jonge P, Coyne JC, et al. Depression screening andpatient outcomes in cardiovascular care: a systematic review. JAMA2008;300:2161-71.4. Seelig MD, Katon W. Gaps in depression care: why primary carephysicians should hone their depression screening, diagnosis, andmanagement skills. J Occup Environm Med 2008;50:451-8.5. Jureidini J, Tonkin A. Overuse of antidepressant drugs for the treatmentof depression. Cns Drugs 2006;20:623-32.

Should African Americans be overtreated for depression the same as whites are? Commentary on Waldman et al (2009)

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