Skip to main content Accessibility help
×
Home

Depressive role impairment and subthreshold depression in older black and white women: race differences in the clinical significance criterion

  • Mary F. Wyman (a1) (a2), Erin M. Jonaitis (a2) (a3), Earlise C. Ward (a4), Megan Zuelsdorff (a2) (a3) and Carey E. Gleason (a1) (a2) (a3)...

Abstract

Objectives:

We examined race differences in the DSM-IV clinical significance criterion (CSC), an indicator of depressive role impairment, and its impact on assessment outcomes in older white and black women with diagnosed and subthreshold depression.

Design:

We conducted a secondary analysis of a community-based interview study, using group comparisons and logistic regression.

Setting:

Lower-income neighborhoods in a Midwestern city.

Participants:

411 community-dwelling depressed and non-depressed women ≥ 65 years (45.3% Black; mean age = 75.2, SD = 7.2) recruited through census tract-based telephone screening.

Measurements:

SCID interview for DSM-IV to assess major depression and dysthymia; Center for Epidemiologic Studies-Depression Scale to define subthreshold depression (≥16 points); Mini-Mental State Examination, count of medical conditions, activities of daily living, and mental health treatment to assess health factors.

Results:

Black participants were less likely than Whites to endorse the CSC (11.8% vs. 24.1%; p = .002). There were few race differences in depressive symptom type, severity, or count. Blacks with subthreshold depression endorsed more symptoms, though this comparison was not significant after adjustments. Health factors did not account for race differences in CSC endorsement. Disregarding the CSC-eliminated differences in diagnosis rate, race was a significant predictor of CSC endorsement in a logistic regression.

Conclusions:

Race differences in CSC endorsement are not due to depressive symptom presentations or health factors. The use of the CSC may lead to underdiagnosis of depression among black older adults. Subthreshold depression among Blacks may be more severe compared to Whites, thus requiring tailored assessment and treatment approaches.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Depressive role impairment and subthreshold depression in older black and white women: race differences in the clinical significance criterion
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Depressive role impairment and subthreshold depression in older black and white women: race differences in the clinical significance criterion
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Depressive role impairment and subthreshold depression in older black and white women: race differences in the clinical significance criterion
      Available formats
      ×

Copyright

Corresponding author

Correspondence should be addressed to: Mary F. Wyman, PhD, W.S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, GRECC - 11G, Madison, WI 53705, USA. Phone: +1 608-280-7000; Email: mfwyman@wisc.edu.

References

Hide All
Adams, K. B. and Moon, H. (2009). Subthreshold depression: characteristics and risk factors among vulnerable elders. Aging & Mental Health, 13, 682692. doi: 10.1080/13607860902774501
Adebimpe, V. R., Hedlund, J. L., Cho, D. W. and Wood, J. B. (1982). Symptomatology of depression in black and white patients. Journal of the National Medical Association, 74, 185190.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV (4th ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM 5 (5th ed.). Arlington, VA: American Psychiatric Publishing.
American Society of Health-System Pharmacists. (1996). American hospital formulary service drug information. Bethesda, MD: By the authority of the Board of Directors of the American Society of Hospital Pharmacists.
Andresen, E. M., Malmgren, J. A., Carter, W. B. and Patrick, D. L. (1994). Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 7784.
Ayalon, L. and Young, M. A. (2003). A comparison of depressive symptoms in African Americans and Caucasian Americans. Journal of Cross-Cultural Psychology, 34, 111124. doi: 10.1177/0022022102239158
Azar, A. R., Murrell, S. A. and Mast, B. T. (2005). Race and vascular depression risk in community-dwelling older adults. The American Journal of Geriatric Psychiatry, 13, 329332. doi: 10.1176/appi.ajgp.13.4.329
Beals, J. et al. (2004). Challenges in operationalizing the DSM-IV clinical significance criterion. Archives Of General Psychiatry, 61, 11971207. doi: 10.1001/archpsyc.61.12.1197
Belgrave, F. Z. and Abrams, J. A. (2016). Reducing disparities and achieving equity in African American women’s health. American Psychologist, 71, 723733. doi: 10.1037/amp0000081
Bell, C. C. and McBride, D. F. (2011). A commentary for furthering cultural sensitivity within research in geriatric psychiatry. The American Journal of Geriatric Psychiatry, 19, 397402. doi: 10.1097/JGP.0b013e318214ad43
Benjamini, Y. and Hochberg, Y. (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B (Methodological), 57, 289300.
Black, A. R. and Peacock, N. (2011). Pleasing the masses: messages for daily life management in African American women’s popular media sources. American Journal of Public Health, 101, 144150. doi: 10.2105/ajph.2009.167817
Black, A. R. and Woods-Giscombe, C. (2012). Applying the stress and ‘Strength’ hypothesis to Black women’s breast cancer screening delays. Stress Health, 28, 389396. doi: 10.1002/smi.2464
Blalock, A. J. and Joiner, T. E. Jr. (2000). Interaction of cognitive avoidance coping and stress in predicting depression/anxiety. Cognitive Therapy and Research, 24, 4765.
Blazer, D. G., Hughes, D. C. and George, L. K. (1987). The epidemiology of depression in an elderly community population. Gerontologist, 27, 281287. doi: 10.1093/geront/27.3.281
Blazer, D. G., Landerman, L. R., Hays, J. C., Simonsick, E. M. and Saunders, W. B. (1998). Symptoms of depression among community-dwelling elderly African-American and white older adults. Psychological Medicine, 28, 13111320.
Breslau, J., Kendler, K. S., Su, M., Gaxiola-Aguilar, S. and Kessler, R. C. (2005). Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychological Medicine, 35, 317327.
Callahan, C. M. and Wolinsky, F. D. (1994). The effect of gender and race on the measurement properties of the CES-D in older adults. Medical Care, 32, 341356.
Chuan, S. K., Kumar, R., Matthew, N., Heok, K. E. and Pin, N. T. (2008). Subsyndromal depression in old age: clinical significance and impact in a multi-ethnic community sample of elderly Singaporeans. International Psychogeriatrics, 20, 188200. doi: 10.1017/S1041610207006187
Conner, K. O. et al. (2010). Barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults. Aging & Mental Health, 14, 971983. doi: 10.1080/13607863.2010.501061
Coyne, J. C. and Marcus, S. C. (2006). Health disparities in care for depression possibly obscured by the clinical significance criterion. The American Journal of Psychiatry, 163, 15771579. doi: 10.1176/ajp.2006.163.9.1577
Davis, R. E. et al. (2013). Ethnic identity, questionnaire content, and the dilemma of race matching in surveys of African Americans by African American interviewers. Field Methods, 25, 142161. doi: 10.1177/1525822x12449709
Diefenbach, M. A. and Leventhal, H. (1996). The common-sense model of illness representation: theoretical and practical considerations. Journal of Social Distress and the Homeless, 5, 11.
Dunlop, D. D., Song, J., Lyons, J. S., Manheim, L. M. and Chang, R. W. (2003). Racial/ethnic differences in rates of depression among preretirement adults. American Journal of Public Health, 93, 19451952.
Field, A. (2009). Discovering Statistics using SPSS (3rd ed.). London: SAGE Publications Ltd.
Fillenbaum, G. G. (1988). Multidimensional functional assessment of older adults: The Duke Older Americans Resources and Services procedures. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington, DC: American Psychiatric Press, Inc.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Ford, B. C., Bullard, K. M., Taylor, R. J., Toler, A. K., Neighbors, H. W. and Jackson, J. S. (2007). Lifetime and 12-month prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders among older African Americans: findings from the National Survey of American Life. American Journal of Geriatric Psychiatry, 15, 652659. doi: 10.1097/JGP.0b013e3180437d9e
Fyffe, D. C., Sirey, J. A., Heo, M. and Bruce, M. L. (2004). Late-life depression among black and white elderly homecare patients. The American Journal of Geriatric Psychiatry, 12, 531535. doi: 10.1176/appi.ajgp.12.5.531
Gatz, M., Johansson, B., Pedersen, N., Berg, S. and Reynolds, C. (1993). A cross-national self-report measure of depressive symptomatology. International Psychogeriatrics, 5, 147156. doi: 10.1017/S1041610293001486
Gonzalez, H. M., Vega, W. A., Williams, D. R., Tarraf, W., West, B. T. and Neighbors, H. W. (2010). Depression care in the United States: too little for too few. Archives Of General Psychiatry, 67, 3746. doi: 10.1001/archgenpsychiatry.2009.168
Haigh, E. A. P., Bogucki, O. E., Sigmon, S. T. and Blazer, D. G. (2017). Depression among older adults: a 20-year update on five common myths and misconceptions. The American Journal of Geriatric Psychiatry. doi: 10.1016/j.jagp.2017.06.011
Heller, K., Viken, R. J. and Swindle, R. W. Jr. (2010). Screening for depression in African American and Caucasian older women. Aging & Mental Health, 14, 339346.
Hosmer, D. W. and Lemeshow, S. (1989). Applied Logistic Regression. New York: John Wiley & Sons.
Jang, Y., Park, N. S., Kang, S. Y. and Chiriboga, D. A. (2014). Racial/ethnic differences in the association between symptoms of depression and self-rated mental health among older adults. Community Mental Health Journal, 50, 325330. doi: 10.1007/s10597-013-9642-2
Jimenez, D. E., Alegria, M., Chen, C. N., Chan, D. and Laderman, M. (2010). Prevalence of psychiatric illnesses in older ethnic minority adults. Journal of the American Geriatrics Society, 58, 256264. doi:10.1111/j.1532-5415.2009.02685.x
Jimenez, D. E., Cook, B., Bartels, S. J. and Alegria, M. (2013). Disparities in mental health service use of racial and ethnic minority elderly adults. Journal of the American Geriatrics Society, 61, 1825. doi: 10.1111/jgs.12063
Judd, L. L., Rapaport, M. H., Paulus, M. P. and Brown, J. L. (1994). Subsyndromal symptomatic depression: a new mood disorder? The Journal of Clinical Psychiatry, 55(Suppl), 1828.
Kales, H. C. et al. (2013). Racial differences in adherence to antidepressant treatment in later life. American Journal of Geriatric Psychiatry, 21, 9991009. doi: 10.1016/j.jagp.2013.01.046
Kessler, R. C., McGonagle, K. A., Swartz, M., Blazer, D. G. and Nelson, C. B. (1993). Sex and depression in the National Comorbidity Survey. I: lifetime prevalence, chronicity and recurrence. Journal of Affective Disorders, 29, 8596.
Kim, G., Decoster, J., Huang, C. H. and Chiriboga, D. A. (2011). Race/ethnicity and the factor structure of the center for epidemiologic studies depression scale: a meta-analysis. Cultural Diversity and Ethnic Minority Psychology, 17, 381396. doi: 10.1037/a0025434
Kind, A. J. et al. (2014). Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Annals of Internal Medicine, 161, 765774. doi: 10.7326/m13-2946
Long, K., Sudha, S. and Mutran, E. J. (1998). Elder-proxy agreement concerning the functional status and medical history of the older person: the impact of caregiver burden and depressive symptomatology. Journal of the American Geriatrics Society, 46, 11031111.
Meeks, T. W., Vahia, I. V., Lavretsky, H., Kulkarni, G. and Jeste, D. V. (2011). A tune in “a minor” can “b major”: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. Journal of Affective Disorders, 129, 126142. doi: 10.1016/j.jad.2010.09.015
Moos, R., Cronkite, R., Billings, A. and Finney, J. (1988). Health and Daily Living Form Manual. Palo Alto, CA: Social Ecology Laboratory, Dept of Psychiatry & Behavioral Sciences, Stanford University Medical Center.
Pinquart, M. and Sorensen, S. (2005). Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: a meta-analysis. Gerontologist, 45, 90106.
Radloff, L. S. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385401. doi: 10.1177/014662167700100306
Skarupski, K. A. et al. (2005). Black-white differences in depressive symptoms among older adults over time. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 60, P136142.
Spitzer, R. L. and Wakefield, J. C. (1999). DSM-IV diagnostic criterion for clinical significance: does it help solve the false positives problem? American Journal of Psychiatry, 156, 18561864.
Steffens, D. C., Artigues, D. L., Ornstein, K. A. and Krishnan, K. R. (1997). A review of racial differences in geriatric depression: implications for care and clinical research. Journal of the National Medical Association, 89, 731736.
Swindle, R. W., Cronkite, R. C. and Moos, R. (1989). Life stressors, social resources, coping, and the 4-year course of unipolar depression. Journal of Abnormal Psychology, 98, 468477.
Swindle, R. W., Heller, K., Alexander, D. B., Allen, S. M. and Wyman, M. F. (2001). Sources of stressor-specific negative transactions and depressive symptoms among White and African American older women. Applied Developmental Science, 5, 98111. doi: 10.1207/S1532480XADS0502_5
Tappen, R. M., Rosselli, M. and Engstrom, G. (2012). Use of the MC-FAQ and MMSE-FAQ in cognitive screening of older African Americans, Hispanic Americans, and European Americans. The American Journal of Geriatric Psychiatry, 20, 955962. doi: 10.1097/JGP.0b013e31825d0935
Wakefield, J. C., Schmitz, M. F. and Baer, J. C. (2010). Does the DSM-IV clinical significance criterion for major depression reduce false positives? Evidence from the National Comorbidity Survey Replication. The American Journal of Psychiatry, 167, 298304. doi: 10.1176/appi.ajp.2009.09040553
Ward, E. C., Mengesha, M. M. and Issa, F. (2014). Older African American women’s lived experiences with depression and coping behaviours. Journal of Psychiatric and Mental Health Nursing, 21, 4659. doi: 10.1111/jpm.12046
Watson, K. T., Roberts, N. M. and Saunders, M. R. (2012). Factors associated with anxiety and depression among African American and White women. ISRN Psychiatry, 2012, 432321. doi: 10.5402/2012/432321
Williams, D. R. et al. (2007). Prevalence and distribution of major depressive disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites: results from the National Survey of American Life. Archives of General Psychiatry, 64, 305315. doi: 10.1001/archpsyc.64.3.305
Wood, R. Y., Giuliano, K. K., Bignell, C. U. and Pritham, W. W. (2006). Assessing cognitive ability in research: use of MMSE with minority populations and elderly adults with low education levels. Journal of Gerontological Nursing, 32, 4554.
Woodward, A. T., Taylor, R. J., Bullard, K. M., Aranda, M. P., Lincoln, K. D. and Chatters, L. M. (2012). Prevalence of lifetime DSM-IV affective disorders among older African Americans, Black Caribbeans, Latinos, Asians and non‐Hispanic White people. International Journal of Geriatric Psychiatry, 27, 816.

Keywords

Type Description Title
WORD
Supplementary materials

Wyman et al. supplementary material
Wyman et al. supplementary material 1

 Word (18 KB)
18 KB
UNKNOWN
Supplementary materials

Wyman et al. supplementary material
Wyman et al. supplementary material 2

 Unknown (182 KB)
182 KB

Depressive role impairment and subthreshold depression in older black and white women: race differences in the clinical significance criterion

  • Mary F. Wyman (a1) (a2), Erin M. Jonaitis (a2) (a3), Earlise C. Ward (a4), Megan Zuelsdorff (a2) (a3) and Carey E. Gleason (a1) (a2) (a3)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed