Risk factors for inadequate treatment ("disadvantaged groups"):
(1) age >= 75 years
(2) racial groups other than Whites and Blacks ("Hispanic or other", including Asian Americans and Native Americans)
(3) patients without additional coverage to supplemental Medicare (reflecting limitations of Medicare coverage of drug costs and mental health services)
Some factors discussed by the authors that may contribute to treatment difficulties:
(1) side effects of antidepressants such as tricyclic antidepressants, resulting in poor compliance
(2) presence of comorbidities that may cause physicians to avoid antidepressants over concerns about side effects or drug interactions
(3) failure of the patient to view depression as a medical problem
(4) cultural attitudes towards the elderly and depression
(5) not being married (single, separated or widowed)
Other factors that may contribute (from other algorithms):
(1) decreased mobility that reduces access to health care
(2) cost of medications (unable to afford)
(3) total number of medications (polypharmacy)
(4) level of social support
