Dataset Information

Changes in depressive symptoms over age among older Americans: Differences by gender, race/ethnicity, education, and birth cohort.

ABSTRACT: Despite concerns about recent trends in the health and functioning of older Americans, little is known about dynamics of depression among recent cohorts of U.S. older adults and how these dynamics differ across sociodemographic groups. This study examined sociodemographic differences in mid- and late-life depressive symptoms over age, as well as changes over time. Using nationally representative data from the Health and Retirement Study (1994-2014), we estimated mixed effects models to generate depressive symptoms over age by gender, race/ethnicity, education, and birth cohort in 33,280 adults ages 51-90 years. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression scale. Women compared to men, low compared to high education groups, and racial/ethnic minorities compared to whites exhibited higher depressive symptoms. The largest disparity resulted from education, with those without high school degrees exhibiting over two more predicted depressive symptoms in midlife compared to those with college degrees. Importantly, war babies and baby boomers (born 1942-1959) exhibited slightly higher depressive symptoms with more decreasing symptoms over age than their predecessors (born 1931-1941) at ages 51-65. We additionally observed an age-as-leveler pattern by gender, whereby females compared to males had higher depressive symptomology from ages 51-85, but not at ages 86-90. Our findings have implication for gauging the aging population's overall well-being, for public health policies aimed at reducing health disparities, and for anticipating demand on an array of health and social services.

SUBMITTER: Abrams LR

PROVIDER: S-EPMC6476127 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Changes in depressive symptoms over age among older Americans: Differences by gender, race/ethnicity, education, and birth cohort.

Abrams Leah R LR Mehta Neil K NK

SSM - population health 20190410

Despite concerns about recent trends in the health and functioning of older Americans, little is known about dynamics of depression among recent cohorts of U.S. older adults and how these dynamics differ across sociodemographic groups. This study examined sociodemographic differences in mid- and late-life depressive symptoms over age, as well as changes over time. Using nationally representative data from the Health and Retirement Study (1994-2014), we estimated mixed effects models to generate ...[more]

PMID: 31024986

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Project description:ObjectiveTo describe disparities along the depression treatment cascade, from indication for antidepressant treatment to effective treatment, in HIV-infected individuals by gender and race/ethnicity.MethodsThe Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort includes 31,000 HIV-infected adults in routine clinical care at 8 sites. Individuals were included in the analysis if they had a depressive symptoms measure within one month of establishing HIV care at a CNICS site. Depressive symptoms were measured using the validated Patient Health Questionnaire-9 (PHQ-9). Indication for antidepressant treatment was defined as PHQ-9 ≥ 10 or a current antidepressant prescription. Antidepressant treatment was defined as a current antidepressant prescription. Evidence-based antidepressant treatment was considered treatment changes based on a person's most recent PHQ-9, in accordance with clinical guidelines. We calculated the cumulative probability of moving through the depression treatment cascade within 24 months of entering CNICS HIV care. We used multivariable Cox proportional hazards models to estimate associations between gender, race/ethnicity, and a range of depression outcomes.ResultsIn our cohort of HIV-infected adults in routine care, 47% had an indication for antidepressant treatment. Significant drop-offs along the depression treatment cascade were seen for the entire study sample. However, important disparities existed. Women were more likely to have an indication for antidepressant treatment (HR 1.54; 95% CI 1.34, 1.78), receive antidepressant treatment (HR 2.03; 95% CI 1.53, 2.69) and receive evidence-based antidepressant treatment (HR 1.67; 95% CI 1.03, 2.74), even after accounting for race/ethnicity. Black non-Hispanics (HR 0.47, 95% CI 0.35, 0.65), Hispanics (HR 0.63, 95% CI 0.44, 0.89) and other race/ethnicities (HR 0.35, 95% CI 0.17, 0.73) were less likely to initiate antidepressant treatment, compared to white non-Hispanics.ConclusionsIn our cohort of HIV-infected adults depressive symptoms were common. Important disparities in the prevalence of depressive symptoms and receipt of antidepressant treatment existed by gender and race/ethnicity.

Project description:BACKGROUND:Very few studies with nationally representative samples have investigated the combined effects of race/ethnicity and socioeconomic position (SEP) on polypharmacy (PP) among older Americans. For instance, we do not know if prevalence of PP differs between African Americans (AA) and white older adults, whether this difference is due to a racial gap in SEP, or whether racial and ethnic differences exist in the effects of SEP indicators on PP. Aims: We investigated joint effects of race/ethnicity and SEP on PP in a national household sample of American older adults. Methods: The first wave of the University of Michigan National Poll on Healthy Aging included a total of 906 older adults who were 65 years or older (80 AA and 826 white). Race/ethnicity, SEP (income, education attainment, marital status, and employment), age, gender, and PP (using 5+ medications) were measured. Logistic regression was applied for data analysis. Results: Race/ethnicity, age, marital status, and employment did not correlate with PP; however, female gender, low education attainment, and low income were associated with higher odds of PP among participants. Race/ethnicity interacted with low income on odds of PP, suggesting that low income might be more strongly associated with PP in AA than white older adults. Conclusions: While SEP indicators influence the risk of PP, such effects may not be identical across diverse racial and ethnic groups. That is, race/ethnicity and SEP have combined/interdependent rather than separate/independent effects on PP. Low-income AA older adults particularly need to be evaluated for PP. Given that race and SEP have intertwined effects on PP, racially and ethnically tailored interventions that address PP among low-income AA older adults may be superior to universal interventions and programs that ignore the specific needs of diverse populations. The results are preliminary and require replication in larger sample sizes, with PP measured directly without relying on individuals' self-reports, and with joint data collected on chronic disease.

Dataset Information

Changes in depressive symptoms over age among older Americans: Differences by gender, race/ethnicity, education, and birth cohort.

Publications

Changes in depressive symptoms over age among older Americans: Differences by gender, race/ethnicity, education, and birth cohort.

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