Depression and depression care in diabetes: relationship to perceived discrimination in African Americans.

Abstract

Depression is more prevalent in both African Americans and Caucasians with diabetes (1) than in nondiabetic control subjects (2), and it is associated with worse diabetes outcomes (3,4). Prospective studies (5) show that everyday encounters with discrimination predict subsequent depressive symptoms in nondiabetic individuals. When discrimination is perceived, specifically in health care, it may also interfere with depression care. This study investigated perceived discrimination, depressive symptoms, and depression care in diabetic African Americans. Participants were African-American adults with diabetes attending 2004–2006 American Diabetes Association health fairs in northeastern U.S. cities. Attendees responded to a sign advertising “Research for African Americans with diabetes.” After informed consent, participants completed questionnaires and provided fingerprick blood samples for A1C assessment (6). Participants were paid $5.00 and given A1C results with referrals to community health centers. Demographic questions included age, sex, insurance, primary care provider, and socioeconomic status (SES), which was assessed with income and education. A medical history questionnaire asked about physician-diagnosed disorders (including depression) and whether medication was taken for each disorder. These questions were modeled after the Centers for Disease Control’s survey questions (7,8) for patient report of physician-diagnosed disorders. Participants completed three additional questionnaires, as follows. The Center for Epidemiological Studies Depression (CESD) scale (9) is a 20-item measure of depressive symptoms. A score of >21 discriminates between depressed and nondepressed individuals in medical populations (10,11). α in this sample was 0.87. The Schedule of Racist Events (SRE) (12) is an 18-item questionnaire that measures frequency and stressfulness of racial discrimination situations (e.g., in …