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Comparison of three societally derived health-state classification values among older African Americans with depressive symptoms.

ABSTRACT: To compare societal values across three health-state classification systems in older African Americans with depression and to describe the association of these instruments to depression severity.We summarized baseline values for EQ-5D (US weights) and HUI2/3 (Canadian weights) and their subscales for 118 older African American participants enrolled in a randomized depression treatment trial and calculated correlations between the different instruments. We evaluated ceiling and floor effects for each instrument by comparing the proportion at the highest and lowest possible score for each tool. Also, utility scores were assessed by level of depression severity (mild, moderate, moderate severe, severe) scores as measured by the Patient Health Questionnaire (PHQ-9).Mean utility values were 0.58 (SD = 0.21) for EQ-5D, 0.52 (SD = 0.21) for HUI2, and 0.36 (SD = 0.31) for HUI3. For the EQ-5D, 72 % of participants reported having some problems on the anxiety/depression domain. On the emotion domain for the HUI2, 23 % reported the highest level of impairment compared to only 3 % on the HUI3. No participant scored at the floor for the EQ-5D, HUI2, or HUI3 index; one participant scored at the ceiling value on the HUI3 index. Correlations ranged from 0.63 to 0.82 (all of which were significant at an alpha level of 0.05). In general, utility scores trended inversely with depression level.Small differences in the three preference-weighted health-state classification systems were evident for this sample of older African Americans with depressive symptoms, with HUI scores lower than EQ-5D. For this sample, utility scores were lower (i.e., poorer) than the general United States population with depression on each utility measure.

SUBMITTER: Jutkowitz E

PROVIDER: S-EPMC3822045 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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Comparison of three societally derived health-state classification values among older African Americans with depressive symptoms.

Jutkowitz Eric E Pizzi Laura L Hess Edward E Suh Dong-Churl DC Gitlin Laura N LN

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 20120913 6

<h4>Purpose</h4>To compare societal values across three health-state classification systems in older African Americans with depression and to describe the association of these instruments to depression severity.<h4>Methods</h4>We summarized baseline values for EQ-5D (US weights) and HUI2/3 (Canadian weights) and their subscales for 118 older African American participants enrolled in a randomized depression treatment trial and calculated correlations between the different instruments. We evaluate ...[more]

PMID: 22972437

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Project description:Effective care models for treating older African Americans with depressive symptoms are needed.To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans.Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov: NCT00511680).A senior center and participants' homes from 2008 to 2010.African Americans aged 55 years or older with depressive symptoms.A multicomponent, home-based intervention delivered by social workers or a wait-list control group that received the intervention at 4 months.Self-reported depression severity at 4 months (primary outcome) and depression knowledge, quality of life, behavioral activation, anxiety, function, and remission at 4 and 8 months.Of 208 participants (106 and 102 in the intervention and wait-list groups, respectively), 182 (89 and 93, respectively) completed 4 months and 160 (79 and 81, respectively) completed 8 months. At 4 months, participants in the intervention group showed reduced depression severity (difference in mean change in Patient Health Questionnaire-9 score from baseline, -2.9 [95% CI, -4.6 to -1.2]; difference in mean change in Center for Epidemiologic Studies Depression Scale score from baseline, -3.7 [CI, -5.4 to -2.1]); improved depression knowledge, quality of life, behavioral activation, and anxiety (P < 0.001); and improved function (P = 0.014) compared with wait-list participants. More intervention than wait-list participants entered remission at 4 months (43.8% vs. 26.9%). After treatment, control participants showed benefits similar in magnitude to those of participants in the initial intervention group. Those in the initial intervention group maintained benefits at 8 months.The study had a small sample, short duration, and differential withdrawal rate.A home-based intervention delivered by social workers could reduce depressive symptoms and enhance quality of life in most older African Americans.National Institute of Mental Health.

Project description:Background and objectivesFamily ties and role relationships through their effects on exchanges of resources and social support are critical health contexts for older African Americans. We studied the influence of affect-based (positive or negative) social relations and respondent-role network centrality on depressive symptoms in older African Americans compared to two ethno-racial groups, Black Caribbeans and Non-Hispanic Whites.Research design and methodsWe used data from the multigenerational 2004 National Survey of American Life Family Connections across Generations and Nations Study (NSAL 3-Gen). For respondents aged 50 years or older, we used tie affect (positive or negative) to code family role relations and two-mode (where an entity or thing is connected to a different type of entity, here individuals are connected to role relations) family networks. We used survey linear regressions to probe the independent association of relations and networks on depressive symptoms among older African Americans as compared to Black Caribbeans and Non-Hispanic Whites.ResultsNegative and positive relations are significantly associated with depressive symptoms, but there were some ethno-racial differences. For example, the negative Father relation is significantly associated with greater depressive symptoms among African Americans, but not in Black Caribbeans and Non-Hispanic Whites. Negative two-mode networks (connections from individuals to role relations) are significantly associated with depressive symptoms among African Americans and in the two comparison ethno-racial groups, while there is no significant association between positive networks and depressive symptoms.Discussion and implicationsWe found that negative relations had larger effects on depressive symptoms than positive ones, and conversely that negative networks had larger effects than positive networks. Simultaneously modeling social relations and networks could potentially enhance our understanding of the links between social structure, and depressive symptoms among older adults in African American and other ethno-racial minorities.

Dataset Information

Comparison of three societally derived health-state classification values among older African Americans with depressive symptoms.

Publications

Comparison of three societally derived health-state classification values among older African Americans with depressive symptoms.

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