A research framework for cognitive aging and Alzheimer's disease among diverse US Latinos: Design and implementation of the Hispanic Community Health Study/Study of Latinos—Investigation of Neurocognitive Aging (SOL-INCA)

Hispanics/Latinos are the largest ethnic/racial group in the United States and at high risk for Alzheimer's disease and related dementia (ADRD). Yet, ADRD among diverse Latinos is poorly understood and disparately understudied or unstudied compared to other ethnic/racial groups that leave the nation ill-prepared for major demographic shifts that lay ahead in coming decades. The primary purpose of this Perspectives article was to provide a new research framework for advancing Latino ADRD knowledge, encompassing the unique sociocultural, cardiometabolic, and genomic aspects of Latino health, aging, and ADRD. In addition, we describe some of the research challenges to progress in Latino ADRD research. Finally, we present the Study of Latinos – Investigation of Neurocognitive Aging (SOL-INCA) as an example of implementing this new framework for advancing Latino ADRD research.     

The relationship between depressive symptoms and walking among Hispanic older adults: A longitudinal,cross-lagged panel analysis

Objectives: This study examines the relationship between depressive symptoms and walking behavior across 30 months in a prospective study of 217 community-dwelling, Hispanic older adults in Miami, Florida (ages 70–100 years).

Method: Analyses examine the direction of the relationship between depressive symptoms and physical activity (i.e., walking) over time, as well as test for a potential bi-directional or reciprocal relationship between these two variables.

Results: Structural equation modeling (SEM) with a cross-lagged panel design revealed that walking was unrelated to subsequent depressive symptoms. However, depressive symptoms were related to subsequent walking behavior at every time-point, such that higher levels of depressive symptoms were predictive of less walking in the future. Older adults who had clinically-relevant depressive symptoms at the initial assessment had 1.34 times the risk of not walking 30 months later, compared to older adults without clinically-relevant depressive symptoms.

Conclusion: Results support the need for primary care providers to evaluate and address depressive symptoms among older adults, as a means of reducing sedentary behavior and potentially improving health. Further research on the prevention and management of depressive symptoms and sedentary behavior is needed, given the morbidity related to both of these health risks, particularly for minority and low-socio-economic status (SES) older adults.     

Antidepressant use in a nationally representative sample of community‐dwelling US Latinos with and without depressive and anxiety disorders

Background: Antidepressant drugs are among the most widely prescribed drugs in the United States; however, little is known about their use among major ethnic minority groups. Method: Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of Latino and non‐Latino White adults antidepressant use. Setting: The 48 coterminous United States was the setting. Participants: Household residents aged 18 years and older (N=9,250). Main outcome: Past year antidepressant use. Results: Compared to non‐Latino Whites, few Latinos, primarily Mexican Americans, with 12‐month depressive and/or anxiety disorders reported past year antidepressant use. Mexican Americans (OR=0.48; 95%CI=0.30–0.77) had significantly lower odds of use compared to non‐Latino Whites, which were largely unaffected by factors associated with access to care. Over half of antidepressant use was by respondents not meeting 12‐month criteria for depressive or anxiety disorders. Lifetime depressive and anxiety disorders explained another 21% of past year antidepressant use, leaving another 31% of drug use unexplained. Discussion: We found a disparity in antidepressant use for Mexican Americans compared to non‐Latino Whites that was not accounted for by differences in need and factors associated with access to care. About one third of antidepressant use was by respondents not meeting criteria for depressive or anxiety disorders. Our findings underscore the importance of disaggregating Latino ethnic groups. Additional work is needed to understand the medical and economic value of antidepressant use beyond their primary clinical targets. Depression and Anxiety, 2009. Published 2009 Wiley‐Liss, Inc.     

Depressive symptoms and psychiatric distress in low income Asian and Latino primary care patients: prevalence and recognition

The aims of the study were to: (a) assess the degree to which primary care physicians recognize psychiatric distress among an ethnically diverse primary care sample composed primarily of Asians and Hispanics; and (b) to investigate the relationship between patient and physician sociodemographic factors and overall diagnostic recognition of psychiatric distress. The study sample is comprised of 252 consecutively-selected patients and eleven primary care general internists from general medicine clinics in a large public ambulatory medical center. The measures used were the Center for Epidemiologic Studies-Depression (CES-D) scale, a demographic questionnaire, and an acculturation scale; these measures were completed during interviews conducted by trained bilingual research assistants. Physicians completed a mental health treatment summary immediately after the patient's visit. Hierarchical logistic regression analyses were performed in order to examine: (1) the degree to which providers identified psychiatric distress and (2) overall diagnostic recognition among this sample in relation to demographic characteristics and degree of acculturation. As measured by the CES-D, almost one half (47.3%) of the Latino and 41.6% of the Asian patients had depressive symptoms indicative of psychiatric distress. In contrast, physicians identified 43.8% of Latino patients and only 23.6% of Asian patients as being psychiatrically distressed (p < .01). Physicians were more likely to classify Latinos and those with higher acculturation status as distressed (p < .01 and p < .05, respectively). Higher patient acculturation status was the only factor significantly associated with overall diagnostic recognition (p < .05), as measured by physician agreement with the CES-D. Being Asian and/or having low acculturation levels may put the patient at risk for non-detection of psychiatric distress. The high prevalence of distress lends support to initiating improved methods for screening and detection of depression among low income and racially diverse primary care patients.     

Profiles of depression in a treatment‐seeking Hispanic population: Psychometric properties of the Patient Health Questionnaire‐9

ObjectivesScreening instruments can be powerful tools in assisting primary care providers with detecting depression in their patients and monitoring treatment response. Health disparities among racial and ethnic minorities result from inaccurate assessment in primary care.MethodsThe current study used baseline data from two federally funded research studies of treatment for depression among Hispanics in primary care. The Patient Health Questionnaire‐9 (PHQ‐9) was administered at baseline prior to the study interventions, and 499 participants provided responses.ResultsConfirmatory factor analyses found excellent factor validity for the PHQ‐9, yet reliability remained poor. Possible heterogeneity in depressive item scores was examined, and latent profile analysis identified four distinct profiles of PHQ‐9 responses. Profiles included a lower depression, moderate/somatization, moderate/negative self‐view, and severe depression profiles. Results indicate modest support for the PHQ‐9 and its use among Hispanics for the purpose of depression screening.ConclusionCapturing four profiles of depression in a large primary care sample helps characterize the manifestation of depression in a Hispanic population. The single item related to fatigue had the greatest variation across groups indicating it might be useful as a screening item. Inadequate evaluation of symptoms could lead to significant under identification of the disorder among Hispanics.     

Psychological distress and psychiatric diagnoses among primary caregivers of children undergoing hematopoietic stem cell transplant: an examination of prevalence,correlates, and racial/ethnic differences

ObjectiveThe aims of the study were to examine the prevalence of self-reported psychological distress, examine the prevalence of interview-rated psychiatric diagnoses, identify correlates of psychological distress and psychiatric diagnosis and examine racial/ethnic group differences on measures of psychological distress among primary caregivers of children preparing to undergo hematopoietic stem cell transplant (HSCT).MethodsCaregivers (N=215) completed the Beck Anxiety Inventory, Beck Depression Inventory (BDI), Impact of Events Scale, and a psychiatric interview assessing major depressive disorder, generalized anxiety disorder and panic disorder. Regression analyses examined correlates of distress and psychiatric diagnosis. Comparisons were made between racial/ethnic groups.ResultsPosttraumatic stress symptoms were reported by 54% of caregivers during the time preparing for the child's HSCT. Twenty-seven percent of caregivers met diagnostic criteria for at least one of the psychiatric diagnoses during this time. Few factors were associated with distress or psychiatric diagnosis, except the child scheduled for allogeneic transplant, being married and prior psychological/psychiatric care. Sociodemographic factors accounted for racial/ethnic group differences, except that Hispanic/Latino caregivers reported higher BDI scores than non-Hispanic white caregivers.ConclusionCaregivers may be at greater risk of posttraumatic stress symptoms than anxiety or depression. Prior psychological/psychiatric treatment is a risk factor for greater psychological distress and psychiatric diagnosis during this time. Racial differences are mostly due to sociodemographic factors.     

Caregiver self-efficacy, ethnicity, and kinship differences in dementia caregivers.

OBJECTIVE: The authors sought to determine the effect of kinship status (daughters versus wives) and ethnicity (Hispanic/Latino versus Caucasian) on self-efficacy to perform tasks relevant to caregiving in a sample of family caregivers for people with memory problems. METHODS: Baseline data were collected from 238 female caregivers who participated in an intervention program. Ethnic and kin relationship groups were compared on measures of caregiver self-efficacy, acculturation within the Hispanic/Latino sample, and the relationship of self-efficacy to key outcome variables. RESULTS: Hispanics/Latinos reported higher self-efficacy on two of three self-efficacy subscales (Responding to Disruptive Behaviors and Controlling Negative Thoughts About Caregiving). Daughters reported higher self-efficacy on all three self-efficacy scales. Among Hispanics/Latinos, acculturation did not relate strongly to self-efficacy. Caucasian and spousal caregivers appeared to make more generalized appraisals about caregiving. CONCLUSION: Higher self-efficacy among Hispanic/Latino caregivers may relate to cultural values about caregiving and/or ethnic differences in appraisal. Wives may be more at risk for low self-efficacy, which may relate to greater role frustration and distress. This study highlights the heterogeneity among caregivers in their experience of caregiving.     

Mental health in senior housing: Racial/ethnic patterns and correlates of major depressive disorder

Objectives: Mental health problems are associated with disability, overuse of medical care, higher rates of mortality and suicide as well as personal suffering for older adults. Residents of urban, low-income senior housing may face increased risk of a variety of mental health problems, including depression. This study identified the prevalence of multiple mental health problems in older residents of low-income senior housing and explored correlates of major depressive disorder for the two largest ethnic groups: black and Latino.

Method: In-person diagnostic interviews identified rates of mental illness in a sample of 635 residents of 13 low-income senior housing buildings in a medium-sized northeastern city. Applying George's Social Antecedent Model of Depression, logistic regression analyses identified shared and unique correlates of depression for Latino and black participants.

Results: This population had high rates of major depressive disorder (26%), generalized anxiety disorder (12%) and other mental health problems that varied significantly by ethnic and racial group. Separate multivariate models for Latino and black people showed that younger age, more chronic conditions and social distress were related to major depressive disorder for both ethnic groups. Perceived environmental stress, shorter tenure in the building, poorer perceived health, higher life stress and fewer leisure activities were associated with depression for Latinos only.

Conclusion: Mental health screening and treatment services are needed in senior housing to address these high rates of mental illness. Unique constellations of correlates of depression for different ethnic groups underscore a need for culturally competent approaches to identification and treatment.     

Prevalence, patterns, and correlates of co-occurring substance use and mental disorders in the United States: variations by race/ethnicity

ObjectiveThis study examines racial/ethnic differences in the prevalence, patterns, and correlates of co-occurring substance use and mental disorders (COD) among Whites, Blacks, Latinos, and Asians using data from the Collaborative Psychiatric Epidemiology Studies.MethodWe first estimated the prevalence of various combinations of different co-occurring depressive and anxiety disorders among respondents with alcohol, drug, and any substance use (alcohol or drug) disorders in each racial/ethnic group. We then estimated the prevalence of different patterns of onset and different psychosocial correlates among individuals with COD of different racial/ethnic groups. We used weighted linear and logistic regression analysis controlling for key demographics to test the effect of race/ethnicity. Tests of differences between specific racial/ethnic subgroups were only conducted if the overall test of race was significant.ResultsRates of COD varied significantly by race/ethnicity. Approximately 8.2% of Whites, 5.4% of Blacks, 5.8% of Latinos, and 2.1% of Asians met criteria for lifetime COD. Whites were more likely than persons in each of the other groups to have lifetime COD. Irrespective of race/ethnicity, most of those with COD reported that symptoms of mental disorders occurred before symptoms of substance use disorders. Only rates of unemployment and history of psychiatric hospitalization among individuals with COD were found to vary significantly by racial/ethnic group.ConclusionsOur findings underscore the need to further examine the factors underlying differences between minority and nonminority individuals with COD as well as how these differences might affect help seeking and utilization of substance abuse and mental health services.     

Sociodemographic and health correlates of sleep in U.S. Hispanic older adults

BackgroundThis project aims to understand the sociodemographic and health correlates of poor sleep in U.S. Hispanic older adults.MethodsData from the National Social Life, Health, and Aging Project (NSHAP): Wave 2 were analyzed to understand the prevalence of poor sleep among Hispanic older adults, sociodemographic predictors of sleep patterns, and the association between sleep quality and chronic disease. Only the data from Hispanic participants (n = 345) were used in the present study. Self-reported demographic, self-reported and actigraphy-measured sleep, and self-report health measures were used.ResultsResults of regression analyses indicated that self-reported restless sleep significantly predicted self-rated physical and mental health, hypertension, pain, and self-rated general happiness. Feeling rested was significantly associated with self-rated physical health and mental health, pain, and self-rated happiness. Neither restless sleep nor feeling rested were significant predictors of diabetes. Actigraphy-measured sleep duration was not significantly associated with health outcomes.ConclusionsWhile sleep deprivation has serious physical and mental health consequences for Hispanics, sleep disorders in Hispanic older adults have been overlooked in research. This study sheds some light on the associations between sleep and health in Hispanic older adults. Examination of potential mechanisms linking poor sleep with mental and physical health in Hispanic older adults is a critical next step.     

Depression and onset of cardiovascular disease in the US middle-aged and older adults

Objectives: To examine the relationship between depression and onset of cardiovascular disease (CVD) among the US middle-aged and older adults.

Methods: The study sample came from 1992–2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey, consisting of 8597 community-dwelling adults aged 51–61 years old in 1992 with no CVD history. A score of ≥3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan–Meier estimator and Cox proportional hazards model were performed to examine the association between baseline depressive symptoms and future CVD event. Subgroup analyses were conducted by sex and race/ethnicity.

Results: Compared with their counterparts without clinically relevant depressive symptoms, adults with clinically relevant depressive symptoms in 1992 were 27% (hazard ratio [HR] = 1.27, 95% confidence interval = 1.17–1.39) more likely to report new diagnosis of CVD during the 18 years of follow-up. A significant dose–response relationship was present between severity of depressive symptoms and elevated CVD risk. The adjusted HRs for males and Hispanics appeared moderately larger than for their female and non-Hispanic white or African American counterparts, although the differences were not statistically significant.

Conclusion: Holistic promotion of mental health through prevention, education, treatment, and rehabilitation is warranted to reduce CVD risk in the US middle-aged and older population.     

Anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and disorders among Latinos in primary care

The present investigation examined the interactive effects of anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and psychopathology among 143 Latinos (85.7% female; M_age = 39.0, SD = 10.9; 97.2% used Spanish as their first language) who attended a community-based primary healthcare clinic. Results indicated that the interaction between anxiety sensitivity and subjective social status was significantly associated with number of mood and anxiety disorders, panic, social anxiety, and depressive symptoms. The form of the significant interactions indicated that individuals reporting co-occurring higher levels of anxiety sensitivity and lower levels of subjective social status evidenced the greatest levels of psychopathology and panic, social anxiety, and depressive symptoms. The present findings suggest that there is merit in focusing further scientific attention on the interplay between anxiety sensitivity and subjective social status in regard to understanding, and thus, better intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.     

The Multidimensional Influence of Acculturation on Digit Symbol-Coding and Wisconsin Card Sorting Test in Hispanics

Objective: The purpose of the current study was to evaluate the relative contribution of acculturation to two tests of nonverbal test performance in Hispanics.

Method: This study compared 40 Hispanic and 20 non-Hispanic whites on Digit Symbol-Coding (DSC) and the Wisconsin Card Sorting Test (WCST) and evaluated the relative contribution of the various acculturation components to cognitive test performance in the Hispanic group.

Results: Hispanics performed significantly worse on DSC and WCST relative to non-Hispanic whites. Multiple regressions conducted within the Hispanic group revealed that language use uniquely accounted for 11.0% of the variance on the DSC, 18.8% of the variance on WCST categories completed, and 13.0% of the variance in perseverative errors on the WCST. Additionally, years of education in the United States uniquely accounted for 14.9% of the variance in DSC.

Conclusions: The significant impact of acculturation on DSC and WCST lends support that nonverbal cognitive tests are not necessarily culture free. The differential contribution of acculturation proxies highlights the importance of considering these separate components when interpreting performance on neuropsychological tests in clinical and research settings. Factors, such as the country where education was received, may in fact be more meaningful information than the years of education of education attained. Thus, acculturation should be considered an important factor in any cognitive evaluation of culturally diverse individuals.     

Depressive symptoms and cognitive impairment: A 10-year follow-up study from the Survey of Health,Ageing and Retirement in Europe

BackgroundDepressive symptoms and cognitive impairment often coexisted in the elderly. This study investigates the effect of late-life depressive symptoms on risk of mild cognitive impairment (MCI).MethodsA total of 14,231 dementia- and MCI free participants aged 60+ from the Survey of Health, Ageing, and Retirement in Europe were followed-up for 10 years to detect incident MCI. MCI was defined as 1.5 standard deviation (SD) below the mean of the standardized global cognition score. Depressive symptoms were assessed by a 12-item Europe-depression scale (EURO-D). Severity of depressive symptoms was grouped as: no/minimal (score 0–3), moderate (score 4–5), and severe (score 6–12). Significant depressive symptoms (SDSs) were defined as EURO-D score ≥ 4.ResultsDuring an average of 8.2 (SD = 2.4)-year follow-up, 1,352 (9.50%) incident MCI cases were identified. SDSs were related to higher MCI risk (hazard ratio [HR] = 1.26, 95% confidence intervals [CI]: 1.10–1.44) in total population, individuals aged 70+ (HR = 1.35, 95% CI: 1.14–1.61) and women (HR = 1.28, 95% CI: 1.08–1.51) in Cox proportional hazard model adjusting for confounders. In addition, there was a dose–response association between the severity of depressive symptoms and MCI incidence in total population, people aged ≥70 years and women (p-trend <0.001).ConclusionsSignificant depressive symptoms were associated with higher incidence of MCI in a dose–response fashion, especially among people aged 70+ years and women. Treating depressive symptoms targeting older population and women may be effective in preventing MCI.     

Psychosocial Factors in the Relationship between Socioeconomic Status and Cardiometabolic Risk: the HCHS/SOL Sociocultural Ancillary Study

Background

U.S. Hispanics/Latinos display a high prevalence of metabolic syndrome (MetSyn), a group of co-occurring cardiometabolic risk factors (abdominal obesity, impaired fasting glucose, dyslipidemia, elevated blood pressure) associated with higher cardiovascular disease and mortality risk. Low socioeconomic status (SES) is associated with higher risk for MetSyn in Hispanics/Latinos, and psychosocial factors may play a role in this relationship.

Purpose

This cross-sectional study examined psychosocial factors in the association of SES and MetSyn components in 4,996 Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study.

Methods

MetSyn components were measured at the baseline examination. Participants completed interviews to determine psychosocial risks (e.g., depression) and resources (e.g., social support) within 9 months of baseline (< 4 months in 72.6% of participants). Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to identify latent constructs and examine associations.

Results

Participant mean age was 41.7 years (SE = 0.4) and 62.7% were female. CFA identified single latent factors for SES and psychosocial indicators, and three factors for MetSyn [blood pressure, lipids, metabolic factors]. SEMs showed that lower SES was related to MetSyn factors indirectly through higher psychosocial risk/lower resources (Y-Bχ² (df = 420) = 4412.90, p < .05, RMSEA = .042, SRMR = .051). A statistically significant effect consistent with mediation was found from lower SES to higher metabolic risk (glucose/waist circumference) via psychosocial risk/resource variables (Mackinnon’s 95% asymmetric CI = ?0.13 to ?0.02).

Conclusions

SES is related to metabolic variables indirectly through psychosocial factors in U.S. Hispanics/Latinos of diverse ancestries.

     

Short sleep is associated with more depressive symptoms in a multi-ethnic cohort of older adults

ObjectivesTo evaluate cross-sectional and prospective associations between short and long sleep duration and depressive symptoms in older adults (aged >65 years).MethodsThe data from a subsample of the racially/ethnically diverse Northern Manhattan Study were analyzed. Depressive symptoms were assessed twice with the Center for Epidemiologic Studies Depression Scale (CES-D), approximately 5 years apart. The presence of depressive symptoms was defined as a CES-D score ≥16 or use of antidepressants. Self-reports of short (<6 h), intermediate (6–8 h) and long (≥9 h) sleep were assessed prior to the initial CES-D. Logistic regression was used to evaluate the cross-sectional associations between short and long sleep durations with depressive symptoms, using intermediate sleep as the reference. The prospective association between sleep duration and depression in a sample of participants without depressive symptoms at first CES-D was also analyzed. All models were adjusted for demographic, behavioral, and vascular risk factors.ResultsThe initial sample consisted of 1110 participants: 62% women, 69% Hispanic, 17% black, 14% white. Short sleep was reported by 25%, intermediate sleep by 65%, and long sleep by 9%. Depressive symptoms were described in 25% of the initial sample. Short sleep, but not long sleep, was associated with depressive symptoms at baseline (adjusted OR 1.8, 95% CI 1.3–2.6), and at follow-up (adjusted OR 1.9, 95% CI 1.1–3.5; median follow-up = 5.1 years).ConclusionShort sleep duration had a cross-sectional and prospective association with depressive symptoms in an urban multi-ethnic cohort of older adults.     

Lifetime and 12-month intermittent explosive disorder in Latinos

This study examined the occurrence, correlates, and psychiatric co-morbidities of lifetime and 12-month intermittent explosive disorder (IED) and whether impairment due to IED differed across Latino groups. We used data on 2,554 Latino adults (75.5% response rate) from the National Latino and Asian American Study (NLAAS). Lifetime and 12-month prevalence of IED among Latinos were 5.8% and 4.1%, respectively. Unemployment was a common risk factor for both lifetime and 12-month IED. Protective factors for both lifetime and 12-month IED were having poor/fair English proficiency and being born outside the U.S. mainland. Cubans, Mexicans and other Latinos had lower odds of both lifetime and 12-month IED relative to Puerto Ricans, while Puerto Ricans with IED did not demonstrate worse impairment compared with the other groups with IED. Lifetime and 12-month IED were associated with several depressive, anxiety, and substance use disorders. Given its significant association with a wide-range of mental disorders, future research should consider the validity of IED as a unique disorder or whether it is merely a constellation of symptoms that accompanies a variety of mental diseases.     

Exploring the relationship between physical health,depressive symptoms,and depression diagnoses in Hispanic dementia caregivers

Objectives: The present study examined the relationship between self-reported physical health, depressive symptoms, and the occurrence of depression diagnosis in Hispanic female dementia caregivers. Participants: Participants were 89 Hispanic female dementia caregivers. Design: This study used a cross-sectional design. Baseline depression and physical health data were collected from participants enrolled in the ‘Reducing Stress in Hispanic Anglo Dementia Caregivers’ study sponsored by the National Institute on Aging. Measurements: Physical health was assessed using the Medical Outcome Study Short Form-36 (SF-36), a one-item self-report health rating, body mass index, and the presence or history of self-reported physical illness. Depressive symptoms were assessed using the Center for Epidemiologic Studies–Depression Scale (CES-D). The occurrence of depression diagnosis was assessed using the Clinical Interview for DSM-IV Axis I Disorders (SCID). Analysis: Multiple linear and logistic regression analysis was used to examine the extent to which indices of physical health and depressive symptoms accounted for variance in participants’ depressive symptoms and depressive diagnoses. Results. Self-reported indices of health (e.g., SF-36) accounted for a significant portion of variance in both CES-D scores and SCID diagnoses. Caregivers who reported worsened health tended to report increased symptoms of depression on the CES-D and increased likelihood of an SCID diagnosis of a depressive disorder. Conclusion. Self-reported health indices are helpful in identifying Hispanic dementia caregivers at risk for clinical levels of depression.