Racial/ethnic differences in the prevalence of depressive symptoms among middle-aged women: The Study of Women's Health Across the Nation (SWAN)

OBJECTIVES: We examined racial/ethnic differences in significant depressive symptoms among middle-aged women before and after adjustment for socioeconomic, health-related, and psychosocial characteristics. METHODS: Racial/ethnic differences in unadjusted and adjusted prevalence of significant depressive symptoms (score >/= 16 on the Center for Epidemiologic Studies Depression [CES-D] Scale) were assessed with univariate and multiple logistic regressions. RESULTS: Twenty-four percent of the sample had a CES-D score of 16 or higher. Unadjusted prevalence varied by race/ethnicity (P <.0001). After adjustment for covariates, racial/ethnic differences overall were no longer significant. CONCLUSIONS: Hispanic and African American women had the highest odds, and Chinese and Japanese women had the lowest odds, for a CES-D score of 16 or higher. This variation is in part because of health-related and psychosocial factors that are linked to socioeconomic status.     

Racial disparities in elevated prenatal depressive symptoms among black and white women in eastern north Carolina

PURPOSE: Black women have an increased risk for preterm birth compared with white women, and prior research indicated that maternal prenatal depressive symptoms are associated with increased risk for preterm outcomes among black women. Race-related differences in prenatal depression could be of etiologic significance in understanding racial disparities in preterm birth. Our study focused on Center for Epidemiologic Studies' Depression Scale (CES-D) scores of pregnant black and white women. METHODS: Women were administered the CES-D at the time of their first visit to hospital-based prenatal clinics. Two cutoff scores for the CES-D were used: 16 or higher, which indicates "significant" depressive symptoms, and 23 or higher, which indicates major depressive disorder. RESULTS: For the sample of 1163 women, mean CES-D scores were significantly higher among black (17.4) than white (13.7) women. Of black women, 49% had CES-D scores higher than 15 compared with 33.5% of white women. Also, 27.5% of black women had scores higher than 22 compared with 16% of white women. After adjustment for maternal age, marital status, and education, odds ratios for race for both CES-D cutoff scores were approximately 1.5. CONCLUSIONS: Results of this study indicate that black women have greater rates of prenatal depression than white women.     

Depressive Symptoms in Adolescents Living in Rural America

PURPOSE: The purposes of this pilot study were to examine prevalence of depressive symptoms among rural adolescents and identify related social and environmental variables. METHODS: A convenience sample of 299 14- to 18-year-old agriculture class students at 5 rural high schools in Kentucky and Iowa completed a survey that included demographic information, family farm history, experience with suicide, perception of school environment, and indicators of farm injuries and risky behaviors. Participants also completed the Center for Epidemiologic Studies Depression Scale (CES-D) as well as scales to assess the number of major life events in the last year, active coping use, and family closeness. FINDINGS: The prevalence of a high level of depressive symptoms (CES-D > or = 16) in this sample was 34%. Nine percent had seriously considered suicide in the last year. Unlike previous reports, boys reported as many depressive symptoms as girls. Although the literature reports that engaging in risky behavior is associated with depressive symptoms, the only risky behavior linked with depressive symptoms in this sample was operating a 4-wheel all-terrain vehicle. Other predictors of depressive symptoms included poor family relationships and poor active coping. CONCLUSIONS: Interventions to identify and prevent depressive symptoms in rural adolescents are needed. Boosting active coping and improving family function may also prevent the development of clinical depression in rural adolescents.     

A survey of depressive symptoms among South Korean adults after the Korean financial crisis of late 1997: prevalence and correlates

PURPOSE: We examined the prevalence of high levels of depressive symptoms and their association with sociodemographic and health characteristics in an urban Korean population following the financial crisis in late 1997. METHODS: Using data from a cross-sectional survey conducted in Ansan-city, Korea, from June 1999 to June 2000, we examined the prevalence and correlates of depressive symptoms in a randomly selected sample of 4897 (2531 male and 2366 female) subjects aged 18 to 92 years. The prevalence and odds ratios of "probable" and "definite" depressive symptoms, defined as a Center for Epidemiologic Studies Depression Scale (CES-D) score of > or = 16 and > or = 24, respectively, were calculated. RESULTS: The mean CES-D score and prevalence of "probable" and "definite" depression were significantly higher in women (15.63, 41.67%, and 12.05%, respectively) than in men (14.43, 35.05%, and 8.10%, respectively) (p < 0.0001). In multiple logistic regression analysis, being female, unemployed, unmarried, self-assessed as unhealthy, and having a low income were found to be significant predictors of "probable" and "definite" depressive symptoms in Korean adults. CONCLUSIONS: Although current data cannot be directly compared with those reported in the most recently published Korean data from 1994, considerably high mean CES-D score and prevalence of depression speculate that the Korean financial crisis of 1997 had an effect on the development of depressive symptoms in Korean adults.     

Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore,Maryland

The purpose of this study was to examine the relation between maternal depressive symptoms and spontaneous preterm birth. From 1991 to 1993, pregnant, African-American women were prospectively enrolled at four hospital-based clinics in Baltimore, Maryland, that serve low-income areas of the city. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess depressive symptoms. Multiple logistic regression analysis estimated the independent contribution of maternal depressive symptoms to spontaneous preterm birth, controlling for behavioral, clinical, and demographic variables. Among the 1,399 women in the sample, 117 (8.4%) had a spontaneous preterm delivery. Spontaneous preterm birth occurred among 12.7% of those with a CES-D score in the upper 10th percentile and among 8.0% of those with a lower score (relative risk = 1.59). The adjusted odds ratio for an elevated CES-D score was 1.96 (95% confidence interval: 1.04, 3.72); hence, maternal depressive symptoms in this sample of African-American women were independently associated with spontaneous preterm birth. Effective treatment of depression in pregnant women could ultimately result in a reduction of spontaneous preterm births.     

Prevalence and Factors Associated with Depressive Symptoms in Malay Women

Background: Due to a dearth of research on depressive symptoms in Malaysia, particularly in Malay women, a community study was conducted to examine the prevalence and factors associated with current depressive symptoms in rural and urban Malay women with low socioeconomic status.

Method: Four hundred eighty-seven women (N rural = 242, N urban = 245) were interviewed. Information on socio-demographic variables, potential risk factors (family history of mental health problems, lifetime major depressive symptoms, and current life stressors), and current depressive symptoms (measured by the Centre for Epidemiologic Studies Depression Scale, CES-D) was collected.

Results: The prevalence of current depressive symptoms (CES-D scores ≥ 16) reported was 34.5%, while the prevalence of lifetime major depressive symptoms was 27.5%. A significantly higher rate of current depressive symptoms was observed in urban women compared to rural women, χ² (1, N = 487) = 3.99, p < .05. However, no significant difference was found in the two groups of women in the prevalence of lifetime major depressive symptoms. The results of the multiple hierarchical regression analysis indicated that three potential factors (family history of mental health problems, lifetime major depressive symptoms, and current life stressors) were positively associated with current depressive symptoms, accounting for 17.8% of the variance, over and above the socio-demographic variables.

Conclusion: The prevalence of depressive symptoms reported in the study was comparable to past studies. Among the factors associated with current depressive symptoms, the single most important was lifetime major depressive symptoms, followed by current life stressors, and family history of mental health problems. Among the socio-demographic variables used, perceived health status was the most important. The factors associated with depressive symptoms found in this study are consistent with past findings in the West, implying the universality of the phenomenon and common factors related to depressive symptoms in women.     

A Comparison of Depressive Symptoms in Stroke and Primary Care: Applying Rasch Models to Evaluate the Center for Epidemiologic Studies-Depression Scale

OBJECTIVES: Clinical trials and community-based studies often include the Center for Epidemiologic Studies-Depression scale (CES-D) as a measure of depression outcome. We compared responses to symptom-related items on the CES-D by depressed stroke and primary-care patients for several purposes: 1) to illustrate the use of Item Response Theory (IRT)-based (Rasch) models for comparing scale functioning across different patient subgroups; and 2) to inform clinicians and outcome researchers about scale functioning and depressive symptomatology in stroke- compared with primary care-based depression. METHODS: Two data sources were analyzed, including 32 depressed patients who were 3 months poststroke, and 366 depressed primary-care patients. Presence of depression was based on a CES-D score 16 or higher. Rasch models were used to assess item fit and compare item hierarchies between depressed primary-care and stroke patients. RESULTS: Item hierarchies were similar for poststroke depression and primary care-based depression. Interpersonal disruption items were the most difficult to endorse for both groups. No items misfit the scale in primary-care depression. Items relating to restless sleep, unfriendliness, and crying slightly misfit the scale in stroke patients, that is, may measure a different trait. Differential item functioning (DIF) between the groups was identified for items relating to appetite, restless sleep, crying, and feeling disliked. CONCLUSIONS: Results generally supported the use of the CES-D as measure of depression outcome, particularly in primary care-based depression. DIF may imply that slightly different clusters of depressive symptoms are reported by depressed stroke patients compared with primary care, but this is conjectural given the small stroke sample size and the same items have been previously associated with bias in studies of large nonstroke samples. This study found Rasch models to be useful tools to investigate scale performance for different clinical applications.     

Plasma folate concentrations are associated with depressive symptoms in elderly Latina women despite folic acid fortification

BACKGROUND: A relation between low folate status and depression has been recognized since the 1960s. Since 1998, flour in the United States has been fortified with folic acid, and the prevalence of folate deficiency has decreased dramatically. OBJECTIVE: We investigated whether, in this era of folic acid fortification, low folate status is a determinant of depressive symptoms in a cohort of elderly Latinos (aged >/=60 y) participating in the Sacramento Area Latino Study on Aging (SALSA). DESIGN: In a cross-sectional logistic regression analysis of data from SALSA (n = 627 M, 883 F), odds ratios (ORs) were ascertained for elevated depressive symptoms [Center for Epidemiologic Studies Depression Scale (CES-D) score >/=16] among tertiles of plasma folate. Depressive symptoms were assessed by using the CES-D. Plasma folate concentrations were determined by radioassay. RESULTS: The prevalence of folate deficiency (plasma folate 相似文献   

Depressive symptoms in rural West Virginia: labor market and health services correlates

The prevalence and socioeconomic correlates of depressive symptoms in rural West Virginia were assessed. A random-digit-dialed telephone interview was administered to a community-dwelling sample of adults, ages 18 to 64, residing in the 40 rural counties of the Appalachian State of West Virginia. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Overall rates of depressive symptoms were substantially higher than in the nation as a whole. Gender differences were lower than expected due to a high rate of depressive symptoms among men. Depressive symptoms were inversely associated with higher socioeconomic position. One-third of those who described themselves in "good mental health" reported depressive symptoms. About half who reported depressive symptoms had never seen a mental health professional or a physician for mental health problems. Efforts to increase awareness and access to mental health services are needed to promote the mental health of rural West Virginian populations.     

Women's help-seeking patterns for depression.

Depression tends not to be accurately identified and treated in primary care settings. Women of color are especially likely to use these settings for mental health issues but are less likely to be diagnosed appropriately. A study was conducted within four Florida primary care clinics serving primarily low-income families. Participants included 321 women (Black, 22%, Hispanic, 23.5%, White, 38.6%) who completed a confidential questionnaire while waiting to be seen by clinic staff. Ten percent reported recent major depression, with 26.7% indicating depressive symptoms during the past two years. Depressed women were significantly more likely to report physical violence during the past year. Respondents turned primarily to family, friends, and medical clinics for their depression. They found turning to clinic staff to be helpful and described psychosocial interventions as useful. Members of all ethnic/racial groups reported barriers to seeking help, including perceived separation between mental health and general health and stigma. Implications are discussed in terms of appropriate community education and screening procedures.     

Depressive Symptoms Among Reservation-based Pregnant American Indian Adolescents

Objectives To examine rates and correlates of depressive symptoms among pregnant reservation-based American Indian (AI) adolescents from the Southwestern United States (N = 53). Methods Data were derived from a study evaluating a home-visiting program designed to promote positive parenting among young families. Participants included a volunteer, convenience sample of expectant mothers who completed behavioral and mental health self-report questionnaires. Depressive symptoms were assessed using the Center for Epidemiological Studies-Depression scale (CES-D). Three risk domains were analyzed in relation to depressive symptoms: sociodemographics, family relations, and psychosocial functioning. Results Forty-seven percent of expectant mothers scored at or above the widely accepted clinical cutoff score of 16 on the CES-D; 30% scored at or above 20, a score more likely to reflect elevated depressive symptoms among adolescents; and almost 20% scored at or above 28 (one standard deviation above the mean), a score suggestive of clinical depression. Higher levels of depressive symptoms were associated with less use of public assistance, external locus of control, less social support, and lower self-esteem. Conclusions Data suggest that a large proportion of pregnant AI adolescents reported elevated depressive symptoms, though rates are similar to non-pregnant AI adolescent samples.     

合肥市329名打工妹抑郁症状及其与社会资本和社会网络的关系

目的初步了解打工妹抑郁症状现况,探讨抑郁症状与社会资本、社会网络的关系。方法在横断面研究中,用方便取样方法在合肥市1家工厂和6家饭店招募329名16～28岁未婚打工妹,累计打工时间为1月～10年。采用流调中心用抑郁量表（CES-D）对其抑郁症状进行评定,抑郁评分≥20分界定为有抑郁心理症状;采用自编问卷评估社会资本和社会网络：社会资本共6个维度,包括工作场所特征、居住环境排外性等;社会网络包括网络大小和网络密度,其取值范围分别为1～15,0～1。结果本样本抑郁症状检出率为52.9%,多元Logistic回归分析显示饭店服务员发生抑郁症状的危险性是工厂工人的0.554倍;年龄为21～28岁的打工妹发生抑郁症状的危险性是20岁以下者的0.506倍;社会支持评分和居住环境诚信评分的增加,可降低抑郁症状的危险性（OR=0.964、OR=0.758）。结论本研究初步提示打工妹抑郁症状相当常见,增加社会心理支持,提高居住环境诚信,有可能降低该人群抑郁心理症状。     

Low-income rural women and depression: factors associated with self-reporting

OBJECTIVE: To examine factors associated with self-reporting depression for low-income rural women experiencing depressive symptoms. METHODS: Data were from 219 Rural Families Speak participants with CES-D scores >15. Chi-square and multiple logistic regression were utilized. RESULTS: Just over one half (52.5%) of respondents who were experiencing depressive symptoms self-reported depression, whereas 47.5% of respondents self-reported no depression. Women reporting depression were significantly likelier to report physical health problems, injury/illness, and more frequent physician visits. Women reporting no depression were significantly likelier to have been pregnant in the previous 3 years. CONCLUSIONS: Women reporting depression had more health care system exposure and perhaps depressive symptomotology knowledge. Public health campaigns should educate about depressive symptoms, including postpartum depression, to reduce stigma and increase treatment-seeking.     

Depression decreases cardiorespiratory fitness in older women

BACKGROUND: Depression is associated with decreased physical functioning and increased morbidity and mortality from cardiovascular disease and cancer. Whereas physical fitness delays all-cause mortality, little is known of the exercise capacity of depressed women. METHOD: SPPARCS is a community-based longitudinal study of physical activity and fitness in people > or =55 years. Of 1,246 women, 663 were free of known cardiac and cerebrovascular disease, and performed treadmill exercise. Most (71%) were interviewed and retested 2 years and 4 years later (55%). Two indicators of depression were used: (a) Center for Epidemiologic Studies-Depression Scale (CES-D) > or =16; (b) use of antidepressant medication. RESULTS: By CES-D score, 8.4% had depressive symptoms (first round). Depressed women showed lower levels of all markers of treadmill exercise [exercise duration, peak VO2, Oxygen Uptake Efficiency Slope (OUES)]. CONCLUSIONS: Depression is associated with impaired physical fitness and treadmill exercise performance in older women.     

Postpartum depression and its psychosocial correlates: A longitudinal study among a group of women in Turkey

ABSTRACT

The postpartum period is a window of risk for psychological disturbances and particularly for depressive symptoms. This study explored the relationships between postpartum depression and prepartum depressive symptoms, marital adjustment, support from family, previous depressive symptomology, and pregnancy planning. A total of 128 women who were receiving prenatal care at a state hospital in Istanbul, Turkey, and who were in the last trimester of their pregnancy participated in the first phase of the study. Of these, eighty-seven women also participated in the second phase, during the 3–6 month postpartum period. The results indicated that depressed mood in the last trimester of pregnancy, family support, care and support from spouse, previous depression history, and unplanned pregnancy were significant risk factors for postpartum depressive symptoms; significant differences were found for study variables as a function of women’s scores on the Edinburgh Postnatal Depression Scale in pregnancy and in the postpartum period. The recommendation is made to use screening tools, like the Edinburgh Postnatal Depression Scale, in the course of routine prenatal care, and to refer women with Edinburgh Postnatal Depression Scale scores above the cutoff score for further clinical examination.     

Higher zinc intake buffers the impact of stress on depressive symptoms in pregnancy

Prenatal depression is a public health concern. This study's objectives are to model associations involving dietary zinc intake, psychosocial stress, and sociodemographic factors as they interrelate in the development of depressive symptoms in a cohort of pregnant women from London, Ontario (Prenatal Health Project). We hypothesized that (1) psychosocial stress is intermediate in the causal pathway between sociodemographic factors and zinc intake and that (2) zinc intake serves as a partial mediator between sociodemographic factors, psychosocial stress, and the development of depressive symptoms. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Psychosocial stress was measured by validated scales and summarized into a composite score. Zinc intake was quantified from food frequency questionnaire and nutrient supplement data. Regression methods were used. The Baron and Kenny method was applied to test mediation hypotheses. Stress-zinc interaction terms were added to the regression model predicting CES-D score to test a possible moderating role for zinc. Our analyses showed that social disadvantage, higher stress, and lower zinc intake were associated with higher CES-D score. Every 1-point increase in stress score was associated with a 1-point increase in CES-D score. Being in the lowest quintile of zinc intake was associated with a 1-point increase in CES-D score; although not clinically meaningful, the association was robust. Evidence was not in favor of the mediation hypotheses, but showed instead that zinc intake moderated the association between stress and depressive symptoms; being in the highest zinc quintile appeared to buffer the impact of stress.     

Perinatal depression among black Caribbean women

The present paper describes findings from a mixed-method, longitudinal cohort study into perinatal depression among black Caribbean women. Using symptom scores from the Edinburgh Postnatal Depression Scale (EPDS), 101 black Caribbean and 200 white British women accessing maternity services in Manchester, UK, were screened for depressive symptoms in the last trimester of pregnancy and 6 weeks following delivery. The purpose of the study, which was undertaken between February 2000 and February 2001, was to estimate the prevalence of depressive symptoms during and after pregnancy among black Caribbean women compared to white British women in the same geographical area, and to explore black Caribbean women's beliefs about perinatal depression and their attitudes to help-seeking. Despite higher levels of self-reported risk, black Caribbean women were less likely than white British women to score above threshold (EPDS > or = 12) during pregnancy (chi2 = 4.16, d.f. = 1, P = 0.041). Although equally likely to score above threshold postnatally, they were less likely to receive treatment (chi2 = 4.20, d.f. = 1, P = 0.040) and more likely to be referred to secondary care (Fisher's Exact Test, P = 0.049). Qualitative findings suggest important differences between black Caribbean women's beliefs, attitudes and associated help-seeking practices, and those previously reported. Lower rates of depressive symptoms might partly be accounted for by conceptualisations of mental illness which differ from those of white British and South Asian women, and mistrust of the mental health services. This study showed that black Caribbean ethnicity is an important dimension in understanding the social patterning of mental illness. The findings have implications for the equitable provision of primary care services since black Caribbean women experienced depressive symptoms in pregnancy and early motherhood, but were less likely than their white British counterparts to receive treatment.     

Depressive symptoms and their relationship with endogenous reproductive hormones and sporadic anovulation in premenopausal women

PurposeTo determine whether depressive symptoms are associated with ovulation or reproductive hormone concentrations in eumenorrheic women without a reported diagnosis of clinical depression.MethodsA prospective cohort of 248 regularly menstruating women, aged 18 to 44 years (27.3 ± 8.2) were evaluated for depressive symptoms at baseline using the 20-item Center for Epidemiological Studies Depression (CES-D) scale and categorized dichotomously (<16, no depressive symptoms [92%] vs. ≥16, depressive symptoms [8%]). Serum concentrations of estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone were measured up to eight times per cycle for up to two menstrual cycles. Linear mixed models estimated associations between depressive symptoms and hormone concentrations, whereas generalized linear mixed models assessed their relationship with sporadic anovulation.ResultsNo significant associations were identified between depressive symptoms and reproductive hormone levels (all P > .05) or the odds of sporadic anovulation (adjusted odds ratio, 1.1; 95% confidence interval, [0.02–5.0]), after adjusting for age, race, body mass index, perceived stress level, and alcohol consumption.ConclusionsDespite reported associations between mental health and menstrual cycle dysfunction, depressive symptoms were not associated with reproductive hormone concentrations or sporadic anovulation in this cohort of regularly menstruating women with no recent (within 1 year) self-reported history of clinical depression.     

Prevalence of depressive symptoms in a Japanese occupational setting: a preliminary study.

We measured the prevalence of depressive symptoms in 2,190 Japanese tax office workers using the Japanese version of the Center for Epidemiologic Studies Depression Scale (CES-D). Score distribution by sex was more symmetrical and the mean score of each sex was higher than in the United States population. A high level of depressive symptoms was found in 15.2 percent of males and 10.6 percent of females by controlling for age and marital status. Males aged 50 years and over had more depressive symptoms than other male age groups. Perceived stress, related both to family life and the workplace, was associated with a high level of depressive symptoms. "Long-distance marriage" ("business bachelorhood"), peculiar to Japanese occupations, had little influence on depressive symptomatology.     

Screening for depressive symptoms among HCV-infected injection drug users: Examination of the utility of the CES-D and the beck depression inventory

The prevalence of depression is high among injection drug users (IDUs) and among those infected with the hepatitis C virus (HCV). Moreover, one of the drugs used in the standard treatment for HCV infection (interferon) has been known to exacerbate, underlying psychiatric disorders such as depression and has been associated with the development of major, depressive disorder among HCV-infected patients. For these reasons, the most recent National Institutes of Health consensus statement on the management of HCV infection recommends the identification and treatment of depression prior to the start of HCV treatment. This study aimed to examine the extent of current moderate/severe depressive symptoms in a cohort of HCV-infected IDUs as measured by two screening tools, the Center for Epidemiologic Studies Depression Scale (CES-D) and the Beck Depression Inventory (BDI). Subjects were participants in a multisite behavioral intervention trial among HCV-seropositive, human immunodeficiency virus-negative IDUs aged 18–35 years; the trial was designed to prevent secondary transmission of HCV and to enhance uptake of HCV treatment. Baseline data on demographics, risk behaviors, depression, alcohol use, and health care utilization were measured via audio computer-assisted self-interview. A factor analysis was conducted on each scale to examine the clustering of items used in each to measure depressive symptoms. Baseline depressive symptoms, as measured via the CES-D and the BDI, were also compared using Pearson’s correlation coefficient. Of 193 HCV-infected individuals enrolled to date, 75,6% were male, and 65.3% were white. Median age was 25.8 years. Factor analyses revealed that these scales measured depression differently; a distinct somatic component was present in the BDI, but not the CES-D. Using cutoff scores of 23 for the CES-D and 19 for the BDI, 44.0% and 41.5% of the participants were identified as having moderate/severe depressive symptoms, respectively. Over half (56.0%) were identified as having depressive symptoms