Depression

Depression More Often Chronic And Disabling Among Blacks

Frequency less; severity worse.

Depression More Often Chronic And Disabling Among Blacks

Rates of major depression are higher among whites, but the condition
appears more likely to be severe, untreated and disabling among
blacks, according to a report in the March issue of Archives of
General Psychiatry, one of the JAMA/Archives journals.

Major depression is the fourth leading cause of disability
worldwide, according to background information in the article. The
relationship between race and depression is complex; although
studies have suggested that blacks have a lower rate of depression,
they may have reduced access to mental health services and often
receive poorer quality care.

David R. Williams, Ph.D., Harvard School of Public Health, Boston,
and colleagues assessed the prevalence, persistence, treatment and
disability of depression in three racial groups using data from a
national survey conducted between 2001 and 2003. Of the 6,082
individuals who took the survey, 891 were non-Hispanic whites; 1,621
were Caribbean blacks, who identify themselves as black and are of
West Indian or Caribbean descent; and 3,570 were African-Americans,
who identify as black but do not have ancestral ties to the
Caribbean. During face-to-face and telephone interviews,
participants answered questions about their sociodemographic
background and the symptoms associated with depression. Those whose
interviews indicated depression were also asked how severe their
symptoms were and how much their condition impaired their daily
lives.

More whites (17.9 percent) than African Americans (10.4 percent) or
Caribbean blacks (12.9 percent) had depression during their
lifetimes. The rates of depression in the 12 months before the
interview were similar between the three groups (5.9 percent for
African Americans, 7.2 percent for Caribbean blacks and 6.9 percent
for whites). Chronicity – meaning the percentage of those with
lifetime depression who reported depression in the previous 12
months – was higher among African Americans (56.5 percent) and
Caribbean blacks (56 percent) than whites (38.6 percent).

“Fewer than half of the African Americans (45 percent) and fewer
than a quarter (24.3 percent) of the Caribbean blacks who met the
criteria received any form of major depressive
disorder therapy,” the authors write. Although treatment rates for
whites were not measured in this survey, this compares with a
national average of 57 percent of adults with major depression who
receive treatment. “In addition, relative to whites, both black
groups were more likely to rate their major depressive disorder as
severe or very severe and more disabling.”

Studying why blacks are less likely to develop depression and why
they fare worse once they become depressed could offer valuable
insights into the workings of this condition. “Future research
should explore the extent to which social support systems, including
religious participation and psychological resources, such as high
levels of self-esteem, can provide some protection to the black
population from exposure to adverse social conditions,” the authors
continue. “The findings of this study highlight the importance of
identifying high-risk subgroups in racial populations and the
continuing need to target cost-effective interventions to them.”

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The National Survey of American Life is supported by a grant from
the National Institute of Mental Health, with supplemental support
from the Office of Behavioral and Social Science Research at the
National Institutes of Health and the University of Michigan. Please
see the article for additional information, including other authors,
author contributions and affiliations, financial disclosures,
funding and support, etc.

Source: JAMA and Archives Journals, March 5, 2007

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