Depressive symptoms are doubled in older British South Asian and Black Caribbean people compared with Europeans: associations with excess co-morbidity and socioeconomic disadvantage.

E D Williams,T Tillin,N Chaturvedi,R Stewart,C Tuson,A D Hughes,M Richards

doi:10.1017/s0033291714002967

Abstract

Despite elevated risk profiles for depression among South Asian and Black Caribbean people in the UK, prevalences of late-life depressive symptoms across the UK's three major ethnic groups have not been well characterized. Data were collected at baseline and 20-year follow-up from 632 European, 476 South Asian and 181 Black Caribbean men and women (aged 58-88 years), of a community-based cohort study from north-west London. The 10-item Geriatric Depression Scale was interviewer-administered during a clinic visit (depressive symptoms defined as a score of ⩾4 out of 10), with clinical data (adiposity, diabetes, cardiovascular disease, cognitive function) also collected. Sociodemographic, psychosocial, behavioural, disability, and medical history information was obtained by questionnaire. Prevalence of depressive symptoms varied by ethnic group, affecting 9.7% of White European, 15.5% of South Asian, and 17.7% of Black Caribbean participants. Compared with White Europeans, South Asian and Black Caribbean participants were significantly more likely to have depressive symptoms (odds ratio 1.79, 95% confidence interval 1.24-2.58 and 1.80, 1.11-2.92, respectively). Adjustment for co-morbidities had most effect on the excess South Asian odds, and adjustment for socioeconomic position had most effect on the elevated Black Caribbean odds. Higher prevalence of depressive symptoms observed among South Asian people were attenuated after adjustment for physical health, whereas the Black Caribbean increased prevalence was most explained by socioeconomic disadvantage. It is important to understand the reasons for these ethnic differences to identify opportunities for interventions to address inequalities.

Highlights

Depression is one of the leading causes of morbidity, healthcare use and loss of productivity worldwide (WHO, 2008)
People who did not attend clinics were younger (p < 0.001), more likely to be female (p = 0.006), have lower socioeconomic position (SEP) (p < 0.001), and have poor self-rated health (p = 0.002). These differences applied across ethnic groups and clinic attendance rates were very similar across ethnic groups (44% European, 43% South Asian, 46% Black Caribbean)
South Asian people were younger than White Europeans and Black Caribbean participants had a higher proportion of women than men

Summary

Introduction

Depression is one of the leading causes of morbidity, healthcare use and loss of productivity worldwide (WHO, 2008). Variations in chronic disease prevalence have been identified (Smith et al 2000), with both South Asian and Black Caribbean groups tending to have worse profiles (Fischbacher et al 2007; Tillin et al 2013). Despite marked ethnic group differences in risk factors for depression, including socioeconomic adversity, experience of discrimination, health behaviours, disability and chronic disease (Nazroo, 2003; Karlsen et al 2005; Craig et al 2006; Williams et al 2011, 2012; Tillin et al 2013), surprisingly few UK studies have characterized ethnic group variations in depression. Despite elevated risk profiles for depression among South Asian and Black Caribbean people in the UK, prevalences of late-life depressive symptoms across the UK’s three major ethnic groups have not been well characterized

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