Minority Health

Blacks with diabetes are no more likely to be depressed than other blacks, but those with both problems use more health care

The rate of diabetes among blacks in the United States is twice that of the general population (13 vs. 6.2 percent). Deaths from diabetes and certain types of diabetes complications are more common among blacks than among whites. Previous studies with predominantly white subjects found a positive association between diabetes and depression, but in a recent study involving only black subjects, no such association was found. The researchers did find that blacks who had both diabetes and depression used more acute care health services, such as emergency room visits and inpatient hospitalizations. This pattern of use may lead to higher health care costs among patients with diabetes who are depressed, regardless of race. The study was supported by the Agency for Healthcare Research and Quality (HS11131).

Researchers led by Baqar A. Husaini, Ph.D., of Tennessee State University, and Robert S. Levine, of Meharry Medical College, interviewed 303 black adults (over one-fourth had diabetes) in a primary care clinic serving low-income patients. Researchers asked the subjects about their levels of health care use. The researchers used a nine-item symptom checklist to determine whether or not patients had symptoms of major depression. Diabetes was not significantly associated with depressive symptoms. Seventeen percent of blacks with diabetes had symptoms of depression, compared with 13 percent of those who did not have diabetes.

The presence of diabetes alone had no significant effect on physician visits or ER visits, but it was associated with 21 percent fewer hospital days than patients who had neither diabetes nor depression. Depressed patients without diabetes reported 76 percent more physician visits than patients with neither diabetes nor depression. Patients with diabetes and depression reported nearly three times as many ER visits and three times as many hospital days as patients with neither diabetes nor depression. Depression may be hindering these patients from seeking more routine health care, that is, visits to the doctor's office that might prevent ER and hospital visits, conclude the researchers.

See "Diabetes, depression, and healthcare utilization among African Americans in primary care," by Dr. Husaini, Pamela C. Hull, M.A., Darren E. Sherkat, Ph.D., and others, in the April 2004 Journal of the National Medical Association 96(4), pp. 476-484.

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