Racial Disparities Can Lead to Depression in Old People

A recent cross-sectional study, published in the Journal of American Medical Association (JAMA), says that racial and ethnic disparities in older adults have been identified as a reason for developing late-life depression.

Depression is considered to be a global burden disease that affects an individual’s life entirely. Anxiety and Depression Association of America (ADAA) has determined that major depressive disorder (MDD) is the leading cause of disability in the US because over 16.1 million adults, more women than men, are suffering from MDD. The National Alliance on Mental Illness (NAMI) suggests that 6.5 million adults aged 65 and over are affected by depression.

Source: Washington Post

The researchers from the Harvard Medical School in Boston comprised data of 25,503 out of 25,871 older adults from a specific racial (personal characteristics) and ethnic (cultural factors) group, including 69.9% of the non-Hispanic white, 19.6% black, 3.9% Hispanic, 1.5% Asian, and 5.1% other multiple or unspecified race. The sample collected from a program called Vitamin D and Omega-3 Trial (VITAL). The program was about cancer and cardiovascular disease prevention because old people are more prone to develop depression who are already suffering from other illnesses like heart diseases and cancer. The team divided the participants according to their race/ethnic differences.

Depression Measurement: The investigators used the eight-item Patient Health Questionnaire depression scale (PHQ-8) which is a diagnostic and severity measurement tool for assessing depressive disorders in large clinical studies. The team also used participant-reported diagnosis, medication and counseling for depression.

Racial/Ethnicity Group Differences: The differences were measured through multivariable zero-inflated negative binomial regression (ZiNBR), a method used to count variables with excessive zeros and it is usually for greater variability in the data set.

Comparison of Race/Ethnic Group with Non-Hispanic White Group

After the scoring of PHQ-8, the researchers found out that black participants, Hispanic groups and other multiple or unspecified groups had 10%, 23%, and 14% higher severity levels of PHQ-8, respectively, as compared to the Non-Hispanic white participants.

One of the authors of this study, Olivia I. Okereke, M.D., S.M., of the department of psychiatry at Massachusetts General Hospital, says:

Our findings were in line with prior reports of higher depression severity among minority older adults, although this study is one of the largest to date. However, it was particularly novel that we saw differences by racial/ethnic group in the specific features of depression. This is potentially important because it has implications for understanding health disparities.

The researchers also used multivariable logistic regression (MLR), a statistical method used to study two or more independent variables simultaneously to find the value of the dependent variable for each subject. The MLR is used to determine the odds of symptoms and treatment of depression of diagnosed depressed people.

The team found out that minority groups including black and Hispanics showed symptoms of anhedonia, a condition in which a person is unable to experience pleasure. They also showed sadness and psychomotor symptoms such as emotional distress, unable to sit still, fatigue, awkward movements, and agitation. On the split side, the symptoms like sleep problems and feelings of guilt have been seen in Hispanic and non-Hispanic white participants. By comparison, 61% of black people showed highly depressive symptoms but were less likely seek any kind of medication or counseling.

Source: CDC

There is a need for future work in a longitudinal setting that could clarify how the racial/ethnic differences observed in this study of severity, symptoms and care of late-life depression can be triggered over time.

Contributing Factors that Trigger Depression in Older People

There isn’t a single factor that causes depression in old people. Multiple factors can contribute to the development of depression such as psychological, biological, environmental and genetic factors. Imbalances in the brain chemicals including norepinephrine, serotonin, and dopamine are considered to be involved in major depressive disorder. The symptoms of developing late-life depression can be any life-threatening illnesses like cancer, diabetes, high blood pressure and cardiovascular diseases. Other factors like loss of a major attachment figure (spouse or friend), retirement, moving to the old house or some other stressful events can raise the risks of experiencing a depressive episode.

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