Neighbourhood composition and depressive symptoms among older Mexican Americans

STUDY OBJECTIVE: Research suggests that economically disadvantaged neighbourhoods confer an increased risk of depression to their residents. Little research has been reported about the association between ethnic group concentration and depression. This study investigated the association between neighbourhood poverty and neighbourhood percentage Mexican American and depressive symptoms for older Mexican Americans in the south western United States. DESIGN: A population based study of older non-institutionalised Mexican Americans from the baseline assessment (1993/94) of the Hispanic established population for the epidemiologic study of the elderly (H-EPESE) merged with 1990 census data. SETTING: Five south western states in the United States. PARTICIPANTS: 3050 Mexican Americans aged 65 years or older. MAIN RESULTS: There was a strong correlation between the percentage of neighbourhood residents living in poverty and the percentage who were Mexican American (r = 0.62; p<0.001). Percentage neighbourhood poverty and percentage Mexican American had significant and opposite effects on level of depressive symptoms among older Mexican Americans. After adjusting for demographic and other individual level factors, each 10% increase in neighbourhood population in poverty was associated with a 0.763 (95% CI 0.06 to 1.47) increase in CES-D score, while each 10% increase in Mexican American neighbourhood population was associated with a -0.548 (95% CI -0.96 to -0.13) unit decrease in CES-D score among older Mexican Americans residing in their neighbourhoods. CONCLUSIONS: The findings suggest a sociocultural advantage conferred by high density Mexican American neighbourhoods, and suggest the need to include community level factors along with individual level factors in community based epidemiological health studies.     

Profiles of depressive symptoms among African Americans and Caribbean Blacks

Latent profile analysis was used to summarize profiles of depressive symptoms among a nationally representative sample of US-born and Caribbean-born Blacks. Analyses are based on the responses of 4915 African Americans and Caribbean Blacks from the National Survey of American Life. A high symptoms and a low symptoms class were identified. Age, gender, negative interaction within the individual's social network (e.g., conflict, demands, criticism) and racial discrimination were associated with depressive symptoms in the low symptoms class, whereas socioeconomic status, gender, emotional support and negative interaction were associated with depressive symptoms in the high symptoms class. The findings demonstrate the heterogeneity within the Black population in the USA and the distinct sociodemographic, family network and stress correlates of depressive symptoms for each latent class.     

Prevalence and predictors of depressive symptoms among rural older Australians and Americans

OBJECTIVE: To examine the predictors of depressive symptoms among older married rural Australian and American men and women, using comparable measures from two separate studies. DESIGN: Postal survey for Australians; telephone interviews for Americans. SETTING: Rural Australia (six states and two territories) and America (Virginia). PARTICIPANTS: Older married rural men and women, aged 65 years and over, in Australia (n = 216) and America (n = 156). MAIN OUTCOME MEASURES: Whether predictors of depressive symptoms, specifically demographic factors, health, pain, functional limitations and social networks, differed according to nationality or sex. RESULTS: Approximately one-third of older rural Australian (37%) and Americans (28%) reported recently experiencing depressive symptoms. For Australian men and women, pain was the strongest predictor of depressive symptoms. For American women, dissatisfaction with social support predicted depressive symptoms, whereas no variable predicted depressive symptoms in American men. CONCLUSIONS: In the context of a globally ageing population, the fact that nearly one in three older rural people on two continents described themselves as recently feeling depressed is a troubling finding of considerable importance to both practitioners and policy-makers. The findings raise questions about the cultural acceptance, definition and manifestations of symptoms of depression in rural communities, as well as the role of different public health and support systems in the two countries.     

Neighbourhood environment and the incidence of depressive symptoms among middle-aged African Americans

AIM: To investigate the association between attributes of subject location and incidence of clinically relevant levels of depressive symptoms (CRLDS), and to investigate whether an association remained after adjusting for individual-level factors using data from the population-based African American Health Study. METHODS: An 11-item depression scale (Center for Epidemiologic Studies Depression scale) was obtained at baseline and 3 years later through in-home evaluations. Census tract and block group deprivation indices were obtained from the 2000 census. The external appearance of the block where the subject lived was rated during sample enumeration, and the interior and exterior of the subject's dwelling were observed during the initial in-home interview. RESULTS: Of 998 subjects at baseline, 21.1% had CRLDS. Although 12.7% of the 672 people without CRLDS at baseline developed them by the 3-year follow-up, univariate and propensity-adjusted analyses revealed no association between the subject's location and the incidence of CRLDS. Sensitivity analyses confirmed the robustness of the findings. CONCLUSION: Despite other studies showing independent effects of neighbourhood characteristics on the prevalence of CRLDS, attributes of subject location are not independent contributors to the incidence of CRLDS in middle-aged urban African Americans.     

Alcohol use and depressive symptoms among Mexican Americans and non-Hispanic Whites

Alcohol use is associated with depressive symptoms in several studies. Using data from a community survey, this study examined whether this relationship (a) can be accounted for by ethnic or sociodemographic differences among persons who engage in various levels of alcohol use; and (b) differs for Mexican Americans (N = 1244) and non-Hispanic Whites (N = 1149). Using large quantities of alcohol, and, among men, daily drinking, were associated with depressed mood. These associations were similar for Mexican Americans and non-Hispanic Whites, and associations of quantity and frequency with depression were independent of each other. Among women, the cultural and demographic characteristics of high-quantity drinkers and abstainers (both of whom tended to be Mexican Americans) accounted for the association of alcohol use with depression. Among men, there was some suggestion that unemployment and unmarried status mediated the association of alcohol quantity with depression. People who drank greater quantities of alcohol per occasion reported more somatic depressive symptoms, and more frequent male drinkers reported more of most types of depressive symptoms.     

Age group differences in depressive symptoms among older adults with functional impairments

This study used data from the 2000 interview wave of the Health and Retirement Study to examine age group differences in the likelihood of self-reported depressive symptomatology among a nationally representative sample of 3,035 adults age 55 years or older who had at least one activities of daily living (ADL) or instrumental activities of daily living (IADL) limitation. Depression was defined as scoring three points or higher on the eight-point Center for Epidemiological Studies Depression Scale. The results show that respondents age 75 years or older with one ADL/IADL impairment or more were significantly less likely to be depressed than were those between ages 55 and 64 with the same degree of functional impairment. It is recommended that doctors, social workers, and other health care and social services providers pay special attention to younger old adults with health problems and functional limitations because they have a greater risk of being depressed.     

Mediterranean diet and depressive symptoms among older adults over time

Objective

To examine whether adherence to a Mediterranean-based dietary pattern is predictive of depressive symptoms among older adults.

Design

Generalized estimating equation models were used to test the association between a Mediterranean-based dietary pattern and depressive symptoms over time. Models were adjusted for age, sex, race, education, income, widowhood, antidepressant use, total calorie intake, body mass index, smoking, alcohol consumption, number of self-reported medical conditions, cognitive function, and physical disability.

Setting

Chicago, Illinois.

Participants

Community-dwelling participants (n=3502) of the Chicago Health and Aging Project aged 65+ years (59% African American) who had no evidence of depression at the baseline.

Measurements

Adherence to a Mediterranean-based dietary pattern was assessed by the MedDietScore. Dietary evaluation was performed with a food frequency questionnaire at baseline and related to incident depression as measured by the presence of four or more depressive symptoms from the 10-item version of the Center for Epidemiologic Studies Depression scale.

Results

Over an average follow-up of 7.2 years, greater adherence to a Mediterranean-based diet was associated with a reduced number of newly occurring depressive symptoms (parameter estimate = ?0.002, standard error = 0.001; p = 0.04). The annual rate of developing depressive symptoms was 98.6% lower among persons in the highest tertile of a Mediterranean-based dietary pattern compared with persons in the lowest tertile group.

Conclusion

Our results support the hypothesis that adherence to a diet comprised of vegetables, fruits, whole grains, fish, and legumes may protect against the development of depressive symptoms in older age.     

Gender differences in depressive symptoms among older Korean American immigrants

Despite consistent reports over many years of a greater prevalence of depression among women, mechanisms underlying the gender difference remain unclear. Mechanisms relevant to immigrant elderly populations are virtually unexplored. The present study examined gender variations in depressive symptoms using a community sample of 230 older Korean American immigrants (M(age) = 69.8; standard deviation = 7.05) in Florida. We were interested in examining not only mean differences but gender differences in the impact of demographic variables (age, marital status, and education), health constraints (chronic conditions and functional disability), and personal resources (sense of control, social network, and acculturation) on depressive symptoms. Consistent with previous literature, women scored higher on depressive symptoms than men. In a hierarchical regression model, women and those with more chronic conditions, greater functional disability, and lower sense of control were found to have more depressive symptoms. The interaction of gender-by-chronic conditions was found to be significant, and further analysis indicated that the association of chronic conditions with mental well-being was stronger for women. The findings suggest that among older Korean immigrants, women are at particular risk of declining psychological well-being in the face of physical health problems and call attention to the need for interventions designed to promote their physical and mental health.     

Comparison of hospice use and demographics among European Americans,African Americans,and Latinos

The goals of this study were to compare the rate of use of hospice services and other relevant characteristics of European American, African American, and Latino hospice patients. Information on length of stay in hospice, marital status, age, disposition at termination, living situation, caregiver, referral source, and payment method was collected on patients who used hospice care in southern New Jersey between the years 1995 and 2001 (N = 1958). African Americans and Latinos were both found to use services at significantly lower rates than European Americans. In addition, African American use of hospice declined significantly during this time period, while European American use increased. Differences were also found among the groups in marital status, living situation, caregiver, referral source, and payment method. These differences highlight the need for hospice providers to recognize issues unique to minority groups. The reasons for these disparities need to be clarified by further research.     

Injuries among older Americans with and without Medicare

OBJECTIVES: We evaluated the generalizability of Medicare fee-for-service data for patients hospitalized with injuries. METHODS: We used 1998-2000 Medicare hospitalization data and National Hospital Discharge Survey (NHDS) data to analyze patients aged 65 years and older with principal injury diagnoses. RESULTS: Demographics and injury patterns were similar in Medicare data and NHDS Medicare data. Injured patients without Medicare or health maintenance organization coverage were younger, less likely to have hip fractures, and more likely to have head or chest injuries. Mortality and discharge to long-term care were not significantly affected by insurance coverage, after we controlled for injury type and severity, age, gender, and comorbidity. Medicare patients had slightly longer hospital lengths of stay. CONCLUSIONS: Hospital outcomes are generally similar among older patients with a given anatomic injury, regardless of insurance coverage.     

Prevalence and correlates of depressive symptoms among older U.S. adults

Using data from telephone interviews conducted during 1985, we investigated the prevalence and correlates of depressive symptoms in a national probability sample of 1,232 noninstitutionalized U.S. residents 65 years of age and older. The association between depressive symptoms and personal attributes, personal resources, illness behavior, life events, and self-reported health was examined through chi-square and logistic regression analyses. We measured depressive symptoms with the Center for Epidemiologic Studies--Depression (CES-D) scale using a score of 16 or greater as an indication of high depressive symptoms. Prevalence of high depressive symptoms was 9.9% in the total sample. For black males the prevalence of depressive symptoms was 7.4%, and for white males it was 6.8%. For black females the prevalence of depressive symptoms was 20.8%, while for white females it was 11.5%. In the regression analysis, female gender, single marital status, poor self-reported assessment of health, illness behavior, and a low number of club/organization memberships were significantly associated with high depressive symptoms. In comparison to respondents reporting good to excellent health, those reporting poor to fair health were almost four times more likely to report a high number of depressive symptoms (odds ratio = 3.97).     

A mixed-methods exploration of faith,spirituality, and health program interest among older African Americans with HIV

Quality of Life Research - Persons living with HIV (PLWH) are living into old age with more complex care needs that non-PLWH. Promoting quality of life should include advance care planning (ACP)...     

Acute exposure to violent neighborhood crime and depressive symptoms among older individuals in Colombia

To assess the association between acute exposure to neighborhood violent crimes and depression we combined representative, individual-level and geo-coded data for individuals aged 60 years and above living in four major cities in Colombia from the 2010 Demographic and Health Survey (DHS) with objective information on the timing and location of violent crimes. Exploiting spatial and temporal variation in the occurrence of crimes we find that being acutely exposed to a violent crime is positively associated with the number of depressive symptoms.     

Comorbid depressive symptomatology: isolating the effects of chronic medical conditions on self-reported depressive symptoms among community-dwelling older adults

Advances in medical technology and surgical knowledge have greatly extended the life expectancy of older individuals with chronic disabilities. Among the older adult population the prevalence of comorbid chronic illness and depressive symptoms has often been investigated. Yet there continues to be a lack of understanding about the consequences of specific chronic illnesses on depressive symptoms. Using cross-sectional data while simultaneously controlling the effects of various socioenvironmental, demographic, and other factors, this study analyzed the prevalence of self-reported depressive symptoms in relation to chronic illness. The cumulative effect of medical comorbidity and the specific effect of individual chronic illnesses were examined. The sample consisted of 359 older white Americans aged 55-93. Overall, the findings show that self-reports of depressive symptoms were greater among those individuals who also reported digestive disorders, respiratory ailments, and heart problems. These results suggest that for older white Americans these three chronic conditions may present a greater mental health burden than other chronic illnesses.     

Life dissatisfaction and eating behaviors among older African Americans: The protective role of social support

Objectives

To examine (a) the influences of life dissatisfaction and dietary social support on eating behaviors (a high-fat diet and fruit/vegetable consumption) of older African Americans and (b) the moderating role of perceived dietary social support on the association between their life dissatisfaction and unhealthy eating behaviors.

Design

Baseline data from a larger intervention study of mid-life and older African Americans. The study incorporated a quasi-experimental design with random selection of participants, stratifying for age and gender.

Setting

Six churches in North Florida.

Participants

One hundred and seventy-eight (132 females and 46 males with a median age of 60) older African Americans.

Measurements

A structured questionnaire elicited personal data as well as information on eating behaviors, life dissatisfaction, and perceived dietary social support.

Results

Older African Americans with more cumulative life adversity, as reflected by high life dissatisfaction, had significantly poorer eating behaviors including the consumption of a high-fat diet and low intake of fruits and vegetables. Older African Americans?? dietary choices were also associated with their perceived social support. More importantly, perceived social support acted as a buffer to mitigate the influence of life dissatisfaction on older African Americans?? eating behaviors.

Conclusion

Life dissatisfaction places older African Americans at risk for unhealthy eating behaviors. However, high levels of dietary social support can protect older African Americans from the influence of life dissatisfaction on unhealthy eating behaviors. There are practical implications of this research for health interventions and programming.     

Social relations and depressive symptoms in older adults with knee osteoarthritis

Depressive symptoms often occur as a comorbid condition in the context of chronic illnesses such as arthritis. However, the role of both social support and social strain in relation to depressive symptoms has not been adequately explored. This study investigates the association of support and strain with depressive symptoms among a sample of older men and women in the USA (N = 298, mean age 71 years) who have knee osteoarthritis (OA). Data were collected from a survey mailed to residents who had previously participated in the Osteoarthritis Study in Seniors (OASIS), a longitudinal observational study of OA progression (survey response rate was 77%). Hierarchical regression analyses revealed significant associations of both support and strain with depressive symptoms, while statistically controlling for a variety of demographic, psychosocial and disease-related variables. In addition, social support significantly buffered the relation between social strain and depressive symptoms. The interaction effect was not significantly different for women and men, nor were the individual associations of support and strain with depressive symptoms conditioned by participant gender. The results add to the ongoing discussion regarding gender and social relations as well as highlight the role of both positive (social support) and negative (social strain) aspects of social interactions in relation to the psychological functioning of older adults coping with a chronic illness.     

Indicators of material hardship and depressive symptoms among homebound older adults living in North Carolina

This study used the concept of material hardship to understand how unmet needs related to food, housing, and health influence depressive symptoms among homebound older adults (N = 345) in North Carolina. Using data from the Nutrition and Function Study, 37% reported high levels of depressive symptoms and 17.4% indicated not receiving needed health care. Approximately 10% of respondents were food insecure; 30.7% were at risk for food insecurity; and 39.7% reported having to choose between either food and medication or food and paying bills. Adjusted logistic regression model revealed that food insecurity status (OR = 4.9) and age 60-74 y (OR = 2.4) were significantly associated with a greater number of depressive symptoms. Other indicators of material hardship, such as having a major financial difficulty, unmet health need, and inadequate housing, were not significant. By far, food insecurity was the most salient influence on depressive symptoms. These findings have important implications for service providers, researchers, and policymakers.     

Intergenerational relationships and depressive symptoms among older adults in urban China: The roles of loneliness and insomnia symptoms

The prevalence of depressive symptoms in older Chinese adults has increased recently. Intergenerational relationships play an important role in the mental health conditions of older adults, especially in Chinese culture. Therefore, this study aims to unravel the complex connection between intergenerational relationships and depression, and to explore the potential mediating roles of loneliness and nighttime insomnia symptoms within that connection. A cross‐sectional household survey was conducted in China with 2038 participants aged 65 years or above. Variables were measured using the Center for Epidemiologic Studies Short Depression Scale, the Intergenerational Relationship Quality Scale for Aging Chinese Parents (IRQS‐AP), three nighttime insomnia symptoms extracted from the Insomnia Severity Index and the De Jong Gierveld Six‐Item Loneliness Scale. The IRQS‐AP includes four subdimensions: consensual‐normative solidarity, structural‐associational solidarity, affectual closeness and intergenerational conflicts. Path analyses were performed in Mplus to investigate regression coefficients and mediating effects. Results showed that three general intergenerational relationships (consensual‐normative solidarity, affectual closeness and intergenerational conflicts) were significantly correlated with all mental health outcomes, including their symptoms of loneliness, insomnia and depression. A serial mediation model suggested that loneliness mediated the connection between those constructs of intergenerational relationships and depression, with an independent path to insomnia symptoms via loneliness. The proposed mediators fully mediated the effects of affectual closeness on depression. Nighttime insomnia symptoms alone mediated only the relationship between intergenerational conflicts and depression independently from paths involving depression. Removal of sleep item from CES‐D did not affect the results of paths. Our findings highlight the importance of intergenerational relationships for mental health, especially for the mediating effects of loneliness and nighttime insomnia symptoms on the relationship between intergenerational relationships and depression. Effective mental health services for older adults can address their feelings of loneliness and sleep problems, especially for those who have a poor relationship with their adult children.     

Predictors of employment status among African Americans with sickle cell disease

Adults living with sickle cell disease (SCD) have extremely high rates of unemployment; however, very little is known about factors that contribute to their vocational outcomes. This study examined demographic, illness perception, and psychological variables as predictors of employment status among 115 adult respondents who completed a cross-sectional survey as part of the Cooperative Study of Sickle Cell Disease. Logistic regression analysis indicated that gender, assertiveness, and perceived impact of SCD were unique predictors of employment status. Women were 2.88 times more likely to be employed than men, and the odds of being employed increased by a factor of 2.47 for each one unit decrease in assertiveness. More favorable perceptions of SCD were also associated with a two-fold increase in employment. The results suggest that demographic and psychosocial factors may play a more important role in predicting employment outcomes in adults with SCD than previously recognized.