Sudano J, Jr ; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1237.
Case Western Reserve University, Medicine, 2500 Metrohealth Drive, Cleveland , OH 44109 Tel. 216.778.1399 Fax 216.778.3945
RESEARCH OBJECTIVE: To (1) determine the independent effect of 8 factors on the onset of depression in older adults; (2) to explain observed racial/ethnic differences in the onset of depression; and (3) to examine whether or not these factors operate differently for women and men. STUDY DESIGN: Prospective cohort observational study. The data is from the 1994 (wave 2) and 1996 (wave 3) of the Health and Retirement Study (HRS), a nationally-representative sample of U.S. adults age 55-65 as of their 1996 interview. Using self-reports, depression was first defined at each wave using an 8-measure modified CES-D scale, with those respondents scoring 4 or more categorized as depressed. Only respondents categorized as not depressed at wave 2 (1994) were included in the analysis. Independent variables included 1994 baseline information as well as changes in those variables across the study period (2 years). Logistic regression was used to determine the independent effect of socioeconomic status, insurance status, marital status, self-reported overall health, physical limitations, chronic disease, health behaviors and employment in explaining the onset of depression as well as racial/ethnic differences. Stratified analysis examined gender differences in the explanatory factors. POPULATION STUDIED: 9,824 persons were interviewed in the initial interview in 1992. 8,683 persons responded to both the 1994 and 1996 depression items. A total of 67 persons had incomplete 1994 and 1996 interviews, leaving a total of 6,765 persons were categorized as not depressed as of the 1994 interview and available for analysis in this study. For males, the sample included 2,468 whites, 412 blacks, and 204 Hispanics. For females, 2,836 whites, 593 blacks, and 253 Hispanics. PRINCIPAL FINDINGS: Incidence of depression between 1994 and 1996 was higher among blacks and Hispanics compared whites, but this relationship held across gender for only Hispanics. Unadjusted odds ratios for onset of depression were 1.47 (95% CI =1.03-2.07) and 2.16 (95% CI=1.37-3.39) for black and Hispanic females, respectively, compared to whites, and 1.39 (95% CI=0.82-2.36) and 2.12 (95% CI=1.40-3.21) for black and Hispanic males, respectively, compared to whites. In the multivariate analysis, the major independent contributors to explaining the onset of depression where lower socio-economic status, loss of insurance, divorce/separation or loss of a spouse, development of a new physical limitation associated with mobility. Marked differences in the independent effect were noted for females compared to males. Most of the effects in the non-stratified analysis seem to have been driven by the effect of these factors on females. Only the marital status changes and the development of new physical difficulties were significant for males. Most of the racial/ethnic differences in onset could be attributed to lower socio-economic status and development of new physical difficulties. CONCLUSIONS: Very different explanations for the onset of depression may exist for men and women, in this older population of adults. Socio-economic status and related physical limitations explain the majority of racial/ethnic variations in onset of depression. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Attention to gender differences in the causes of depression must be emphasized. Social and family stressors as well as the pernicious effects of lower socio-economic status must be recognized and addressed if we are to reduce racial/ethic disparities in mental health.
Publication Types:
Keywords:
- Adult
- African Americans
- African Continental Ancestry Group
- Aged
- Depression
- Depressive Disorder
- Depressive Disorder, Major
- Ethnic Groups
- European Continental Ancestry Group
- Female
- Health Behavior
- Hispanic Americans
- Humans
- Male
- Marital Status
- Odds Ratio
- Risk Factors
- September 11 Terrorist Attacks
- Social Class
- hsrmtgs
UI: 103624271
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