Abstract
Knowledge gaps persist regarding racial and ethnic variation in late-life depression, including differences in specific depressive symptoms and disparities in care. To examine racial/ethnic differences in depression severity, symptom burden, and care. This cross-sectional study included 25 503 of 25 871 community-dwelling older adults who participated in the Vitamin D and Omega-3 Trial (VITAL), a randomized trial of cancer and cardiovascular disease prevention conducted from November 2011 to December 2017. Data analysis was conducted from June to September 2018. Racial/ethnic group (ie, non-Hispanic white; black; Hispanic; Asian; and other, multiple, or unspecified race). Depressive symptoms, assessed using the Patient Health Questionnaire-8 (PHQ-8); participant-reported diagnosis, medication, and/or counseling for depression. Differences across racial/ethnic groups were evaluated using multivariable zero-inflated negative binomial regression to compare PHQ-8 scores and multivariable logistic regression to estimate odds of item-level symptom burden and odds of depression treatment among those with diagnosed depression. There were 25 503 VITAL participants with adequate depression data (mean [SD] age, 67.1 [7.1] years) including 12 888 [50.5%] women, 17 828 [69.9%] non-Hispanic white participants, 5004 [19.6%] black participants, 1001 [3.9%] Hispanic participants, 377 [1.5%] Asian participants, and 1293 participants [5.1%] who were categorized in the other, multiple, or unspecified race group. After adjustment for sociodemographic, lifestyle, and health confounders, black participants had a 10% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (rate ratio [RR], 1.10; 95% CI, 1.04-1.17; P < .001); Hispanic participants had a 23% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.23; 95% CI, 1.10-1.38; P < .001); and participants in the other, multiple, or unspecified group had a 14% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.14; 95% CI, 1.04-1.25; P = .007). Compared with non-Hispanic white participants, participants belonging to minority groups had 1.5-fold to 2-fold significantly higher fully adjusted odds of anhedonia (among black participants: odds ratio [OR], 1.76; 95% CI, 1.47-2.11; among Hispanic participants: OR, 1.96; 95% CI, 1.43-2.69), sadness (among black participants: OR, 1.31; 95% CI, 1.07-1.60; among Hispanic participants: OR, 2.09; 95% CI, 1.51-2.88), and psychomotor symptoms (among black participants: OR, 1.77; 95% CI, 1.31-2.39; among Hispanic participants: OR, 2.12; 95% CI, 1.28-3.50); multivariable-adjusted odds of sleep problems and guilt appeared higher among Hispanic vs non-Hispanic white participants (sleep: OR, 1.24; 95% CI, 1.01-1.52; guilt: 1.84; 95% CI, 1.31-2.59). Among those with clinically significant depressive symptoms (ie, PHQ-8 score ≥10) and/or those with diagnosed depression, black participants were 61% less likely to report any treatment (ie, medications and/or counseling) than non-Hispanic white participants after adjusting for confounders (adjusted OR, 0.39; 95% CI, 0.27-0.56). In this cross-sectional study, significant racial and ethnic differences in late-life depression severity, item-level symptom burden, and depression care were observed after adjustment for numerous confounders. These findings suggest a need for further examination of novel patient-level and clinician-level factors underlying these associations.
Highlights
Depression is a leading cause of disability and global disease burden and poses serious consequences for affected individuals and society alike.[1]
After adjustment for sociodemographic, lifestyle, and health confounders, black participants had a 10% higher severity level of Patient Health Questionnaire–8 (PHQ-8) scores compared with non-Hispanic white participants; Hispanic participants had a 23% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.23; 95% CI, 1.10-1.38; P < .001); and participants in the other, multiple, or unspecified group had a 14% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.14; 95% CI, 1.04-1.25; P = .007)
Compared with non-Hispanic white participants, participants belonging to minority groups had 1.5-fold to 2-fold significantly higher fully adjusted odds of anhedonia, sadness, and psychomotor symptoms; multivariable-adjusted odds of sleep problems and guilt appeared higher among Hispanic vs non-Hispanic white participants
Summary
Depression is a leading cause of disability and global disease burden and poses serious consequences for affected individuals and society alike.[1]. In a 2013 meta-analysis,[2] estimated current and lifetime prevalence rates of major depressive disorder among older adults were 3.3% and 16.5%, respectively; current prevalence of significant LLD symptoms (ie, encompassing major and minor depression) is higher, at 19%.3. Disparities may include underdiagnosis,[9] lower likelihood of receiving depression treatment, and differences in treatment quality.[10,11,12] Potential disparities[9,13] are concerning, given that the higher current depression burden,[14,15,16,17] symptom severity,[16] and depression-related role dysfunction[18] reported among older adults from minority groups may lead to greater adverse long-term health consequences from depression.[19,20] For example, older adults from minority groups bear a disproportionate share of the burden of dementia; it is plausible that a proportion of the variation in dementia risk among older adults from minority groups may be explained by LLD and its interplay with prevalent medical comorbidities.[21,22] it is critical to measure the extent of the disparities in symptom severity, burden, and care as well as to evaluate potential social, behavioral, and health status determinants that may partly underlie disparities
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