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

Published online by Cambridge University Press:  28 August 2019

Mary F. Wyman Open the ORCID record for Mary F. Wyman [Opens in a new window] ,
Erin M. Jonaitis ,
Earlise C. Ward ,
Megan Zuelsdorff  and
Carey E. Gleason
Mary F. Wyman*
Affiliation:
W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
Erin M. Jonaitis
Affiliation:
School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA Alzheimer’s Disease Research Center, Madison, WI, USA
Earlise C. Ward
Affiliation:
School of Nursing, University of Wisconsin, Madison, WI, USA
Megan Zuelsdorff
Affiliation:
School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA Alzheimer’s Disease Research Center, Madison, WI, USA
Carey E. Gleason
Affiliation:
W.S. Middleton Memorial Veterans Hospital, Madison, WI, USA School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA Alzheimer’s Disease Research Center, Madison, WI, USA
*
Correspondence should be addressed to: Mary F. Wyman, PhD, W.S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, GRECC - 11G, Madison, WI 53705, USA. Phone: +1 608-280-7000; Email: [email protected].
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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.

Keywords

older adultsAfrican Americans/Blackspsychiatric assessmentdepressionsubthreshold depression
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 3: Issue Theme: Improving Healthcare in Long-Term Care and Nursing Homes , March 2020 , pp. 393 - 405
Copyright
© International Psychogeriatric Association 2019

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