Racial disparities in diagnosis and treatment of depression Associated with androgen deprivation therapy for prostate cancer

Objectives To analyze potential racial disparities in the diagnosis and management of depression associated with androgen deprivation therapy. Methods TriNetX health record network was queried for prostate cancer patients treated with androgen deprivation therapy from 2003-2023. Differences in rates of depression diagnosis and treatment were compared between White and Black patients. Means, odds ratios, and t-tests were calculated in univariate analysis with 95% confidence intervals. Results Data was queried from 93 healthcare organizations to yield 78,313 prostate cancer patients treated with androgen deprivation therapy. Patients on androgen deprivation therapy had 60% greater odds of developing depression versus other patients [9% vs 6%; OR 1.6; 95% CI (1.5-1.7); p<0.0001]. Of those with depression secondary to androgen deprivation therapy, only 35% were treated with antidepressants. After starting androgen deprivation therapy, White patients had 30% greater odds of being diagnosed with depression, compared to Black patients [10% vs 8%; OR 1.3; 95% CI (1.2-1.4); p<0.001]. White patients also had higher odds of being treated with a first line antidepressant than Black patients [56% vs 48%; OR 1.4, 95% CI (1.2-1.6), p<0.001]. Conclusions This analysis confirms a significant association between androgen deprivation therapy and the development of clinical depression and highlights its medical undertreatment. Importantly, our findings also indicate significant racial disparities in the identification and treatment of depression. Routine screening initiatives that account for social determinants of health may alleviate this disparity. Limitations of this study include retrospective design and lack of data describing severity of depression, which might correlate with need for medication.