Disparities In Depressive Symptoms Research Articles

Differences in sexual identity dimensions between bisexual and other sexual minority individuals: Implications for minority stress and mental health.

Bisexual individuals experience poorer mental health than other sexual minority individuals. One explanation for this is that biphobia predisposes bisexual individuals to have a more ambiguous sexual identity and fewer opportunities for stress-ameliorating forms of coping and support. This study explores sexual identity and sexual identity dimensions-prominence, valence, integration, and complexity-in bisexual and other sexual minority individuals. We describe differences in sexual identity dimensions between bisexual and other sexual minority individuals and test two explanations for mental health disparities between them: whether sexual identity dimensions directly impact mental health and whether they moderate the impact of stress on mental health. Data came from a longitudinal study of a diverse sample of sexual minority individuals (N = 396, 71 bisexual respondents) sampled from community venues in New York City. Sexual identity was prominent for both bisexual and other sexual minority individuals, but bisexual individuals reported lower valence and integration of sexual identity in their identity structures. The hypothesis that sexual identity dimensions moderate the impact of minority stress on mental health was not supported. After several longitudinal assessments, however, we concluded that identity valence (but not integration or complexity) and depressive symptoms were bidirectionally associated so that differences in valence between bisexual and other sexual minority individuals explained, in part, disparities in depressive symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Darker days? Recent trends in depression disparities among U.S. adults.

Depression is the most prevalent mood disorder in the United States, and disparities in depressive symptoms and treatment by socioeconomic status have been well-documented. Recent evidence suggests the prevalence of depression is increasing, but less is known about time trends in disparities. Using nationally representative data from the National Health and Nutrition Examination Survey, we examined patterns of depressive symptoms (Patient Health Questionnaire-9) and treatment (self-reported psychotherapy and psychopharmacology). We assessed time trends in depression disparities by educational attainment among U.S. adults 2005-2014 using logistic regression models. Among the least educated groups, the odds of moderate to severe depressive symptoms increased; for the most educated, they remained stable (women) or decreased (men). At the same time, odds of receiving treatment, conditional on being depressed, declined (women) or remained stable (men) for the least educated group, whereas treatment rates stayed steady (women) or increased (men) for the most educated. Between 2005 and 2014, overall depression prevalence increased. Despite recent policies designed to improve mental health care coverage, depression treatment rates were unable to keep pace. The least educated consistently had the highest rates of moderate to severe depressive symptoms and the lowest rates of treatment. Disparities in depression by educational attainment have persisted or worsened. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sexual Orientation, Relationships with Parents, Stress, and Depressive Symptoms among Adults

Disparities in depressive symptoms as a function of sexual orientation have been well documented, but less is known about their origins. This study examines whether, even in adulthood, less favorable parental relationships are associated with disparities in depressive symptoms as a function of sexual orientation. Cross-sectional data were drawn from Wave IV of the National Longitudinal Study of Adolescent to Adult Health. Gay, lesbian, and bisexual (GLB) participants reported lower quality parental relationships, greater stress, and more depressive symptoms than did heterosexual participants. Lower quality parental relationships were associated with higher stress. Higher stress and lower quality parental relationships were associated with more depressive symptoms. GLB individuals reported lower father relationship quality and higher stress, which partially mediated the association of sexuality and depressive symptoms. Lesbian and bisexual women reported lower mother relationship quality and higher stress, which fully mediated the association of sexuality and depressive symptoms. While no differences in mother relationship quality existed for men, mother relationship quality was more strongly associated with depressive symptoms for gay and bisexual men than for heterosexual men. Even in adulthood, greater stress and depressive symptoms among GLB individuals were at least partially accounted for by less favorable parental relationships.

The role of social support in family socio-economic disparities in depressive symptoms during early pregnancy: Evidence from a Chinese birth cohort

BackgroundFew studies have examined the association between a composite measure of family socio-economic position (SEP)22SEP, socio-economic position. and depressive symptoms among Chinese pregnant women, nor any potential underlying mechanisms which may be amenable to preventative interventions. MethodsWe investigated the association between a composite SEP measure and depressive symptoms during early pregnancy, and tested for mediation by social support and moderation by parity in the Born in Guangzhou Cohort Study (n = 12,382) using adjusted logistic regression and causal mediation analysis. ResultsIn this population, 18.4% of women experienced depressive symptoms before the 20th gestational week. Compared with the highest quartile, the lowest SEP score quartile was associated with a higher risk of depressive symptoms (OR 1.50, 95% CI 1.31–1.71), which was more pronounced among multiparous women than nulliparous women (P for interaction <0.001). Social support mediated the association between SEP and depressive symptoms, with greater proportion mediated in nulliparous women (73.4% for the lowest SEP score quartile) than multiparous women (30.5%). LimitationsDepressive symptoms were measured by Self-rated Depression Scale, which is not designed as a clinical diagnosis tool for depression. We only had information on perceived social support but not actual social support, although these two parameters were modestly correlated. ConclusionLower SEP was associated with higher risk of depressive symptoms in pregnant women, driven by social support. And the association between SEP and depressive symptoms and mediation by social support were modified by parity. Whether this association extends to the post pregnancy period or is amenable to cost-effective interventions should be investigated in further studies.

Sexual Orientation and Depressive Symptoms in Adolescents.

Sexual orientation disparities in adolescent depressive symptoms are well established, but reasons for these disparities are less well understood. We modeled sexual orientation disparities in depressive symptoms from late adolescence into young adulthood and evaluated family satisfaction, peer support, cyberbullying victimization, and unmet medical needs as potential mediators. Data were from waves 2 to 6 of the NEXT Generation Health Study (n = 2396), a population-based cohort of US adolescents. We used latent growth models to examine sexual orientation disparities in depressive symptoms in participants aged 17 to 21 years, conduct mediation analyses, and examine sex differences. Relative to heterosexual adolescents, sexual minority adolescents (those who are attracted to the same or both sexes or are questioning; 6.3% of the weighted sample) consistently reported higher depressive symptoms from 11th grade to 3 years after high school. Mediation analyses indicated that sexual minority adolescents reported lower family satisfaction, greater cyberbullying victimization, and increased likelihood of unmet medical needs, all of which were associated with higher depressive symptoms. The mediating role of cyberbullying victimization was more pronounced among male than female participants. Sexual minority adolescents reported higher depressive symptoms than heterosexual adolescents from late adolescence into young adulthood. Collectively, low family satisfaction, cyberbullying victimization, and unmet medical needs accounted for >45% of differences by sexual orientation. Future clinical research is needed to determine if interventions targeting these psychosocial and health care-related factors would reduce sexual orientation disparities in depressive symptoms and the optimal timing of such interventions.

Temporal trends in educational inequalities in non-communicable diseases in Korea, 2007-2015.

BackgroundSocioeconomic inequalities in non-communicable diseases are known to exist; however there is a paucity of research describing the secular trends in these inequalities. To this end, the current study aims to explore the recent time trends in social patterning of selected non-communicable diseases among Korean adults between 2007 and 2015.MethodsUsing data from the Korea National Health and Nutrition Examination Survey (KNHANES), temporal trends in socioeconomic inequalities in diabetes, arthritis, asthma and depressive symptoms were assessed across three time points. Respondents were adults aged 20 years or over (N = 47,091, 20,180 men and 26,911 women). Socioeconomic circumstance was assessed based on highest level of educational attainment. We estimated prevalence ratios with 95% confidence intervals using Poisson regression with robust variance estimation (adjusted for age, smoking status, alcohol consumption, obesity, and physical activity) separately for men and women. The magnitude of the inequalities was computed using the relative index of inequality (RII).ResultsIn men, diabetes was not associated with educational attainment, while there was evidence of a negative association in women across surveys. Similar inverse associations were found with arthritis and depressive symptoms, but these associations were less clear for asthma. RII showed a non-significant increasing trend in educational disparities in depressive symptoms. Meanwhile, relative inequalities in diabetes, arthritis and asthma have narrowed. These trends were, in general, more pronounced in women.ConclusionsThe findings of this study indicate higher burden of selected NCDs among the lower educational groups, particularly among women. In addition, our results indicated some improvements in inequalities in diabetes, arthritis and asthma in recent years. These findings have important implications for understanding the causes of social patterning of NCDs and for the targeting of effective interventions.

Analysis of the relationship between community characteristics and depression using geographically weighted regression.

OBJECTIVESAchieving national health equity is currently a pressing issue. Large regional variations in the health determinants are observed. Depression, one of the most common mental disorders, has large variations in incidence among different populations, and thus must be regionally analyzed. The present study aimed at analyzing regional disparities in depressive symptoms and identifying the health determinants that require regional interventions.METHODSUsing health indicators of depression in the Korea Community Health Survey 2011 and 2013, the Moran’s I was calculated for each variable to assess spatial autocorrelation, and a validated geographically weighted regression analysis using ArcGIS version 10.1 of different domains: health behavior, morbidity, and the social and physical environments were created, and the final model included a combination of significant variables in these models.RESULTSIn the health behavior domain, the weekly breakfast intake frequency of 1-2 times was the most significantly correlated with depression in all regions, followed by exposure to secondhand smoke and the level of perceived stress in some regions. In the morbidity domain, the rate of lifetime diagnosis of myocardial infarction was the most significantly correlated with depression. In the social and physical environment domain, the trust environment within the local community was highly correlated with depression, showing that lower the level of trust, higher was the level of depression. A final model was constructed and analyzed using highly influential variables from each domain. The models were divided into two groups according to the significance of correlation of each variable with the experience of depression symptoms.CONCLUSIONSThe indicators of the regional health status are significantly associated with the incidence of depressive symptoms within a region. The significance of this correlation varied across regions.

Disparities in Depressive Symptoms and Antidepressant Treatment by Gender and Race/Ethnicity among People Living with HIV in the United States

ObjectiveTo describe disparities along the depression treatment cascade, from indication for antidepressant treatment to effective treatment, in HIV-infected individuals by gender and race/ethnicity.MethodsThe Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort includes 31,000 HIV-infected adults in routine clinical care at 8 sites. Individuals were included in the analysis if they had a depressive symptoms measure within one month of establishing HIV care at a CNICS site. Depressive symptoms were measured using the validated Patient Health Questionnaire-9 (PHQ-9). Indication for antidepressant treatment was defined as PHQ-9 ≥ 10 or a current antidepressant prescription. Antidepressant treatment was defined as a current antidepressant prescription. Evidence-based antidepressant treatment was considered treatment changes based on a person’s most recent PHQ-9, in accordance with clinical guidelines. We calculated the cumulative probability of moving through the depression treatment cascade within 24 months of entering CNICS HIV care. We used multivariable Cox proportional hazards models to estimate associations between gender, race/ethnicity, and a range of depression outcomes.ResultsIn our cohort of HIV-infected adults in routine care, 47% had an indication for antidepressant treatment. Significant drop-offs along the depression treatment cascade were seen for the entire study sample. However, important disparities existed. Women were more likely to have an indication for antidepressant treatment (HR 1.54; 95% CI 1.34, 1.78), receive antidepressant treatment (HR 2.03; 95% CI 1.53, 2.69) and receive evidence-based antidepressant treatment (HR 1.67; 95% CI 1.03, 2.74), even after accounting for race/ethnicity. Black non-Hispanics (HR 0.47, 95% CI 0.35, 0.65), Hispanics (HR 0.63, 95% CI 0.44, 0.89) and other race/ethnicities (HR 0.35, 95% CI 0.17, 0.73) were less likely to initiate antidepressant treatment, compared to white non-Hispanics.ConclusionsIn our cohort of HIV-infected adults depressive symptoms were common. Important disparities in the prevalence of depressive symptoms and receipt of antidepressant treatment existed by gender and race/ethnicity.

Disparities in Depressive Symptoms Between Heterosexual and Lesbian, Gay, and Bisexual Youth in a Dutch Cohort: The TRAILS Study.

Lesbian, gay, and bisexual (LGB) youth experience elevated levels of depressive symptoms compared to heterosexual youth. This study examined how differences in depressive symptoms between heterosexual and LGB youth developed from late childhood to early adulthood. The association between sexual orientation and depressive symptoms was estimated from age 11 to 22 using data from the TRacking Adolescents’ Individual Lives Survey, a longitudinal Dutch cohort study. Of the 1738 respondents (54.8 % girls) that provided information on sexual orientation, 151 self-identified as LGB. In line with the Minority Stress Framework, it was tested whether self-reported peer victimization and parental rejection mediated the association between sexual orientation and depressive symptoms. Results indicated that LB girls and bisexuals were at increased risk of depressive symptoms already at age 11. The difference increased over time and was related to pubertal development in girls and bisexual individuals. Furthermore, self-reported peer victimization (for both boys and girls), as well as parental rejection (for girls/bisexuals), mediated the association between sexual orientation and depressive symptoms. The authors conclude that already in late childhood, associations between sexual orientation and depressive symptoms are found, partly due to minority stress mechanisms.Electronic supplementary materialThe online version of this article (doi:10.1007/s10964-015-0403-0) contains supplementary material, which is available to authorized users.

Disparities in Depressive Symptoms and Antidepressant Treatment by Gender and Race/Ethnicity among People Living with HIV in the United States

Disparities in Depressive Symptoms and Antidepressant Treatment by Gender and Race/Ethnicity among People Living with HIV in the United States

Racial/Ethnic Disparities in Depressive Symptoms Among Pregnant Women Vary by Income and Neighborhood Poverty.

We examined racial/ethnic disparities in depressive symptoms during pregnancy among a population-based sample of childbearing women in California (N = 24,587). We hypothesized that these racial/ethnic disparities would be eliminated when comparing women with similar incomes and neighborhood poverty environments. Neighborhood poverty trajectory descriptions were linked with survey data measuring age, parity, race/ethnicity, marital status, education, income, and depressive symptoms. We constructed logistic regression models among the overall sample to examine both crude and adjusted racial/ethnic disparities in feeling depressed. Next, stratified adjusted logistic regression models were constructed to examine racial/ethnic disparities in feeling depressed among women of similar income levels living in similar neighborhood poverty environments. We found that racial/ethnic disparities in feeling depressed remained only among women who were not poor themselves and who lived in long-term moderate or low poverty neighborhoods.

Racial/ethnic disparities in midlife depressive symptoms: The role of cumulative disadvantage across the life course.

This study examines the role of cumulative disadvantage mechanisms across the life course in the production of racial and ethnic disparities in depressive symptoms at midlife, including the early life exposure to health risk factors, the persistent exposure to health risk factors, and varying mental health returns to health risk factors across racial and ethnic groups. Using data from the over-40 health module of the National Longitudinal Study of Youth (NLSY) 1979 cohort, this study uses regression decomposition techniques to attend to differences in the composition of health risk factors across racial and ethnic groups, differences by race and ethnicity in the association between depressive symptoms and health risk factors, and how these differences combine within racial and ethnic groups to produce group-specific levels of--and disparities in--depressive symptoms at midlife. While the results vary depending on the groups being compared across race/ethnicity and gender, the study documents how racial and ethnic mental health disparities at midlife stem from life course processes of cumulative disadvantage through both unequal distribution and unequal associations across racial and ethnic groups.

Sexual Attraction and Trajectories of Mental Health and Substance Use During the Transition from Adolescence to Adulthood

Previous research suggests that sexual minority youth have poorer health-related outcomes than their heterosexual peers. The purpose of this study is to determine whether sexual orientation disparities in mental health and substance use increase, decrease, or remain the same during the transition from adolescence to adulthood. Data are from Waves 1-4 of the National Longitudinal Study of Adolescent Health (n = 8,322; 55% female). Respondents were in grades 7-12 at Wave 1 and aged 24-32 at Wave 4. Latent growth curve modeling is used to compare the mental health and substance use trajectories of youth who consistently report heterosexual attraction versus those who consistently report lesbian, gay, or bisexual (LGB) attraction, those who report a transition to LGB attraction, and those who report a transition to heterosexual attraction. Among women and men, sexual orientation disparities in depressive symptoms and suicidal thoughts persist, but do not increase, during the transition from adolescence to adulthood. The same pattern is observed for disparities in smoking, heavy drinking, and marijuana use among women. Among men, disparities in substance use are only observed between those who report consistent heterosexual attraction and those who transition to heterosexual attraction. Disparities between these groups persist over time for heavy drinking and marijuana use but decrease over time for smoking. While this study finds evidence of numerous disparities in mental health and substance use outcomes during adolescence and young adulthood, particularly among young women, there is no indication that these disparities get larger over time.

Effect of School Racial Composition on Trajectories of Depressive Symptoms from Adolescence Through Early Adulthood

We investigate the effect of high school racial composition, measured as percent of non-Hispanic white students, on trajectories of depressive symptoms from adolescence to early adulthood. We also explore whether the effect of school racial composition varies by respondent race/ethnicity and whether adult socioeconomic status mediates this relationship. We analyzed four waves of data from the National Longitudinal Study of Adolescent Health using 3-level linear growth models. We restricted our sample to respondents enrolled in grades 9–12 in 1994/5 who were interviewed at a minimum in Waves I and IV. This resulted in 10,350 respondents enrolled in 80 high schools in 1994/5 (5,561 whites, 2,030 blacks, 1,834 Hispanics, 738 Asians, and 187 of other race). As the percentage of white students increased at the high school respondents attended in 1994/5, blacks reported more depressive symptoms. This effect did not vary by age. In comparison, Asian and Hispanic respondents who attended predominantly white high schools had lower levels of depressive symptoms than their counterparts who attended predominantly minority schools, but they also experienced a slower decline in depressive symptoms through early adulthood. Adult SES mediated the relationship between high school racial composition and depressive symptoms for black, but not for Asian or Hispanic respondents. Our results suggest that high school racial composition is associated with trajectories of depressive symptoms through early adulthood, but the effect differs by respondents’ race/ethnicity. Racial/ethnic disparities in depressive symptoms during early adulthood may have their origins in adolescence.

Gender differences in the association between socioeconomic status (SES) and depressive symptoms in older adults

With rapid population aging, increasing attention is given to the mental health of older people. This study examined the association between SES and depressive symptoms in older adults. The study population consisted of a representative community sample of 4165 persons aged 65 and older from Wave 1 of the Korean Longitudinal Study of Aging. The Center for Epidemiologic Studies Depression scale was used to measure the extent of depressive symptoms. Socioeconomic indicators included education, household income, and net worth. Analyses were conducted by gender, using multiple linear regression analysis, to identify independent effects of socioeconomic variables on depressive symptoms, controlling for demographics and health-related variables. There was an inverse association between higher levels of socioeconomic factors and depressive symptoms in the study population. A clear difference in the association between depressive symptoms and socioeconomic factors by gender was observed. In the multivariate analysis, wealth was significantly associated with depressive symptoms in men, whereas education and income was so in women. Gender disparities in depressive symptoms across social gradients suggest the need for gender-sensitive investments in health and social services for the disadvantaged segments of the older population.

Physical Disability and Depression: Clarifying Racial/Ethnic Contrasts

This study assesses racial/ethnic disparities in depressive symptoms among persons who are physically disabled and evaluates the extent to which variation in stress exposure, coping resources, and feelings of shame associated with disability account for observed differences. Data are drawn from a Miami-Dade County study that oversampled persons with physical disabilities. The sample used in this study includes individuals of Cuban and other Hispanic heritage, African Americans, and non-Hispanic Whites who identify as physically disabled (N = 550). Cubans and other Hispanics report higher levels of depressive symptoms. This elevation in risk is largely explained by variations in stress exposure, available coping resources, and shame. Findings also suggest that feelings of shame may condition the relationships between both stress exposure and coping resources and depressive symptomatology. Findings demonstrate racial/ethnic differences in depressive symptoms among persons with physical disabilities and highlight the importance of stress exposure, coping resources, and shame for understanding these differences.

Sex and Race Disparities in Health: Cohort Variations in Life Course Patterns

This study assesses changes in sex and race disparities in health over the life course and across cohorts by conducting growth curve analyses of nationally representative longitudinal data that spans 15 years. It finds that changes in disparities in depressive symptoms, disability and self-assessments of health across the life course are cohort-related phenomena: (1. there is significant inter-cohort heterogeneity in health trajectories; (2. intra-cohort sex and race inequalities exist in levels of health but not in growth rates of all health problems; (3. there are inter-cohort variations in the intra-cohort heterogeneity – sex and race gaps change across cohorts in levels of health. Changes in the sex gap in growth rates of depression are also strongly contingent upon cohort membership.