Mihir Shah, MD, on racial disparities in depression among patients on ADT

In this video, Mihir S. Shah, MD, shares the background and key findings from the study, “Racial Disparities in Diagnosis and Treatment of Depression Associated with Androgen Deprivation Therapy for Prostate Cancer,” for which he served as the senior author. Shah is a clinical assistant professor and vice chair of clinical research at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania.

Video Transcript:

Could you describe the background for this study?

Prostate cancer is one of the most common cancers in men in the United States. A lot of these patients will require androgen deprivation therapy at some point in their lifetime during their treatment algorithm. We also know that antigen deprivation therapy has significant side effects like hot flashes, osteoporosis, low libido, erectile dysfunction. We've also learned that there's an increased incidence of depression associated with androgen deprivation therapy. The longer the patient is on androgen deprivation therapy, the higher the likelihood.

When we look at the general population and the rates of depression, what we've noticed is that Black men are at a higher risk or have a higher incidence of depression in their lifetime compared to White men. However, in terms of treatment for depression, White patients tend to be treated at a higher rate in the general population compared to Black patients. So, we sought to investigate if there were racial disparities in incidence and treatment of depression in patients with prostate cancer who are receiving androgen deprivation therapy.

What were the key findings?

We used the TriNetX database and looked at a very large population of patients with prostate cancer who received androgen deprivation therapy, and compared those to those who did not receive androgen deprivation therapy. We looked at the incidence rate of depression in these 2 cohorts. What we found is that patients who received androgen deprivation therapy were at a much higher risk of incidence of depression. The odds ratio was 1.6, suggesting almost a 60% increased incidence rate in this cohort.

We then looked at patients across racial lines when it comes to those that received androgen deprivation therapy. We noticed that if you were White and had prostate cancer and received androgen deprivation therapy, you were more likely to be diagnosed with depression compared to your Black counterparts. Odds ratio being 1.3, suggesting a 30% increased chance. Now that's a bit different than the general population, where the incidence is higher in our Black patients. So, that was interesting.

What we also noticed was when it came to treatment for such depression, the White patients, or White males, were more likely to receive first-line medical therapy for their depression when compared to Black men. Odds ratio being 1.4, suggesting about a 40% higher chance of treatment with first-line medical therapies. When it came to seeking mental health services, there were no racial differences.

This transcription has been edited for clarity.