Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-19T14:26:09.789Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  28 August 2019

Mary F. Wyman Open the ORCID record for Mary F. Wyman [Opens in a new window] ,
Erin M. Jonaitis ,
Earlise C. Ward ,
Megan Zuelsdorff  and
Carey E. Gleason
Mary F. Wyman*
Affiliation:
W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
Erin M. Jonaitis
Affiliation:
School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA Alzheimer’s Disease Research Center, Madison, WI, USA
Earlise C. Ward
Affiliation:
School of Nursing, University of Wisconsin, Madison, WI, USA
Megan Zuelsdorff
Affiliation:
School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA Alzheimer’s Disease Research Center, Madison, WI, USA
Carey E. Gleason
Affiliation:
W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA Alzheimer’s Disease Research Center, Madison, WI, USA
*
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.
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

older adultsAfrican Americans/Blackspsychiatric assessmentdepressionsubthreshold depression
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 3: Issue Theme: Improving Healthcare in Long-Term Care and Nursing Homes , March 2020 , pp. 393 - 405
Copyright
© International Psychogeriatric Association 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adams, K. B. and Moon, H. (2009). Subthreshold depression: characteristics and risk factors among vulnerable elders. Aging & Mental Health, 13, 682–692. doi: 10.1080/13607860902774501CrossRefGoogle ScholarPubMed
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, 185–190.Google ScholarPubMed
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM 5 (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
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.Google Scholar
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, 77–84.CrossRefGoogle Scholar
Ayalon, L. and Young, M. A. (2003). A comparison of depressive symptoms in African Americans and Caucasian Americans. Journal of Cross-Cultural Psychology, 34, 111–124. doi: 10.1177/0022022102239158CrossRefGoogle Scholar
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, 329–332. doi: 10.1176/appi.ajgp.13.4.329CrossRefGoogle ScholarPubMed
Beals, J.et al. (2004). Challenges in operationalizing the DSM-IV clinical significance criterion. Archives Of General Psychiatry, 61, 1197–1207. doi: 10.1001/archpsyc.61.12.1197CrossRefGoogle ScholarPubMed
Belgrave, F. Z. and Abrams, J. A. (2016). Reducing disparities and achieving equity in African American women’s health. American Psychologist, 71, 723–733. doi: 10.1037/amp0000081CrossRefGoogle ScholarPubMed
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, 397–402. doi: 10.1097/JGP.0b013e318214ad43CrossRefGoogle ScholarPubMed
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, 289–300.CrossRefGoogle Scholar
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, 144–150. doi: 10.2105/ajph.2009.167817CrossRefGoogle ScholarPubMed
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, 389–396. doi: 10.1002/smi.2464CrossRefGoogle ScholarPubMed
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, 47–65.CrossRefGoogle Scholar
Blazer, D. G., Hughes, D. C. and George, L. K. (1987). The epidemiology of depression in an elderly community population. Gerontologist, 27, 281–287. doi: 10.1093/geront/27.3.281CrossRefGoogle Scholar
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, 1311–1320.CrossRefGoogle ScholarPubMed
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, 317–327.CrossRefGoogle ScholarPubMed
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, 341–356.CrossRefGoogle ScholarPubMed
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, 188–200. doi: 10.1017/S1041610207006187CrossRefGoogle Scholar
Conner, K. O.et al. (2010). Barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults. Aging & Mental Health, 14, 971–983. doi: 10.1080/13607863.2010.501061CrossRefGoogle ScholarPubMed
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, 1577–1579. doi: 10.1176/ajp.2006.163.9.1577CrossRefGoogle ScholarPubMed
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, 142–161. doi: 10.1177/1525822x12449709CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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, 1945–1952.CrossRefGoogle ScholarPubMed
Field, A. (2009). Discovering Statistics using SPSS (3rd ed.). London: SAGE Publications Ltd.Google Scholar
Fillenbaum, G. G. (1988). Multidimensional functional assessment of older adults: The Duke Older Americans Resources and Services procedures. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
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.Google Scholar
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, 189–198.CrossRefGoogle ScholarPubMed
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, 652–659. doi: 10.1097/JGP.0b013e3180437d9eCrossRefGoogle ScholarPubMed
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, 531–535. doi: 10.1176/appi.ajgp.12.5.531CrossRefGoogle ScholarPubMed
Gatz, M., Johansson, B., Pedersen, N., Berg, S. and Reynolds, C. (1993). A cross-national self-report measure of depressive symptomatology. International Psychogeriatrics, 5, 147–156. doi: 10.1017/S1041610293001486CrossRefGoogle ScholarPubMed
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, 37–46. doi: 10.1001/archgenpsychiatry.2009.168CrossRefGoogle ScholarPubMed
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.2017.06.011CrossRefGoogle Scholar
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, 339–346.CrossRefGoogle ScholarPubMed
Hosmer, D. W. and Lemeshow, S. (1989). Applied Logistic Regression. New York: John Wiley & Sons.Google Scholar
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, 325–330. doi: 10.1007/s10597-013-9642-2CrossRefGoogle ScholarPubMed
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, 256–264. doi:10.1111/j.1532-5415.2009.02685.xCrossRefGoogle ScholarPubMed
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, 18–25. doi: 10.1111/jgs.12063CrossRefGoogle ScholarPubMed
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), 18–28.Google ScholarPubMed
Kales, H. C.et al. (2013). Racial differences in adherence to antidepressant treatment in later life. American Journal of Geriatric Psychiatry, 21, 999–1009. doi: 10.1016/j.jagp.2013.01.046CrossRefGoogle ScholarPubMed
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, 85–96.CrossRefGoogle ScholarPubMed
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, 381–396. doi: 10.1037/a0025434CrossRefGoogle Scholar
Kind, A. J.et al. (2014). Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Annals of Internal Medicine, 161, 765–774. doi: 10.7326/m13-2946CrossRefGoogle ScholarPubMed
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, 1103–1111.CrossRefGoogle ScholarPubMed
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, 126–142. doi: 10.1016/j.jad.2010.09.015CrossRefGoogle ScholarPubMed
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.Google Scholar
Pinquart, M. and Sorensen, S. (2005). Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: a meta-analysis. Gerontologist, 45, 90–106.CrossRefGoogle ScholarPubMed
Radloff, L. S. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. doi: 10.1177/014662167700100306CrossRefGoogle Scholar
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, P136–142.CrossRefGoogle ScholarPubMed
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, 1856–1864.Google ScholarPubMed
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, 731–736.Google ScholarPubMed
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, 468–477.CrossRefGoogle ScholarPubMed
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, 98–111. doi: 10.1207/S1532480XADS0502_5CrossRefGoogle Scholar
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, 955–962. doi: 10.1097/JGP.0b013e31825d0935CrossRefGoogle ScholarPubMed
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, 298–304. doi: 10.1176/appi.ajp.2009.09040553CrossRefGoogle ScholarPubMed
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, 46–59. doi: 10.1111/jpm.12046CrossRefGoogle ScholarPubMed
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: 10.5402/2012/432321CrossRefGoogle ScholarPubMed
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, 305–315. doi: 10.1001/archpsyc.64.3.305CrossRefGoogle ScholarPubMed
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, 45–54.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Supplementary material: File

Wyman et al. supplementary material

Wyman et al. supplementary material 1

Download Wyman et al. supplementary material(File)
File 17.7 KB
Supplementary material: Image

Wyman et al. supplementary material

Wyman et al. supplementary material 2

Download Wyman et al. supplementary material(Image)
Image 182.2 KB