Racial/Ethnic disparities in depression and its theoretical perspectives

Greater Discrimination Frequency and Lower Distress Tolerance Are Associated with Mental Health Problems Among Racially Privileged and Minoritized Adults Accessing an Urban Day Shelter

INTRODUCTION

Discrimination experiences may be a contributing factor to the elevated prevalence of mental health problems among adults experiencing homelessness.

METHODS

Using survey data (N = 552) collected from adults seeking services at an urban day shelter, the relationships between everyday and major discrimination experiences, distress tolerance, and mental health problems (depression, anxiety, post-traumatic stress disorder, poor mental health days) were characterized. Distress tolerance was examined as a moderator of the relationship between discrimination and mental health problems.

RESULTS

Participants were predominantly from racially minoritized groups (59.6%), non-Hispanic (88.7%), and male (70.9%), with an average age of 45.7 years old (SD = 11.7). Descriptive analyses indicated that the main reason for discrimination differed between racially privileged (i.e., White participants) and racially minoritized participants (i.e., participants who identified as Black, American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islander, or multi-race), such that homelessness was most commonly endorsed among racially privileged participants while racial discrimination was most commonly reported among racially minoritized participants. Multivariate logistic regression analyses revealed associations between everyday discrimination, major discrimination, and distress tolerance with mental health problems. Distress tolerance did not moderate the relations between discrimination and mental health problems in most analyses. Notably, major discrimination was no longer associated with all mental health variables when both everyday and major discrimination were included in all models.

CONCLUSION

Findings suggest that reducing everyday discrimination and addressing the adverse impact of everyday discrimination experiences may have a beneficial impact on mental health.

Associations of adolescent substance use and depressive symptoms with adult major depressive disorder in the United States: NSDUH 2016-2019

BACKGROUND

Few studies have focused on the associations of adolescent substance use and depressive symptoms with adult major depressive disorder (MDD).

METHODS

Data from 168,859 adults, among which, 15,959 had experienced MDD in the past year, as indicated by a major depressive episode (MDE) marked by MDD symptoms, were from the 2016-2019 National Surveys on Drug Use and Health. Weighted multivariable logistic regression (MLR) analyses were used to determine the associations.

RESULTS

The overall MDD prevalence was 7.2 %, whereas the prevalence for adults without early onset depressive symptoms prior to age 18 was 4.6 %. Variable cluster analysis revealed that adolescent use of alcohol, cigarettes, marijuana, cocaine, hallucinogen use, and inhalants prior to age 18 were in one cluster. MLR analyses showed that the presence of depressive symptoms prior to age 18 was the major risk factor for MDD, while adolescent use of alcohol, marijuana, and inhalants prior to age 18 were associated with increased odds of MDD (p < 0.05) both in the whole data and the subset of adults without depressive symptoms prior to age 18. Adolescent use of cocaine prior to age 18 were associated with MDD only in the whole data, whereas adolescent smokeless tobacco use was associated with MDD only in those without depressive symptoms prior to age 18.

CONCLUSIONS

These findings highlight the comorbid early substance use and depressive symptoms during adolescence with adult MDD. Intervention strategies should simultaneously address early-onset substance use and depressive symptoms prior to age 18.

Investigating Racial Disparities in Drug Prescriptions for Patients with Endometriosis

Background

Endometriosis is a chronic disease with a long time to diagnosis and several known comorbidities that requires a range of treatments including of pain management and hormone-based medications. Racial disparities specific to endometriosis treatments are unknown.

Objective

We aim to investigate differences in patterns of drug prescriptions specific to endometriosis management in Black and White patients prior to diagnosis and after diagnosis of endometriosis and compare these differences to racial disparities established in the general population.

Study Design

We conduct a retrospective cohort study using observational health data from the IBM MarketScan® Multi-state Medicaid dataset. We identify a cohort of endometriosis patients consisting of women between the ages of 15 and 49 with an endometriosis-related surgical procedure and a diagnosis code for endometriosis within 30 days of this procedure. Cohort is further restricted to patients with at least 3 years of continuous observation prior to diagnosis.We identify a non-endometriosis cohort of women between the ages of 15 and 49 with no endometriosis diagnosis and at least 1 year of continuous observation. We compare prevalence of prescriptions across selected drug classes for Black vs. White endometriosis patients. We further examine prevalence differences in the non-endometriosis cohort and prevalence differences pre- and post-diagnosis in the endometriosis cohort.

Results

The endometriosis cohort comprised 16,372 endometriosis patients (23.3% Black, 66.0% White). Of the 28 drug classes examined, 17 were prescribed significantly less in Black patients compared to 21 in non-endometriosis cohort (n=3,663,904), and 4 were prescribed significantly more in Black patients compared to 6 in the non-endometriosis cohort. Of the 17 drugs prescribed more often in White patients, 16 have larger disparities pre-diagnosis than post-diagnosis.

Conclusions

Our analysis identified significant differences in medication prescriptions between White and Black patients with endometriosis, notably in hormonal treatments, pain management, and treatments for common endometriosis co-morbidities. Racial disparities in drug prescriptions are well established in healthcare, and better understanding these disparities in the specific context of chronic reproductive conditions and chronic pain is important for increasing equity in drug prescription practices.

Sleep Duration and Chronic Disease Among Older Native Hawaiians or Other Pacific Islanders and Asians: Analysis of the Behavioral Risk Factor Surveillance System

OBJECTIVES

Older adults are particularly vulnerable to unhealthy sleep. This study examines the relationship between sleep duration and chronic diseases among older Native Hawaiians or Other Pacific Islanders (NHOPIs) and identifies variations with older Asians.

METHODS

In this cross-sectional study, data were analyzed using the 2016 Behavioral Risk Factor Surveillance System. The total sample of adults 50 years and older included 1277 NHOPIs and 4655 Asians. Weighted, survey logistic regressions were employed to analyze the relationship between sleep duration (i.e., short, healthy, and long) and seven chronic diseases: coronary heart disease, stroke, heart attack/myocardial infarction, pre-diabetes, diabetes, chronic obstructive pulmonary disease, and depressive disorder. Sleep duration was categorized into short sleep (SS; ≤ 6 h), healthy sleep (7-8 h), and long sleep (LS; ≥ 9 h), with healthy sleep as the reference group.

RESULTS

Among NHOPIs, SS and LS were significantly related to stroke (OR 3.19, 95% CI: 1.35-7.53 for SS and OR 9.52, 95% CI: 2.99-30.34 for LS) and SS was associated with pre-diabetes (OR 2.22 CI: 1.07-4.59), after adjusting for all covariates. In contrast, Asians with SS and LS reported higher odds of depression (OR 2.40, 95% CI: 1.20-4.79 and OR 5.03, 95% CI: 1.57-16.13, respectively).

CONCLUSIONS

Findings suggest older NHOPIs with SS or LS experience worse health. NHOPIs and Asians varied on the relationship between sleep and chronic disease, underscoring the need to disaggregate Asian/NHOPI data to understand health disparities.

Mental health of ethnic minorities: the role of racism

Racism and racial discrimination heavily impact on health and mental health of ethnic minorities. In this conceptual paper and narrative review, we aim to report on relevant evidence from the international literature describing the prevalence and the qualitative aspects of mental illness due to racism and ethnic- discrimination in different settings and populations. Some variables related to racism, such as cultural, institutional, interpersonal factors, as well as the concepts of perceived and internalised racism will be described and discussed. These are relevant characteristics in the explanatory model of the relationship between racism and mental health. Epidemiological data on the prevalence of depressive and psychotic symptoms as well as substance abuse/misuse among ethnic minorities in large catchment areas, such as United States and United Kingdom, will be represented. We conclude that anti-racism policies are essential in order to address racism and racial discrimination around the world. Pluralistic societies should be promoted in order to understand mental illnesses among ethnic and cultural minorities. Also, anti-racism programs should be delivered in the educational and health-care settings and their impact evaluated.

Effects of school environment on depression among Black and White adolescents

While the school environment is critical for adolescents' psychological development, how the school environment influences depression among different racial groups has not been fully explored. This study aims to identify the effects of the school environment (school connectedness, school climates, trouble with peers and teachers) on depressive symptoms among Black and White adolescents. It also compares how the effects of school environments differ between Black and White adolescents. This study analyzed wave 6 of the Fragile Families and Child Well-being Study, a longitudinal birth cohort study in 20 major cities across the United States. Almost three-fourth (73.39%) of the adolescents were Black, and 26.61% were White. About half (50.46%) of the adolescents were females, and the mean age of adolescents was 15.39. Multiple regression analysis showed that higher school connectedness and less frequent troubles with teachers were associated with lower depression among Black adolescents. In contrast, only school connectedness was associated with depression among White adolescents. Higher school connectedness was associated with lower depressive symptoms for both Black and White adolescents. However, the magnitude of the effects of school connectedness was found to be statistically weaker among Black adolescents. These findings suggest a need for creating a racially equitable school environment that makes every student feel more connected to their schools, especially Black students.

Examining Race-Based Discrimination, Depression, and Occupational Stress in Black Registered Nurses

Nursing is a highly stressful and demanding profession that can negatively affect mental health, as shown by nurses' high rate of depression. Furthermore, Black nurses may experience additional stress due to race-based discrimination in the work environment. This research aimed to examine depression, experiences of race-based discrimination at work, and occupational stress among Black nurses. To better understand associations between these factors, we conducted multiple linear regression analyses to assess whether (1) past-year or lifetime experiences of race-based discrimination at work and occupational stress predicted depressive symptoms; and (2) controlling for depressive symptoms, past-year and lifetime experiences of race-based discrimination at work predicted occupational stress in a cohort of Black registered nurses. All analyses controlled for years of nursing experience, primary nursing practice position, work setting, and work shift. The results indicated that both past-year and lifetime experiences of race-based discrimination on the job were significant predictors of occupational stress. However, experiences of race-based discrimination at work and occupational stress were not significant predictors of depression. The results of the research highlighted the predictive effect of race-based discrimination on occupational stress in Black registered nurses. This evidence can inform the development of organizational and leadership strategies to improve the well-being of Black nurses in the workplace.

Depressive symptoms and allostatic load have a bidirectional association among Puerto Rican older adults

BACKGROUND

Depression is strongly associated with chronic disease; yet, the direction of this relationship is poorly understood. Allostatic load (AL) provides a framework for elucidating depression-disease pathways. We aimed to investigate bidirectional, longitudinal associations of baseline depressive symptoms or AL with 5-year AL or depressive symptoms, respectively.

METHODS

Data were from baseline, 2-year, and 5-year visits of 620 adults (45-75 years) enrolled in the Boston Puerto Rican Health Study. The Center for Epidemiology Studies Depression (CES-D) scale (0-60) captured depressive symptoms, which were categorized at baseline as low (<8), subthreshold (8-15), or depression-likely (⩾16) symptoms. AL was calculated from 11 parameters of biological functioning, representing five physiological systems. Baseline AL scores were categorized by the number of dysregulated parameters: low (0-2), moderate (3-5), or high (⩾6) AL. Multivariable, multilevel random intercept and slope linear regression models were used to examine associations between 3-category baseline CES-D score and 5-year continuous AL score, and between baseline 3-category AL and 5-year continuous CES-D score.

RESULTS

Baseline subthreshold depressive symptoms [(mean (95% CI)): 4.8 (4.5-5.2)], but not depression-likely symptoms [4.5 (4.2-4.9)], was significantly associated with higher 5-year AL scores, compared to low depressive symptoms [4.3 (3.9-4.7)]. Baseline high AL [19.4 (17.6-21.2)], but not low AL [18.5 (16.5-20.6)], was significantly associated with higher 5-year CES-D score, compared to baseline moderate AL [16.9 (15.3-18.5)].

CONCLUSIONS

Depressive symptoms and AL had a bi-directional relationship over time, indicating a nuanced pathway linking depression with chronic diseases among a minority population.

Complicating Narratives of Sexual Minority Mental Health: An Intersectional Analysis of Frequent Mental Distress at the Intersection of Sexual Orientation, Gender Identity, and Race/Ethnicity

Purpose: Research indicates that sexual minority populations experience mental health inequities. However, few studies have examined mental health outcomes in sexual minority populations while including intersecting dimensions of social identity. This study had two objectives: (1) to quantify the prevalence of frequent mental distress among U.S. adults across intersecting social identity categories and (2) to evaluate the contribution of intersectional interactions to observed inequities. Methods: Using data from the Behavioral Risk Factor Surveillance System 2014-2019 (N = 1,024,261), we performed an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA). Participants were nested in 45 intersectional groups defined by combining 3 sexual orientation (gay/lesbian, bisexual, and heterosexual), 5 gender identity (transgender women, transgender men, gender nonconforming, cisgender women, and cisgender men), and 3 racial/ethnic (non-Hispanic Black, Hispanic/Latinx, and non-Hispanic White) categories. We estimated the predicted probability of frequent mental distress for each stratum. We then calculated the variance partition coefficient (VPC) and proportional change in variance (PCV). Results: We found that multiply marginalized groups tended to have the highest prevalence of frequent mental distress. Groups with racial/ethnic minority individuals were equally represented among low- and high-prevalence groups. The VPC indicated that slightly over 10% of observed variance in prevalence was attributable to group-level differences, while the PCV revealed that a small but meaningful amount of observed heterogeneity in prevalence was due to intersectional interactions between the dimensions of social identity. Conclusion: I-MAIHDA is a promising method for examining the patterning of sexual orientation-based mental health inequities at the population level.

Correlation Between Body Mass Index and Depression/Depression-Like Symptoms Among Different Genders and Races

Background

While being overweight is a risk factor for hyperlipidemia, type 2 diabetes, cancer, and heart disease, it can also be a risk factor for depression and vice versa. In this study, we aimed to evaluate the relationship between body mass index (BMI) and the prevalence of depression symptoms between genders and races.

Methodology

A nationally representative sample was utilized to explore the relationship between depression-related symptoms and BMI status by comparing different genders and racial identities. The National Health and Nutrition Examination Survey (NHANES) data, managed by the Centers for Disease Control and Prevention, was used in this study. Data from 2013 to 2016 were included in the analysis. The Patient Health Questionnaire was used to collect information regarding responses to eight primary questions based on gender, race, and BMI status. Statistical analysis was conducted using descriptive analysis and the chi-square test.

Results

Data were presented as percentages. A majority of both men and women who admitted to having depression or depression-like symptoms more than half the days or nearly every day were overweight or obese. However, men had a higher prevalence compared to women for most questions. Statistical analysis showed that among men and women who felt down, depressed, or hopeless nearly every day, 61.5% (χ² = 5.045, p = 0.992) and 50.9% (χ² = 17.186, p = 0.308) were overweight, respectively. Among the races, those who felt down, depressed, or hopeless nearly every day, non-Hispanic Asian individuals had the lowest percentage of being overweight at 47.7% (χ² = 7.099, p = 0.955), while Hispanic individuals other than Mexican Americans had the highest percentage of being overweight at 67.4% (χ² = 8.792, p = 0.721).

Conclusions

Being overweight or obese appears to have a positive relationship with depression and depression-like symptoms for each gender and race. Similarly, individuals who report having depression-like symptoms are likely to be overweight or obese. Further research is needed to determine other differences in etiologies between genders and races, along with determining whether more individuals become depressed due to being overweight or obese or whether more individuals become overweight or obese due to being depressed. The results of this study are limited to the data obtained through NHANES.

Longitudinal Effects of Racial Discrimination on Depressive Symptoms Among Black Youth: Between- and Within-Person Effects

OBJECTIVE

Black youth experience racial discrimination at high rates. This study sought to further understand the longitudinal effects of racial discrimination on the mental health of Black youth by examining cross-lagged associations between perceived racial discrimination and depressive symptoms at the between-person (interindividual) level and the within-person (intraindividual) level.

METHOD

A group of 346 Black youths (mean age 10.9 years) from the rural southern United States reported racial discrimination and depressive symptoms 4 times over 24.5 months. A cross-lagged panel model was used to examine between-person concurrent and lagged effects, and a random intercept cross-lagged panel model was used to examine within-person concurrent and lagged effects.

RESULTS

There were significant concurrent associations at all waves in both models. Additionally, there were significant lagged effects from perceived racial discrimination to depressive symptoms, but not from depressive symptoms to perceived racial discrimination, in both models.

CONCLUSION

Youth experiencing higher levels of racial discrimination subsequently develop more depressive symptoms than youth experiencing less discrimination (between-person effects), and youth experiencing higher levels of discrimination relative to their own average subsequently report increases in depressive symptoms (within-person effects). These findings provide a rigorous test of conceptual models outlining the harmful effects of racial discrimination on mental health, add to a growing body of work documenting these effects on Black youth, and underscore the need for systemic changes to reduce the amount of discrimination Black youth experience and for interventions to promote resilience among Black youth in the face of cultural marginalization.

Racial Stress and Trauma and the Development of Adolescent Depression: A Review of the Role of Vigilance Evoked by Racism-Related Threat

There are known disparities in the burden of illness and access/quality of care for African, Latino/a, Asian, and Native American (ALANA) patients diagnosed with depressive disorders, which may occur because of health inequities. Racial stress and trauma (RST), or the significant fear and distress that can be imparted from exposure to racism, is one such inequity linked to the development of depression. The current review summarizes past research examining the association between racism, RST, and depression, as well as avenues in which RST becomes biologically embedded in ALANA individuals. We describe multimodal research that supports vigilance as a potential mediator of the association between RST and depression and consider the nuanced role that vigilance plays during experiences with racism. Finally, we describe methodological advances in the assessment of vigilance evoked by RST and the clinical implications that may be generated by future improvements. In each of these areas, we present examples of how ongoing and future research can be leveraged to provide support for psychosocial programs that facilitate autonomous community healing and resilience, increase calls for public policy changes, and support clinical interventions that lessen the burden of racism on ALANA communities.

What Does a Diagnosis of Depression Mean for Patients Undergoing Colorectal Surgery?

BACKGROUND

Depression has been linked to increased morbidity and mortality in patients after surgery. The purpose of this study is to investigate the impact of documented depression diagnosis on in-hospital postoperative outcomes of patients undergoing colorectal surgery.

MATERIALS AND METHODS

Patients from the National Inpatient Sample (2002-2017) who underwent proctectomies and colectomies were included. The outcomes measured included total hospital charge, length of stay, delirium, wound infection, urinary tract infection (UTI), pneumonia, deep vein thrombosis, pulmonary embolism, mortality, paralytic ileus, leak, and discharge trends. Multivariable logistic and Poisson regression analyses were performed.

RESULTS

Of the 4,212,125 patients, depression diagnosis was present in 6.72% of patients who underwent colectomy and 6.54% of patients who underwent proctectomy. Regardless of procedure type, patients with depression had higher total hospital charges and greater rates of delirium, wound infection, UTI, leak, and nonroutine discharge, with no difference in length of stay. On adjusted analysis, patients with a depression diagnosis who underwent colectomies had increased risk of delirium (odds ratio (OR) 2.11, 95% confidence interval (CI) 1.93-2.32), wound infection (OR 1.08, 95% CI 1.03-1.12), UTI (OR 1.15, 95% CI 1.10-1.20), paralytic ileus (OR 1.06, 95% CI 1.03-1.09), and leak (OR 1.37, 95% CI 1.30-1.43). Patients who underwent proctectomy showed similar results, with the addition of significantly increased total hospital charges among the depression group. Depression diagnosis was independently associated with lower risk of in-hospital mortality (colectomy OR 0.58, 95% CI 0.53-0.62; proctectomy OR 0.72, 95% CI 0.55-0.94).

CONCLUSIONS

Patients with a diagnosis of depression suffer worse in-hospital outcomes but experience lower risk of in-hospital mortality after undergoing colorectal surgery. Further studies are needed to validate and fully understand the driving factors behind this.

Racial discrimination, depressive symptoms, and sleep problems among Blacks in the rural South

OBJECTIVES

Experiences of racial discrimination are common for Black Americans and have been associated with depression and sleep disturbance, factors likely involved in the insidious development of health disparities. The current study replicates these associations and examines longitudinal linkages.

METHOD

Black American couples (men: N = 248, M_age = 40, SD = 9; women: N = 277, M_age = 37, SD = 7) and their children, aged 9 to 14 (N = 276, M_age = 11, SD = 1), completed measures of experiences of racial discrimination, depressive symptoms, and sleep problems at baseline and 8-month follow-up. In separate analyses for men, women, and youth, we examined concurrent and prospective associations of racial discrimination with depressive symptoms and sleep problems, then used longitudinal indirect effect models to examine whether depressive symptoms in response to racial discrimination led to increased sleep problems, or vice versa.

RESULTS

Racial discrimination was associated concurrently with depressive symptoms and sleep problems for all family members. Prospective associations were also found with depressive symptoms and sleep problems in fathers and youth, and sleep problems in mothers. Longitudinal models showed significant indirect effects of racial discrimination on change in sleep problems through depressive symptoms for fathers and mothers, and a similar, but nonsignificant, pattern in youth. There were no indirect effects on change in depressive symptoms through sleep problems.

CONCLUSIONS

Persistent associations of racial discrimination with depressive symptoms and sleep problems reflect a lasting impact of racial discrimination. Because discrimination's effects on depression may contribute to increased sleep problems over time, interventions that buffer the effects of discrimination on depressive symptoms may also reduce sleep problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Measurement invariance of the patient health questionnaire-9 (PHQ-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: NHANES 2005-2016

BACKGROUND

Despite its popularity, little is known about the measurement invariance of the Patient Health Questionnaire-9 (PHQ-9) across U.S. sociodemographic groups. Use of a screener shown not to possess measurement invariance could result in under/over-detection of depression, potentially exacerbating sociodemographic disparities in depression. Therefore, we assessed the factor structure and measurement invariance of the PHQ-9 across major U.S. sociodemographic groups.

METHODS

U.S. population representative data came from the 2005-2016 National Health and Nutrition Examination Survey (NHANES) cohorts. We conducted a measurement invariance analysis of 31,366 respondents across sociodemographic factors of sex, race/ethnicity, and education level.

RESULTS

Considering results of single-group confirmatory factor analyses (CFAs), depression theory, and research utility, we justify a two-factor structure for the PHQ-9 consisting of a cognitive/affective factor and a somatic factor (RMSEA = 0.034, TLI = 0.985, CFI = 0.989). On the basis of multiple-group CFAs testing configural, scalar, and strict factorial invariance, we determined that invariance held for sex, race/ethnicity, and education level groups, as all models demonstrated close model fit (RMSEA = 0.025-0.025, TLI = 0.985-0.992, CFI = 0.986-0.991). Finally, for all steps ΔCFI was <-0.004, and ΔRMSEA was <0.01.

CONCLUSIONS

We demonstrate that the PHQ-9 is acceptable to use in major U.S. sociodemographic groups and allows for meaningful comparisons in total, cognitive/affective, and somatic depressive symptoms across these groups, extending its use to the community. This knowledge is timely as medicine moves towards alternative payment models emphasizing high-quality and cost-efficient care, which will likely incentivize behavioral and population health efforts. We also provide a consistent, evidence-based approach for calculating PHQ-9 subscale scores.

Racial/ethnic disparities in specialty behavioral health care treatment patterns and expenditures among commercially insured patients in managed behavioral health care plans

OBJECTIVE

To document differences among racial/ethnic/gender groups in specialty behavioral health care (BH) utilization/expenditures; examine whether these differences are driven by probability vs intensity of treatment; and identify whether differences are explained by socioeconomic status (SES).

DATA SOURCE

The cohort consists of adults continuously enrolled in Optum plans with BH benefits during 2013.

STUDY DESIGN

We modeled each outcome using linear regressions among the entire sample stratified by race/ethnicity, language and gender. Then, we estimated logistic regressions of the probability that an enrollee had any spending/use in a given service category (service penetration) and linear regressions of spending/use among the user subpopulation (treatment intensity). Lastly, all analyses were rerun with SES controls.

DATA COLLECTION

This study links administrative data from a managed BH organization to a commercial marketing database.

PRINCIPAL FINDINGS

We found that in many cases, racial/ethnic minorities had lower specialty BH expenditures/utilization, relative to whites, primarily driven by differences in service penetration. Among women, relative to whites, Asian non-English speakers, Asian English speakers, Hispanic non-English speakers, Hispanic English speakers, and blacks had $106, $95, $90, $48, and $61 less in total expenditures. SES explained racial/ethnic differences in treatment intensity but not service penetration.

CONCLUSIONS

In this population, SES was not a major driver of racial/ethnic differences in specialty BH utilization. Future studies should explore the role of other factors not studied here, such as stigma, cultural competence, and geography.

Sex Moderates Relationships Among School Night Sleep Duration, Social Jetlag, and Depressive Symptoms in Adolescents

Social jetlag, a misalignment between sleep timing on the weekend and during the work week, is associated with depressive symptoms among adults across both sexes. A previous study found that later sleep timing was associated with depressive symptoms in women but not men. To date, however, no research has investigated whether the association between social jetlag and depression varies by sex among adolescents. The current study assessed self-reported sleep, depressive symptoms, and demographic information from 3058 adolescents (48% female, mean [SD] age 15.59 [0.77] years) from the age 15 wave of the Fragile Families and Child Wellbeing Study (FFCWS). Social jetlag was calculated as the absolute value of the midpoint of sleep on the weekend minus the midpoint of sleep during the school week. Depressive symptoms were measured through a modified 5-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). We assessed whether the associations among sleep duration on school nights, social jetlag, and depressive symptoms were similar between male and female adolescents using multiple linear regression. In fully adjusted models, sex moderated the association between school night total sleep time and depressive symptoms ( p < 0.001) and between social jetlag and depressive symptoms ( p = 0.037). In females, but not in males, school night total sleep time was negatively associated with depressive symptoms ( p < 0.001), whereas social jetlag ( p < 0.001) was positively and independently associated with depressive symptoms. The results indicate the importance of regular sleep timing across the week and adequate sleep duration for the maintenance of optimal emotional health among female adolescents.

Temporal trends of co-diagnosis of depression and/or anxiety among female maternal and non-maternal hospitalizations: Results from Nationwide Inpatient Sample 2004-2013

Perinatal depression/anxiety is considered the most underdiagnosed pregnancy complication in the US and is associated with poor maternal and fetal outcomes. However, despite its prevalence, most women who present with depressive symptoms are not screened and do not receive adequate treatment. We examined the clinical co-diagnosis of depression and/or anxiety among maternal and non-maternal hospitalizations among females aged 14-49 from the Nationwide Inpatient Sample (NIS) between 2004 and 2013 (n = 83,472,775). Meta-regression was used to determine annual change and presence of temporal trends. Survey logistic regression was used to examine the association with sociodemographic factors. Rates of diagnosis of depression and/or anxiety disorders demonstrated a temporal increase from 2004-2013, and this increase was mainly driven by non-maternal hospitalizations compared to maternal. Furthermore, non-maternal hospitalizations demonstrated a greater prevalence of depression and/or anxiety diagnoses compared to maternal hospitalizations over the same time period (21•7% versus 2•8%). Among all female hospitalizations, whites were roughly twice as likely as minorities to have a diagnosis of depression and/or anxiety. These results add to the evidence suggestive of the underdiagnosed depression/anxiety present among women of reproductive age, particularly pregnant women and minorities, and underscore the critical role of obstetricians in treating both physical and mental health.

Theories for Race and Gender Differences in Management of Social Identity-Related Stressors: a Systematic Review

Sociodemographic group-specific strategies for stress management may contribute to racial and gender disparities in health outcomes in the USA. We aimed to systematically review theoretical and empirical investigations of factors influencing variation in response to and management of identity-related stress among black and white Americans. OvidPsychInfo and PubMed databases were searched to identify eligible studies. Criteria were participant age of ≥ 18 years, conducted in the US sampling black or white participants, and published in English in a peer-reviewed journal. The final sample included 167 articles. Theories suggesting social status inequities as the primary contributor to disparate strategies employed by black and white women and men to manage social identity-related stress were most frequently tested and supported. Studies disproportionally focused on how women and black persons cope as targets of prejudice and discrimination rather than on how management strategies of men or white persons are affected as perpetrators. Finally, there was theoretical support for an interactive effect of race and gender on stress management, but empirical evidence was lacking, particularly among black men, white women, and white men. The literature could be strengthened through the use of prospective cohorts and nationally representative samples, as well as study designs accounting for potential within-race and within-gender variation in the effects of social identity-related stressors on coping. With greater consistency in methodology, future empirical studies may yield additional information regarding group differences in stress management pertinent to clarifying mechanisms for the health consequences of exposure to social inequity among black and white women and men.

Evaluating the Population Impact on Racial/Ethnic Disparities in HIV in Adulthood of Intervening on Specific Targets: A Conceptual and Methodological Framework

Reducing racial/ethnic disparities in human immunodeficiency virus (HIV) disease is a high priority. Reductions in HIV racial/ethnic disparities can potentially be achieved by intervening on important intermediate factors. The potential population impact of intervening on intermediates can be evaluated using observational data when certain conditions are met. However, using standard stratification-based approaches commonly employed in the observational HIV literature to estimate the potential population impact in this setting may yield results that do not accurately estimate quantities of interest. Here we describe a useful conceptual and methodological framework for using observational data to appropriately evaluate the impact on HIV racial/ethnic disparities of interventions. This framework reframes relevant scientific questions in terms of a controlled direct effect and estimates a corresponding proportion eliminated. We review methods and conditions sufficient for accurate estimation within the proposed framework. We use the framework to analyze data on 2,329 participants in the CFAR [Centers for AIDS Research] Network of Integrated Clinical Systems (2008-2014) to evaluate the potential impact of universal prescription of and ≥95% adherence to antiretroviral therapy on racial disparities in HIV virological suppression. We encourage the use of the described framework to appropriately evaluate the potential impact of targeted interventions in addressing HIV racial/ethnic disparities using observational data.

Gendered race modification of the association between chronic stress and depression among Black and White U.S. adults

Chronic stress stemming from social inequity has long been recognized as a risk factor for poor physical and psychological health, yet challenges remain in uncovering the mechanisms through which such exposures affect health outcomes and lead to racial and gender health disparities. Examination of sociocultural influences on group identity, coping, and the expression of stress may yield relevant insight into potential pathways of inequity's effect on risk for chronic disease. The objective of this study was to examine the relationship between chronic stress as measured by allostatic load (AL) and depression by gendered race group. Using National Health and Nutrition Examination Survey 2005-2010 data, we included Black and White U.S. adults aged 18-64 years (n = 6,431). AL was calculated using 9 biomarkers; scores ≥4 indicated high risk. Depression was assessed using the Patient Health Questionnaire-9; scores ≥10 indicated likely clinical depression. Logistic models estimated odds of depression as a function of AL for each gendered race group adjusting for age and family poverty-to-income ratio. Effect modification was assessed by analysis of variance and relative excess risk due to the interaction. We observed modification on the multiplicative scale. High AL was more strongly associated with depression among White women and Black men than among Black women or White men. In conclusion, a potential manifestation of high chronic stress burden, depression, differs across gendered race groups. These disparities may be due to group-specific coping strategies that are shaped by unequal social contexts. (PsycINFO Database Record

Depression in Registered Nurses: A State of the Science

Registered nurses suffer from depression at almost twice the rate of individuals in other professions. Major depression affects both employees and organizations. Depression is linked to increases in work absenteeism, short-term disability, and decreased productivity and presenteeism. Depression experienced by registered nurses may not be fully preventable, but realizing its presence and prevalence in the workplace is of vital importance. It is essential that we have a healthy, vibrant, and present registered nurse workforce to ensure that quality patient outcomes are achieved. This review of 36 articles assesses the current state of the science related to depression in registered nurses so that occupational health nurses can create pathways and work environments for better mental health for registered nurses.

Trends of diagnosis-specific work disability after newly diagnosed diabetes: a 4-year nationwide prospective cohort study

OBJECTIVE

We examined trends of diagnosis-specific work disability after newly diagnosed diabetes, comparing individuals with diabetes with those without diabetes, and identified the subgroups with the highest levels of work disability.

RESEARCH DESIGN AND METHODS

The register data of diabetes medication and in- and outpatient hospital visits were used to identify all recorded new diabetes cases among the population aged 25-59 years in Sweden in 2006 (n = 14,098). Data for a 4-year follow-up of ICD-10 physician-certified sickness absence and disability pension days (2007‒2010) were obtained from the Swedish Social Insurance Agency. Comparisons were made using a random sample of the population without recorded diabetes (n = 39,056).

RESULTS

The most common causes of work disability were mental and musculoskeletal disorders; diabetes as a reason for disability was rare. Most of the excess work disability among people with diabetes compared with those without diabetes was owing to mental disorders (mean difference adjusted for confounding factors 18.8‒19.8 compensated days/year), musculoskeletal diseases (12.1‒12.8 days/year), circulatory diseases (5.9‒6.5 days/year), diseases of the nervous system (1.8‒2.0 days/year), and injuries (1.0‒1.2 days/year). The disparity in mental disorders first widened and then narrowed, while the difference in other major diagnostic categories was stable over 4 years. The highest rate (45.3 days/year) was found among people who had diabetes, lived alone, and were disabled from work owing to mental disorders.

CONCLUSIONS

The increased risk of work disability among those with diabetes is largely attributed to comorbid mental, musculoskeletal, and circulatory diseases. It is important to monitor comorbid conditions and take account of socioeconomic disadvantage.

Effectiveness of the relaxation response-based group intervention for treating depressed chinese american immigrants: a pilot study

Background: This study examined the feasibility, safety and efficacy of an 8-week Relaxation Response (RR)-based group. Methods: Twenty-two depressed Chinese American immigrants were recruited. Outcomes measures were response and remission rates, the Hamilton Rating Scale for Depression, Clinical Global Impressions Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, and the Multidimensional Scale of Perceived Social Support Scale. Results: Participants (N = 22) were 82% female, mean age was 53 (±12). After intervention, completers (N = 15) showed a 40% response rate and a 27% remission rate, and statistically significant improvement in most outcome measures. Discussion: The RR-based group is feasible and safe in treating Chinese American immigrants with depression.

The role of gender and race in the relation between adolescent distress tolerance and externalizing and internalizing psychopathology

Distress tolerance (DT) is an established construct contributing to the onset and maintenance of psychopathology in adulthood; however, few studies have examined the role of DT in older adolescent psychopathology. Emerging data suggest that gender and race may influence this relation. Therefore, the current study examined the relation between gender, race, and DT on parent-reported internalizing and externalizing DSM-oriented symptoms among a community sample of 128, 14-18 year old adolescents. Results indicated a moderating effect of gender on affective problems, such that females with low DT, but not males, displayed significantly greater affective problems. Findings also indicated a significant moderating effect of race, such that Caucasians with low DT, but not African Americans, displayed significantly higher somatic, oppositional defiant, and conduct problems. These findings suggest that DT is an important clinical variable in older adolescence, particularly among Caucasians and females.