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

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.

SUBMITTER: Wyman MF

PROVIDER: S-EPMC7047602 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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

Wyman Mary F MF Jonaitis Erin M EM Ward Earlise C EC Zuelsdorff Megan M Gleason Carey E CE

International psychogeriatrics 20200301 3

<h4>Objectives</h4>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.<h4>Design</h4>We conducted a secondary analysis of a community-based interview study, using group comparisons and logistic regression.<h4>Setting</h4>Lower-income neighborhoods in a Midwestern city.<h4>Participants</h4>411 community-dwelling ...[more]

PMID: 31455459

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Project description:Abstract Background and Objectives Loneliness is consistently linked to worse depression/depressive symptoms; however, there are few studies that have examined whether the relationship between loneliness and depressive symptoms varies by race. The purpose of this study was to determine whether race moderated the relationship between loneliness and depressive symptoms. Research Design and Methods Data come from the 2014 wave of the Health and Retirement Study (HRS) Core survey and Psychosocial Leave-Behind Questionnaire; only black and white older adults were included in the analysis (N = 6,469). Depressive symptoms were operationalized by the eight-item Center for Epidemiological Studies—Depression scale; however, the “felt lonely” item was removed given concerns with collinearity. Loneliness was operationalized using the Hughes 3-Item Loneliness Scale. Sociodemographic variables included gender, age, education, household income, employment status, marital status, and living alone or with others. Furthermore, social support and negative interactions from family members and friends, and religious service attendance were included in the analysis. Lastly, we created an interaction term between race and loneliness. All analyses used survey weights to account for the complex multistage sampling design of the HRS. Missing data were multiply imputed. Results In multivariable analysis, we found race significantly moderated the relationship between loneliness and depressive symptoms while controlling for sociodemographic covariates, social support and negative interaction variables, and religious service attendance. Discussion and Implications Our findings demonstrate a differential racial effect for loneliness and depressive symptoms. For both blacks and whites, greater loneliness affected depressive symptoms; however, the effect was stronger among whites than it was for blacks. Given this is one of the first studies to examine the differential effects of race on loneliness and depressive symptoms, more research is necessary to determine the consistency of these results.

Project description:To evaluate whether race influences agreement between screening results and documentation of cognitive impairment and delirium.Secondary data analysis.An urban, public hospital and healthcare system.Hospitalized older adults aged 65 and older admitted to general inpatient medical services evaluated for cognitive impairment (n = 851) and evaluated for delirium (n = 424).Cognitive impairment and delirium were measured in each participant using the Short Portable Mental Status Questionnaire (SPMSQ) and the Confusion Assessment Method (CAM), respectively, as the reference identification method. Clinical documentation of cognitive impairment and delirium was defined according to the presence of International Classification of Diseases, Ninth Revision (ICD-9), codes from within 1 year before hospitalization through discharge for cognitive impairment or from hospital admission through discharge for delirium.Two hundred ninety-four participants (34%) had cognitive impairment based on SPMSQ performance, and 163 (38%) had delirium based on CAM results. One hundred seventy-one (20%) of those with cognitive impairment had an ICD-9 code for cognitive impairment, whereas 92 (22%) of those with delirium had an ICD-9 code for delirium. After considering age, sex, education, socioeconomic status, chronic comorbidity, and severity of acute illness, of those who screened positive on the SPMSQ, African Americans had a higher adjusted odds ratio (AOR) than non-African Americans for clinical documentation of cognitive impairment (AOR = 1.66, 95% confidence interval (CI) = 0.95-2.89), and of those who screened negative on the SPMSQ, African Americans had higher odds of clinical documentation of cognitive impairment (AOR = 2.10, 95% CI = 1.17-3.78) than non-African Americans. There were no differences in clinical documentation rates of delirium between African Americans and non-African Americans.Racial differences in coding for cognitive impairment may exist, resulting in higher documentation of cognitive impairment in African Americans screening positive or negative for cognitive impairment.

Project description:ObjectiveTo provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes.MethodsSystematic review and meta-analysis. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to care as usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycemic control. Cohen's d is reported.ResultsForty-three randomized controlled trials (RCTs) were selected, and 32 RCTs comprising 3,543 patients were included in the meta-analysis. Our meta-analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95% CI 0.360; 0.609). All interventions showed a significant effect on depression. Pharmacological treatment, group therapy, psychotherapy, and collaborative care had a significant effect on glycemic control. High baseline depression score was associated with a greater reduction in HbA1 c and depressive outcome. High baseline HbA1 c was associated with a greater reduction in HbA1 c.ConclusionAll treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group-based therapy, online treatment, and exercise. Although all interventions were effective for depression, not all treatments were effective for glycemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA1 c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research.

Dataset Information

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

Publications

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

Similar Datasets

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