Abstract
The degree by which depressive symptoms and clinical depression reflect each other may vary across populations. The present study compared Blacks and Whites for the magnitude of the cross-sectional associations between various domains of depressive symptoms and endorsement of clinical disorders of depression. Data came from the National Survey of American Life, 2001-2003. We included 3570 Black (African-Americans) and 891 Non-Hispanic Whites. Predictors were positive affect, negative affect, and interpersonal problems measured using the 12-item Center for Epidemiologic Studies Depression Scale (CES-D). Outcomes were lifetime major depressive disorder (MDD), lifetime major depressive episode (MDE), 12-month MDE, 30-day MDE, and 30-day major depressive disorder with hierarchy (MDDH) based on the Composite International Diagnostic Interview (CIDI). Logistic regression models were applied in the pooled sample as well as Blacks and Whites. Regarding CES-D, Blacks had lower total scores, positive affect, negative affect, and interpersonal problems compared to Whites (p < 0.05 for all comparisons). Blacks also had lower odds of meeting criteria for lifetime MDD and MDE, 12-month MDE, and 30-day MDE and MDDH (p < 0.05 for all comparisons). For most depressive diagnoses, ethnicity showed a positive and significant interaction with the negative affect and interpersonal problems domains, suggesting stronger associations for Blacks compared to Whites. The CES-D total score and CES-D positive affect domain did not interact with ethnicity on CIDI-based depressive diagnoses. Stronger associations between multiple domains of depressive symptoms and clinical depression may be due to higher severity of depression among Blacks, when they endorse the CIDI criteria for the disorder. This finding may explain some of previously observed ethnic differences in social, psychological, and medical correlates of depressive symptoms and clinical depression in the general population as well as clinical settings.
Highlights
Depression is the fourth largest contributor to years lost due to disability (YLD) globally [1]
The Center for Epidemiologic Studies Depression Scale (CES-D) total score and the CES-D positive affect were positively associated with odds of lifetime major depressive disorder (MDD), lifetime major depressive episode (MDE), 12-month MDE, 30-day MDE, and 30-day major depressive disorder with hierarchy (MDDH) among Blacks and Whites with relatively similar odds ratios (OR) values
The CES-D negative affect and the CES-D interpersonal problems were positively associated with lifetime MDD and lifetime MDE in both Blacks and Whites; TABLE 1 | Descriptive statistics of the CES-D factors and depressive disorders based on ethnicity
Summary
Depression is the fourth largest contributor to years lost due to disability (YLD) globally [1]. Used for the measurement of prevalence of clinical depression, the World Health Organization Composite International Diagnostic Interview (CIDI) is a survey tool for population studies. The CIDI has shown consistent sensitivity and specificity among Latinos, non-Latino Blacks, and non-Latino Whites for diagnosis of MDD [8]. It has shown validity for studying Blacks with different ethnicities [6, 7]. The present study compared Blacks and Whites for the magnitude of the cross-sectional associations between various domains of depressive symptoms and endorsement of clinical disorders of depression
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