Racial and ethnic differences in depressive subtypes and access to mental health care in the United States

Help-seeking at the intersection of race and age: Perceived need and treatment access for depression in the United States

Race/ethnicity and age are well-documented factors that influence help-seeking variables for adults with depression, yet the intersection of race/ethnicity and age on help-seeking is less known. The present study examined the intersection of race/ethnicity (comparing racial minority groups to White adults) and age on perceived need, treatment access, and unmet need for mental health services among adults with a past-year major depressive episode (N = 35,033) using data from the 2010-2019 waves of the National Survey on Drug Use and Health. After controlling for age, Black (OR = 0.50), Hispanic (OR = 0.50), Pacific Islander (OR = 0.23), and Asian (OR = 0.39) respondents had lower odds of perceiving need (p's < .001); Black (OR = 0.62), Asian (OR = 0.62), Hispanic (OR = 0.77), and multiracial respondents (OR = 0.75) had lower odds of accessing treatment (p's < .05); and Black (OR = 1.38) and Hispanic (OR = 1.19) respondents had higher odds of reporting an unmet need (p's < .05). After controlling for race, younger and older adults had lower odds of perceiving a need (p's < .05) compared to middle-aged adults. Younger adults had lower odds of accessing treatment and higher odds of experiencing an unmet need (p's < .001). An interaction revealed that Black adults were less likely to perceive need than White adults (p < .001), and this gap was especially large among younger members of both groups (p = .020). These results extend previous research by highlighting the intersection of race/ethnicity and age on help-seeking, with implications for culturally competent and age-appropriate interventions, while emphasizing the need for racial/age equity in the mental health care system.

Hospitalizations for depressive disorders in Ecuador: An eight-year nationwide analysis of trends and demographic insights

BACKGROUND

Sociodemographic characteristics and limited mental health care access may contribute to higher depression rates in low- and middle-income countries. This study aimed to analyze nationwide depressive disorder hospitalizations in Ecuador.

METHODS

We assessed the sociodemographic characteristics, severity, recurrence, and duration of hospitalizations for depressive disorders. The dataset used is publicly available on the Ecuadorian National Institute of Statistics and Censuses website. Multivariable multinomial logistic regression was performed to calculate adjusted relative risk ratios (aRRR).

RESULTS

14,586 hospitalizations were analyzed during 2015-2022. There was a significant increase in depressive disorders hospitalizations, from 9.41 cases per 100,000 inhabitants in 2015 to 13.9 in 2022. Females accounted for 65.7 % of hospital admissions. Depressive disorder hospitalizations had a mean age of 33.43 years. Severe depressive disorders without psychotic symptoms had the highest average hospitalization rate during 2015-2022 with 3.53 cases per 100,000 inhabitants. Individuals aged 20-29 years (aRRR 1.68, 95 % CI 1.27-2.22) and those aged 30-39 years (aRRR 1.81, 95 % CI 1.32-2.47) had higher probabilities of hospitalization for severe depressive disorder without psychotic symptoms. Patients with severe depression with or without psychotic symptoms were more likely of being hospitalized for seven or more days. Ethnic minorities were less likely to be hospitalized for severe depressive disorder without psychotic symptoms.

CONCLUSION

These findings highlight the increasing rates of depressive disorders in low- and middle-income countries such as Ecuador and emphasize the necessity for public health strategies focused on vulnerable groups.

Sociodemographic Patterns of Electroconvulsive Therapy Referral and Utilization in a Tertiary Health Care Facility

OBJECTIVE

Despite electroconvulsive therapy's (ECT) proven effectiveness in various psychiatric conditions, ECT referral and utilization remains suboptimal. This study sought to examine the pattern of ECT referral and utilization at a tertiary care center and to assess factors contributing to the underutilization of ECT.

METHODS

This retrospective study examined patients referred to ECT at this facility from 2022-2023 (N = 76, ≥18 y/o) with demographic data obtained from the electronic medical record.

RESULTS

Seventy-six patients were referred for ECT, with 35 receiving treatments. The treated group had a slightly younger mean age (45.5 vs 46.2 years). Gender distribution varied, with more males receiving ECT (54.3%) and more females declining (70.7%). Whites were the majority in both groups, but Blacks were less likely to receive ECT (14 not treated vs 4 treated), while Hispanics were more likely to be treated (2 not treated vs 7 treated). Declining ECT was more frequent among Whites (61.9%) and Blacks (33.3%), while transportation and logistical issues affected various racial groups with the highest impact on Blacks (42.9%). Major depressive disorder was the primary diagnosis, evenly distributed between treated and nontreated patients. In comparison to state data, Blacks and Asians showed a higher representation among the treatment group with those treated with ECT, 11.4% versus 6.7% and 5.7% versus 3.5%, respectively.

CONCLUSIONS

ECT remains underutilized among minority racial/ethnic groups. Factors contributing to this pattern include referral, patient preference, and/or other specific situations that need to be addressed to reduce disparities.

A Measurement Invariance Analysis of the Anxiety Scale for Autism-Adults in a Sample of Autistic and Non-Autistic Men and Women

The Anxiety Scale for Autism-Adults (ASA-A) captures the autistic anxiety experience, but we do not know whether it is structurally equivalent for men and women, or non-autistic people. Measurement invariance analysis considered gender and diagnostic status (342 cis-gender autistic men (N = 105) and women (N = 237), 316 cis-gender non-autistic men (N = 104) and women (N = 212)). Strict invariance was achieved between autistic men and women and between non-autistic men and women, but the ASA-A structure is quantitatively different in autistic compared to non-autistic adults. Therefore, this tool cannot be used to directly compare anxiety between these groups. Autistic women scored significantly higher on the ASA-A than autistic men and Uncertainty was the highest scoring factor for autistic participants. Future research should include alternative gender identities.

Racial/Ethnic Variations in the Intergenerational Transmission of Adolescent Depression

Depression tends to be experienced across generations and among racial/ethnic groups through various pathways. However, little is known about racial/ethnic variations in the transmission of adolescent depression among different racial/ethnic groups. This study aims to investigate the intergenerational transmission of adolescent depression across three generations among White, Black, and Hispanic groups. Data were drawn from the Future of Families and Child Wellbeing Study. This study used a nationally representative sample of 2,604 individuals. A multi-group serial mediation analysis was conducted using structural equation modeling. As hypothesized, adolescent depression was transmitted across three generations, from the maternal side. Furthermore, the intergenerational transmission of depression was identified as a sequential transfer from one generation to the next, as opposed to exhibiting a generation-skipping effect. However, no statistically significant racial/ethnic variation was found in the pathways of intergenerational transmission of adolescent depression. In conclusion, depression is a mental disorder that can be transmitted from one generation to the next, and its transmission pathway is shared and similar across White, Black, and Hispanic groups. Regardless of racial/ethnic group, the intergenerational transmission process of depression can be halted with the implementation of appropriate interventions and treatment.

Depressive Symptoms Affect Cognitive Functioning from Middle to Late Adulthood: Ethnoracial Minorities Experience Greater Repercussions

Cognitive deficits, a diagnostic criterion for depressive disorders, may precede or follow the development of depressive symptoms and major depressive disorder. However, an individual can report an increase in depressive symptoms without any change in cognitive functioning. While ethnoracial minority group differences exist, little is known to date about how the relationship between depressive symptoms and cognitive function may differ by ethnoracial minority status. Utilizing data from the Midlife in the United States (MIDUS) study waves II (M2) and III (M3), this study examines the relationship between depressive symptoms and cognitive functioning concurrently and longitudinally in community-dwelling adults, as well as whether the results differed by ethnoracial minority status. Our participants included 910 adults (43.8% male, 80.8% White, 54.4 ± 11.5 years old at M2). Cross-sectionally, depressive symptoms, ethnoracial minority status, and their interaction had significant effects on cognitive function, consistent with previous investigations. Longitudinally, higher M2 depressive symptoms predicted poorer cognitive function at M3 over and above M2 cognitive functioning, but only within the ethnoracial minority sample. Our finding suggests that depressive symptoms predict cognitive functioning both concurrently and across time, and this relationship is moderated by ethnoracial identity, resulting in greater cognitive deficits among ethnoracial minority groups compared to their non-Hispanic White counterparts.

Mental Health Care Use by Ethnicity and Preferred Language in a National Cohort of Community Health Center Patients

OBJECTIVE

Disparities in U.S. mental health care by race and ethnicity have long been documented. The authors sought to compare specialty mental health service use among non-Hispanic White, English-preferring Hispanic, and Spanish-preferring Hispanic patients who accessed care in community health centers (CHCs).

METHODS

Retrospective electronic medical records data were extracted for patients ages ≥18 years who received care in 2012-2020 at a national CHC network. Zero-inflated Poisson regression models were used to estimate the likelihood of receiving mental health services, which was compared with expected annual rates of mental health service use.

RESULTS

Of the 1,498,655 patients who received care at a CHC during the study, 14.4% (N=215,098) received any specialty mental health services. English- and Spanish-preferring Hispanic patients were less likely to have had a mental health visit (OR=0.69, 95% CI=0.61-0.77, and OR=0.65, 95% CI=0.54-0.78, respectively). Compared with non-Hispanic White patients, Spanish-preferring Hispanic patients had an estimated annualized rate of 0.59 (95% CI=0.46-0.76) mental health visits.

CONCLUSIONS

Among patients who were likely to receive specialty mental health services, Spanish-preferring patients had a significantly lower rate of mental health care use. Although overall access to mental health care is improving, unequal access to recurring specialty mental health care remains among patients who do not prefer to use English.

Conventional or Alternative Mental Health Service Utilization According to English Proficiency Among Asians in the United States

After the onset of the COVID-19 pandemic in 2020, Asian Americans in the United States have experienced a surge in anti-Asian crimes, leading to heightened psychological distress among this community. Consequently, the mental well-being of Asian Americans demands greater attention than ever. Regrettably, Asians tend to underutilize or delayed mental health care treatments. This study examines the conventional and alternative mental health service utilization among Asians in the United States according to their English proficiency. From the 2015-2018 National Survey on Drug Use and Health, this study examined 3,424 self-identified non-Hispanic Asians aged 18-64 with Kessler score of at least 5. Stratified bivariate analysis and multivariable logistic regression analysis were conducted. Regardless of English proficiency, Asians did not utilize alternative mental health service more than conventional mental health service. However, those with limited English proficiency consistently utilize care less than those with English proficiency. Need factors, such as mental distress severity and self-rated health status, were significant factors associated with their mental health service utilization. English proficiency remains a structural factor in preventing Asians from utilizing mental health services regardless of the nature of services. Due to the COVID-19 pandemic, more Asians have been experiencing mental distress. This study demonstrates a particular need for mental health services that are culturally specific and Asian language friendly.

Variations in sociodemographic and health-related factors are linked to distinct clusters of individuals with depression based on the PHQ-9 instrument: NHANES 2007-2018

BACKGROUND

Depression is a heterogeneous disease. Identification of latent depression subgroups and differential associations across these putative groups and sociodemographic and health-related factors might pave the way toward targeted treatment of individuals.

METHODS

We used model-based clustering to identify relevant subgroups of 2900 individuals with moderate to severe depression (defined as scores ≥10 on the PHQ-9 instrument) from the NHANES cross-sectional survey. We used ANOVA and chi-squared tests to assess associations between cluster membership and sociodemographics, health-related variables, and prescription medication use.

RESULTS

We identified six latent clusters of individuals, three based on depression severity and three differentially loaded by somatic and mental components of the PHQ-9. The Severe mental depression cluster had the most individuals with low education and income (P < 0.05). We observed differences in the prevalence of numerous health conditions, with the Severe mental depression cluster showing the worst overall physical health. We observed marked differences between the clusters regarding prescription medication use: the Severe mental depression cluster had the highest use of cardiovascular and metabolic agents, while the Uniform severe depression cluster showed the highest use of central nervous system and psychotherapeutic agents.

LIMITATIONS

Due to the cross-sectional design we cannot make conclusions about causal relationships. We used self-reported data. We did not have access to a replication cohort.

CONCLUSIONS

We show that socioeconomic factors, somatic diseases, and prescription medication use are differentially associated with distinct and clinically relevant clusters of individuals with moderate to severe depression.

Trends in Racial-Ethnic Disparities in Adult Mental Health Treatment Use From 2005 to 2019

OBJECTIVE

Although U.S. mental health treatment rates increased in the 2000s, gaps in treatment among racial-ethnic groups grew. Little is known, however, about national trends after 2012, when treatment access increased overall. This study assessed trends in racial-ethnic disparities in past-year treatment rates among people with a major depressive episode, serious psychological distress, or serious mental illness.

METHODS

National Survey on Drug Use and Health (2005-2019) data of adults with a past-year major depressive episode (N=49,791) or serious psychological distress (N=89,233) and of adults with past-year serious mental illness (N=24,944; 2008-2019) were analyzed. Linear risk regressions were used to model trends in past-year use of mental health treatment and included an interaction term between survey year and race-ethnicity.

RESULTS

Treatment use prevalence (2005-2019) among marginalized individuals with a major depressive episode remained lower than that among White people. The magnitude of the disparity in treatment use between White and Hispanic people with major depressive episode decreased slightly (percentage-point difference=-25.1% to -14.9%), whereas the disparity in treatment use between White people and American Indian/Alaska Native people with serious mental illness increased significantly (percentage-point difference=23.4% to -12.2%), from 2005 to 2019. The magnitude of the disparities for other marginalized racial-ethnic groups did not meaningfully change.

CONCLUSIONS

Racial-ethnic disparities in past-year mental health treatment use have persisted. Efforts to reduce disparities should consider structural barriers that hinder treatment use among marginalized groups.

Social determinants and distance from certified treatment centers are associated with initiation of esketamine nasal spray among patients with challenging-to-treat major depressive disorder

Indicated for treatment-resistant depression or major depression with suicidal ideation, esketamine (ESK) is self-administered under supervision at certified treatment centers. Our study was to determine if social determinants of health and distance were associated with ESK utilization. We conducted a retrospective cohort study among 308 US adults initiating ESK between October 11, 2019 and December 31, 2020 and 1540 propensity-score matched controls with treatment-resistant depression or major depression with suicidal ideation. Adjusting for demographics, prior health care utilization and comorbidities, social determinant variables and distance were regressed separately on each outcome: ESK initiation, failure to complete induction (8 treatments in 45 days), and discontinuation within 6 months. ESK initiation was associated with higher population density (odds ratio [OR]: 2.12), American Indian, Alaska Native, Native Hawaiian, Other Pacific Islander (OR: 3.19), and mental health (OR: 1.55) and primary care providers (OR: 1.55) per capita. Lower likelihood of ESK initiation was associated with living > 7.2 miles from a treatment center (OR: 0.75), living in rural areas (OR: 0.64), and percent non-Hispanic African American (OR: 0.58) and Hispanic (OR: 0.40). Health care providers should tailor patient engagement strategies to mitigate potential barriers to initiating and continuing appropriate treatment. Failing to complete induction was associated with substance use disorder and longer distance to treatment center was associated with discontinuation (hazard ratio: 1.48), as was percent Asian population (hazard ratio: 1.37). Prior psychiatric care and residence in counties with high rates of primary care providers per capita, unemployment, and high school graduation were associated with both higher likelihood of completing induction and lower likelihood of discontinuation.

Race, Affordability and Utilization of Supportive Care in Ovarian Cancer Patients

OBJECTIVE

Lack of access to supportive care (SC) among cancer patients have been well documented. However, the role of affordability in this disparity among ovarian cancer (OC) patients remain poorly understood.

METHODS

Patients with OC between 2008 and 2015 were identified from the SEER-Medicare dataset. Racial disparities in utilization of SC medications within the six months of OC diagnosis among patients with Medicare Part D coverage was examined. Multivariable log-binomial regression models were used to examine the associations of race, affordability and SC medications after adjusting for clinical covariates among all patients and separately among patients with advanced-stage disease.

RESULTS

The study cohort included 3697 patients: 86% non-Hispanic White (NHW), 6% non-Hispanic Black (NHB), and 8% Hispanic. In adjusted models, NHB and Hispanic patients were less likely to receive antidepressants compared to NHW patients (NHB: aOR 0.46; 95% CI 0.33-0.63 and Hispanic: aOR 0.79; 95% CI 0.63-0.99). This association persisted for NHB patients with advanced-stage disease (aOR 0.42; 95% CI 0.28-0.62). Patients dual enrolled in Medicaid were more likely to receive antidepressants (overall: aOR 1.34; 95% CI 1.17-1.53 and advanced-stage: aOR 1.29; 95% CI 1.10-1.52). However, patients residing in areas with higher vs. lower proportions of lower educated adults (overall: aOR 0.82; 95% CI 0.70-0.97 and advanced-stage: aOR 0.82; 95% CI 0.68-0.99) were less likely to receive antidepressants.

CONCLUSION

Black OC patients and those living in lower educated areas were less likely to receive antidepressants as SC. Given the importance of post-primary treatment quality of life for cancer patients, interventions are needed to enhance equitable access to SC.

Life Events, Barriers to Care, and Outcomes Among Minority Women Experiencing Depression: A Longitudinal, Mixed-Method Examination

ABSTRACT

The long-term course of depression is not well-understood among minority women. We assessed depression trajectory, barriers to depression care, and life difficulties among minority women accessing health and social service programs as part of the Community Partners in Care study. Data include surveys ( N = 339) and interviews ( n = 58) administered at 3-year follow-up with African American and Latina women with improved versus persistent depression. The majority of the sample reported persistent depression (224/339, 66.1%), ≥1 barrier to mental health care (226/339, 72.4%), and multiple life difficulties (mean, 2.7; SD, 2.3). Many barriers to care ( i.e. , related to stigma and care experience, finances, and logistics) and life difficulties ( i.e. , related to finances, trauma, and relationships) were more common among individuals reporting persistent depression. Results suggest the importance of past experiences with depression treatment, ongoing barriers to care, and negative life events as contributors to inequities in depression outcomes experienced by minority women.

The association of mindfulness and depression stigma among African American women participants in a mindfulness-based intervention: A pilot study

Depression stigma is a potential barrier to engagement in and efficacy of depression treatment. This pilot study examined the association of mindfulness with depression stigma among participants in an eight-week mindfulness-based intervention for depressive symptoms. Thirty-one African American women with depressive symptoms were recruited from an urban Federally Qualified Health Center (FQHC) to participate in a mindfulness intervention (M-Body). Mindfulness, depressive symptoms, and depression stigma were assessed at baseline, eight weeks, and 16 weeks. Focus groups were conducted to examine participants' subjective experiences with the mindfulness intervention. Mindfulness significantly increased from baseline to eight weeks. There was a non-significant decrease in depression from baseline to eight weeks and a significant decrease in depression from baseline to 16 weeks. Depression stigma significantly increased from baseline to eight weeks and significantly decreased from eight to 16 weeks; however, depression stigma did not return to the baseline. An exploratory qualitative analysis of focus group data revealed themes related to direct and indirect factors that may perpetuate and maintain depression stigma. This is one of the first studies to explicitly explore the relationship between mindfulness, depression symptoms, and depression stigma among African American women.

Asian Americans’ Perceived Knowledge of State Vocational Rehabilitation Services for People With Mental Illness

Given the significant role of employment on independent living and well-being among individuals with disabilities, such as those with mental illness, it is important to examine the experiences of racially and ethnically diverse cultural groups, including Asian Americans. However, little research focus has been made toward Asian Americans with disabilities in the rehabilitation counseling field. This study examined knowledge of state vocational rehabilitation (VR) services and the perceived importance and likeliness of receiving VR services in a sample of 315 Asian Americans. Survey questions were developed to ask participants’ perceived importance of receiving various VR services provided within state VR agencies and the likeliness of receiving or recommending each service if they or their family members had a mental illness. The results showed that most participants were not familiar with state VR services. Although slightly different patterns were identified in the participants’ importance and likeliness ratings, the top important and preferable service was diagnosis and treatment. The information gathered in this study has important implications for crafting culturally sensitive and effective outreach and marketing strategies in Asian American communities.

The DIRECT consortium and the REST-meta-MDD project: towards neuroimaging biomarkers of major depressive disorder

Despite a growing neuroimaging literature on the pathophysiology of major depressive disorder (MDD), reproducible findings are lacking, probably reflecting mostly small sample sizes and heterogeneity in analytic approaches. To address these issues, the Depression Imaging REsearch ConsorTium (DIRECT) was launched. The REST-meta-MDD project, pooling 2428 functional brain images processed with a standardized pipeline across all participating sites, has been the first effort from DIRECT. In this review, we present an overview of the motivations, rationale, and principal findings of the studies so far from the REST-meta-MDD project. Findings from the first round of analyses of the pooled repository have included alterations in functional connectivity within the default mode network, in whole-brain topological properties, in dynamic features, and in functional lateralization. These well-powered exploratory observations have also provided the basis for future longitudinal hypothesis-driven research. Following these fruitful explorations, DIRECT has proceeded to its second stage of data sharing that seeks to examine ethnicity in brain alterations in MDD by extending the exclusive Chinese original sample to other ethnic groups through international collaborations. A state-of-the-art, surface-based preprocessing pipeline has also been introduced to improve sensitivity. Functional images from patients with bipolar disorder and schizophrenia will be included to identify shared and unique abnormalities across diagnosis boundaries. In addition, large-scale longitudinal studies targeting brain network alterations following antidepressant treatment, aggregation of diffusion tensor images, and the development of functional magnetic resonance imaging-guided neuromodulation approaches are underway. Through these endeavours, we hope to accelerate the translation of functional neuroimaging findings to clinical use, such as evaluating longitudinal effects of antidepressant medications and developing individualized neuromodulation targets, while building an open repository for the scientific community.

Are Experiences of Racial Discrimination Associated with Postpartum Depressive Symptoms? A Multistate Analysis of Pregnancy Risk Assessment Monitoring System Data

Background: Postpartum depression (PPD) is a serious public health crisis disproportionately affecting women of color. We examine whether interpersonal racial discrimination is associated with higher odds of postpartum depressive symptoms (PPDS) among women of color and how it may vary by race/ethnicity and maternal educational attainment. Materials and Methods: We present a secondary analysis of cross-sectional data from Pregnancy Risk Assessment Monitoring System (PRAMS) postnatal surveys conducted in nine jurisdictions between 2012 and 2015 that included a question about being upset by experiences of racial discrimination within 12 months before giving birth. Results: Being upset by racial discrimination was associated with nearly three times higher odds of PPDS. Among women of color with at least some college education, the higher odds of PPDS associated with racial discrimination were greater than threefold, and for women with less than a high school education were less than twofold. Conclusion: Addressing risk factors for PPD, including racial discrimination, may inform strategies to reduce racial disparities in maternal mental health.

Effects of COVID‐19‐Related Racial Discrimination on Depression and Life Satisfaction Among Young, Middle, and Older Chinese Americans

This study examined the relationship between age and gender on Chinese American adults’ (N = 184) experiences of COVID‐19‐related racial discrimination, depression, and life satisfaction. Results indicated that COVID‐19‐related racial discrimination explained 47.9% of the variance in depression, and COVID‐19‐related racial discrimination and depression explained 42.3% of the variance in life satisfaction.

A distress-continuum, disorder-threshold model of depression: a mixed-methods, latent class analysis study of slum-dwelling young men in Bangladesh

BACKGROUND

Binary categorical approaches to diagnosing depression have been widely criticized due to clinical limitations and potential negative consequences. In place of such categorical models of depression, a 'staged model' has recently been proposed to classify populations into four tiers according to severity of symptoms: 'Wellness;' 'Distress;' 'Disorder;' and 'Refractory.' However, empirical approaches to deriving this model are limited, especially with populations in low- and middle-income countries.

METHODS

A mixed-methods study using latent class analysis (LCA) was conducted to empirically test non-binary models to determine the application of LCA to derive the 'staged model' of depression. The study population was 18 to 29-year-old men (n = 824) from an urban slum of Bangladesh, a low resource country in South Asia. Subsequently, qualitative interviews (n = 60) were conducted with members of each latent class to understand experiential differences among class members.

RESULTS

The LCA derived 3 latent classes: (1) Severely distressed (n = 211), (2) Distressed (n = 329), and (3) Wellness (n = 284). Across the classes, some symptoms followed a continuum of severity: 'levels of strain', 'difficulty making decisions', and 'inability to overcome difficulties.' However, more severe symptoms such as 'anhedonia', 'concentration issues', and 'inability to face problems' only emerged in the severely distressed class. Qualitatively, groups were distinguished by severity of tension, a local idiom of distress.

CONCLUSIONS

The results indicate that LCA can be a useful empirical tool to inform the 'staged model' of depression. In the findings, a subset of distress symptoms was continuously distributed, but other acute symptoms were only present in the class with the highest distress severity. This suggests a distress-continuum, disorder-threshold model of depression, wherein a constellation of impairing symptoms emerge together after exceeding a high level of distress, i.e., a tipping point of tension heralds a host of depression symptoms.

Demographics of Patients Receiving Electroconvulsive Therapy Based on State-Mandated Reporting Data

OBJECTIVES

Electroconvulsive therapy (ECT) is an effective treatment of depression and other psychiatric conditions. There are few comprehensive data on how many patients receive ECT in the United States or about the demographics of ECT recipients. This study characterizes the demographics of those receiving ECT and how these demographics may have changed with time.

METHODS

Freedom of information requests for all data from record keeping inception to January 2019 were sent to the Department of Health or equivalent agency of states that mandate reporting of ECT. Information on demographics and the number of treating facilities was extracted.

RESULTS

Data on 62,602 patients receiving treatment in 3 states (California, Illinois, Vermont) were obtained. Overall, 62.3% were women. Fewer than 1% of patients treated were younger than 18 years, whereas 30.3% were 65 years or older. White patients received a disproportionate proportion of treatments, with all other races underrepresented. The total number of facilities offering ECT in the 3 states declined over the study period.

CONCLUSIONS

Recipients of ECT are more likely to be female, more likely to be elderly, and more likely to be white than the average person in their state.

Psychometric Properties of the Assessment of Perceived Access to Care (APAC) Instrument

Valid measures of perceived access are needed to measure whether health care systems are providing adequate access. This research reports on the psychometric properties of the Assessment of Perceived Access to Care (APAC), which was administered to 1004 Community Health Center patients screening positive for psychiatric disorders. Known-group validity was good, with 6 of the 8 hypothesized associations between social determinants of access and perceived access being significant (P < .01). Better access was significantly (P < .01) correlated with more outpatient mental health visits, indicating good convergent validity. The test-retest Pearson correlation coefficient (0.64) was statistically significant (P < .01). The APAC has acceptable psychometric properties.

Patterns of Psychoactive Medication Use in Community-Dwelling Older Adults in the US in 2016: A Descriptive Cross-Sectional Study

Objectives: We aim to quantify any use and long-term use patterns of psychoactive medications and explore differences in use by sociodemographic factors in older adults (60-85 years) using the 2016 Medical Expenditure Panel Survey. Methods: Prevalence estimates of any use and long-term use were calculated. Chi-square and crude odds ratios were calculated to estimate differences in any use and long-term use of psychoactive medication by sociodemographic characteristics of respondents. Results: Thirty percent of older adults in the US reported any use of psychoactive medications. Long-term use was significantly higher in women (28.3% [95% confidence interval: 26.5, 30.2]), white (27.8 [26.1, 29.7]), presently unmarried (27.5 [25.4, 29.7]), and low-income (30.3 [27.7, 32.9]) subgroups than in men (20.5 [18.4, 22.5]), Black (14.7 [12.3, 17.1]), presently married (22.8 [20.7, 24.9]), and high-income (21.1 [19.1, 23.1]) subgroups, respectively. Discussion: Despite continued risks associated with use, long-term use of psychoactive medications is prevalent in the older adult population in the US. Given the increased complexity of pharmacotherapy regimens in this population, enhanced efforts at improving use of psychoactive medications should be intensified.

Are Filial Piety and Ethnic Community Engagement Associated With Psychological Wellbeing Among Older Chinese American Immigrants? A Cultural Resource Perspective

This research examined whether perceived receipt of filial piety from adult children and ethnic community engagement—two major ethnocultural resources—were associated with psychological wellbeing of older Chinese American immigrants. Analyses used data from the PINE study, a sample of older Chinese adults in Chicago. Tobit regression revealed that elders who received more filial piety and visited community centers experienced less loneliness and depression than their counterparts did. Tests of interactions showed that community center visits moderated the negative relationship between perceived filial piety and depression. Results suggest the importance of community engagement for diminishing depressive symptoms in older Chinese American immigrants, particularly those with culturally weak intergenerational ties. Discussion centers on how visiting community centers in ethnically dense neighborhoods compensates for unfulfilled filial piety expectations by protecting the mental health of minority elders within a rapidly growing and acculturating immigrant population.

Psychological and neighborhood factors associated with urban women's preventive care use

Women are more likely than men to forego care-including preventive care. Understanding which factors influence women's preventive care use has the potential to improve health. This study focuses on the largely understudied areas of psychological barriers (depression) and neighborhood factors (support and stressors) that may be associated with women's preventive care use through secondary analysis of the Chicago Community Adult Health Study. Across models, 30-40% of the variance in preventive care adherence was explained by the neighborhood. Depressive symptoms were not associated with preventive care use when neighborhood factors were included. However, stratified models showed that associations varied by race/ethnicity. Previous research has tended to focus on individual determinants of care, but this study suggests that barriers to care are far more complex. Efforts aimed at improving care utilization need to be multipronged and interventions need to take an individual's demographics, mental health, and context into account.

Subtypes of Depression: Latent Class Analysis in Spanish Old People with Depressive Symptoms

Major depressive disorder (MDD) is one of the most disabling disorders and the one that most contributes to disability. When it occurs in older people, it is an additional burden to their potential physical and cognitive deficiencies, making MDD an important public health problem that supposes a large investment in health. There is a clear lack of consistency between the subtypes of depression found in the literature, ranging from two to seven classes, with three being the most commonly found non-melancholic, melancholic and psychotic, or putative psychotics. The aim of this research is to add knowledge to the profiles of depressive symptoms in a representative sample of older Spanish people, and to study the possible relationship of these symptom profiles with variables that have traditionally been related to depression. Spanish data from the sixth wave of SHARE were used, with 612 Spanish older adults living in Spain. A routine of several LCAs with a different number of classes was performed to answer this first aim to classify Spanish adults with depression symptoms. The results pointed out the presence of three different classes among the participants in the study: psychosomatic (11.12%), melancholic (14.21%), and anhedonic (74.67%). This work represents a step forward to understand the heterogeneity of major depressive disorder, facilitating the diagnosis, and subsequent treatment of older adults.

Predictability of temperaments and negative experiences on higher-order symptom-based subtypes of depression

BACKGROUND

The identification of subtypes of depression based on higher-order symptoms of emotional, thought, and behavioral dysfunction will broaden understanding of the heterogeneity in depression. Furthermore, exploring the ability of temperaments and negative experiences to predict each subtype is an effective way of facilitating treatment decisions.

METHODS

Participants were 417 patients diagnosed with depressive disorder at the psychiatry department of a major medical hospital in Seoul, Korea. A latent profile analysis was performed based on three higher-order scales of the MMPI-2-RF: Emotional/Internalizing Dysfunction, Thought Dysfunction, and Behavioral/Externalizing Dysfunction. Four temperament dimensions were assessed by the Temperament and Character Inventory-Revised-Short, and negative experiences including recent negative life events, number of lifetime traumatic events, and severity of maltreatment, were used as covariates in a multinomial regression analysis.

RESULTS

Four classes were obtained from the latent profile analysis: a "severe mood class" (39.8%), a "moderate mood class" (37.4%), a "mild mood class" (11.3%), and a "severe mood/thought class" (11.5%). Among temperament dimensions, high harm avoidance and low persistence significantly predicted more severe mood classes. Low reward dependence, number of lifetime traumatic events, and severity of maltreatment in negative experiences were significant predictors of the severe mood/thought class.

LIMITATIONS

This study could not explain the more detailed heterogeneity within depression because of over-inclusiveness of the higher-order scales.

CONCLUSIONS

This study identified three latent classes that differed in emotional severity and one other class with thought problems. The distinct dimensions of temperament and different types of negative experiences predicted the identified subtypes.

Demographics, Psychological Distress, and Pain From Pressure Injury

BACKGROUND

There is a knowledge gap regarding factors that influence the intensity of pain associated with pressure injuries.

OBJECTIVES

We examined the influence of age, gender, race, and comorbidity on the relationships between pressure injuries, psychological distress, and pain intensity in hospitalized adults.

METHODS

This study was a cross-sectional, retrospective secondary analysis using data from a regional acute hospital's electronic health records from 2013 to 2016. A sample of 454 cases met the inclusion criteria and were analyzed using path analysis.

RESULTS

The hypothesized model (Model A) and two alternative models (Models B and C) were tested and demonstrated adequate model fit. All tested models demonstrated statistically significant independent direct effects of age on the severity of pressure injury (p < .001) and pain intensity (p = .001), as well as independent direct effects of gender (p ≤ .005), race (p < .001), and comorbidity (p = .001) on psychological distress.

DISCUSSION

Pain management for individuals with pressure injuries should include not only the treatment of wounds but also the individual characteristics of the patient such as demographics, comorbidity, and psychological status that may affect pain. Given the limitations of secondary analyses, further studies are suggested to validate these findings.

Landscapes of healthcare utilization during a dengue fever outbreak in an urban environment of Colombia

The well-being of a population and its health are influenced by a myriad of socioeconomic and environmental factors that interact across a wide range of scales, from the individual to the national and global levels. One of these factors is the provision of health services, which is regulated by both demand and supply. Although an adequate provision can significantly improve health outcomes of a population, lopsided flow of patients to specific health centers can result in serious disparities and potentially delay the timeliness of a diagnosis. In this paper, utilization patterns during an epidemic of dengue fever in the city of Cali, Colombia for the year 2010 are investigated. Specifically, the objectives are to (1) identify health facilities that exhibit patterns of over- and underutilization, (2) determine where patients who are being diagnosed at a particular facility originate from, and (3) whether patients are traveling to their closest facility and hence (4) estimate how far patients are willing to travel to be diagnosed and treated for dengue fever. Analysis is further decomposed by age group and by gender, in an attempt to test whether utilization patterns drastically change according to these variables. Answers to these questions can help health authorities plan for future epidemics, for instance, by providing guidelines as to which facilities require more resources and by improving the organization of health prevention campaigns to direct population seeking health assistance to use facilities that are underutilized.

Using Korean Dramas as a Precision Mental Health Education Tool for Asian Americans: A Pilot Study

Precision mental health (MH) holds great potential for revolutionizing MH care and reducing the burden of mental illness. Efforts to engage Asian Americans in precision MH research is necessary to help reduce MH disparities. Korean drama ("K-drama") television shows may be an effective educational tool to increase precision MH knowledge, attitudes, and behaviors (KAB) among Asian Americans. This study determined whether KAB improved after participating in a K-drama precision MH workshop, and examined the participants' perspectives about K-dramas' utility as an educational tool. A K-drama precision MH workshop in English/Vietnamese/Korean was conducted with a convenience sample (n = 122). Pre-/post-tests on precision MH KAB (genetics and genetic testing, and MH and help-seeking) and a survey on K-dramas' utility as an educational tool were administered. Findings revealed a significant difference in the pre- and post-test KAB scores overall, by genetics and genetic testing, and by MH and help-seeking. There were also significant increases in the overall post-test KAB scores by workshop (language) participation. Overall, participants responded positively on the utility of K-dramas as a precision MH educational tool. This study demonstrates the feasibility of K-drama as an innovative and widely available health education tool to educate communities about precision MH.

The Missing Link in Contemporary Health Disparities Research: A Profile of the Mental and Self-Rated Health of Multiracial Young Adults

This study compared the mental and self-rated health of monoracial and multiracial young adults using data from Wave 3 of the National Longitudinal Adolescent to Adult study. Our analytic sample consisted of 10,535 men and women ages 18-25 that self-identified as monoracial (Asian, Black, Native American, and White) or multiracial (White-Nonwhite and Nonwhite-Nonwhite). We find that when comparing aggregated racial groups, multiracials have poorer mental health than monoracials. However, differences emerge when multiracials are disaggregated into their two primary pairings of White-Nonwhite and Nonwhite-Nonwhite and compared to monoracials collectively and individually. We find that White-Nonwhites have poorer mental and self-rated health relative to monoracials generally and Whites specifically. In contrast, Nonwhite-Nonwhites have greater self-esteem and self-rated health than Whites as well as the aggregated monoracial group. Our findings highlight the complexities of examining multiracial health without researchers using consistent multiracial categories and reference groups. The results are discussed using three new perspectives that are introduced to explain health disparities between monoracial and multiracial persons.

Depressive Disorder in Thyroid Cancer Patients after Thyroidectomy: A Longitudinal Follow-up Study Using a National Cohort

Objective

The present study compared the frequency of depressive disorder in patients with thyroid cancer who had undergone thyroidectomy with the frequency in control individuals.

Study Design

Retrospective population-based cohort study.

Setting

This study used data from the Korean Health Insurance Review and Assessment Service–National Sample Cohort.

Subject and Methods

A total of 3609 participants with thyroid cancer who had undergone thyroidectomy between 2003 and 2011 were enrolled in this study and matched 1:4 with 14,436 control participants by age, sex, income, and region of residence. The cumulative incidence of postoperative depressive disorder was evaluated over a period of 10 years after the thyroidectomies and compared with the incidence in controls. Depressive disorder was diagnosed by a psychiatrist.

Results

The incidence of depressive disorder was significantly higher in the thyroid cancer with thyroidectomy group than in the controls up to postoperative year 1. A subgroup analysis showed the same higher incidence of depressive disorder in the thyroid cancer group than controls for up to 1 year after operations in young adult (≤44 years old), female, urban, and low-income groups. However, the incidence was elevated only in the year of the thyroidectomies themselves in middle-aged and older, rural, and high-income groups.

Conclusion

Patients with thyroid cancer who undergo thyroidectomy have depressive disorder more frequently than normal controls. However, the frequency of depressive disorder after thyroidectomy recovers in a shorter period in middle-aged or older, high-income, and rural-dwelling patients, compared to younger, low-income, and urban-dwelling patients.

Acculturative Stress, Social Problem Solving, and Depressive Symptoms among Korean American Immigrants

The present study examined the relationship among acculturative stress, social problem solving, and depressive symptoms among 107 Korean American immigrants. Hierarchical regression analysis showed that acculturative stress significantly predicted depressive symptoms controlling for different domains of acculturation. With regard to the role of social problem solving, among the five dimensions of social problem solving (i.e., positive problem orientation, negative problem orientation, rational problem solving, impulsive/careless style, and avoidant style), negative problem orientation and impulsive/careless style significantly predicted depressive symptoms. Avoidant style significantly interacted with acculturative stress, indicating that avoidant style is associated with depressive symptoms when acculturative stress is high. The study underscores the impact of culture as well as severity of stress on the relationship among acculturative stress, coping, and depressive symptoms among Korean American immigrants.

Factors associated with health service utilisation for common mental disorders: a systematic review

BACKGROUND

There is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC).

METHODS

We searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using "best fit framework synthesis", with reference to the Andersen socio-behavioural model.

RESULTS

Fifty two studies met inclusion criteria. 46 (88%) were from HIC. Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies. Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported. Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services. There was a lack of research from LMIC and on contextual level factors.

CONCLUSION

In HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that "treatment gap" statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors.

TRIAL REGISTRATION

PROSPERO registration number: 42016046551 .

The use of latent class analysis for identifying subtypes of depression: A systematic review

Depression is a significant public health problem but symptom remission is difficult to predict. This may be due to substantial heterogeneity underlying the disorder. Latent class analysis (LCA) is often used to elucidate clinically relevant depression subtypes but whether or not consistent subtypes emerge is unclear. We sought to critically examine the implementation and reporting of LCA in this context by performing a systematic review to identify articles detailing the use of LCA to explore subtypes of depression among samples of adults endorsing depression symptoms. PubMed, PsycINFO, CINAHL, Scopus, and Google Scholar were searched to identify eligible articles indexed prior to January 2016. Twenty-four articles reporting 28 LCA models were eligible for inclusion. Sample characteristics varied widely. The majority of articles used depression symptoms as the observed indicators of the latent depression subtypes. Details regarding model fit and selection were often lacking. No consistent set of depression subtypes was identified across studies. Differences in how models were constructed might partially explain the conflicting results. Standards for using, interpreting, and reporting LCA models could improve our understanding of the LCA results. Incorporating dimensions of depression other than symptoms, such as functioning, may be helpful in determining depression subtypes.

Racial/ethnic differences in the treatment of adolescent major depressive disorders (MDD) across healthcare providers participating in the medicaid program

BACKGROUND

To examine whether racial/ethnic differences in receipt of MDD treatment could be explained by the specialty of provider diagnosing the adolescent.

METHOD

Adolescents (10-20 years-old) with ≥2 MDD diagnoses were identified using 2005-2007 Medicaid data from Texas. Patients were categorized based on the types of provider who gave the initial MDD diagnosis (psychiatrist (PSY-I), social worker/psychologist (SWP-I), and primary care physician (PCP-I)). Within the sub-cohorts identified by each type of provider, patients were further divided by racial/ethnic groups.

RESULTS

Of the 13,234-new pediatric MDD cases diagnosed, 61% were SWP-I, 33% PSY-I and 6% PCP-I. Results of the analysis using general linear multi-level model showed that being first diagnosed by a psychiatrist was associated with higher chance of receiving MDD related treatment (PCP-I vs. PSY-I (OR: 0.54, 95%CI: 0.4-0.7) and SWP-I vs. PSY-I (OR: 0.17, 95%CI: 0.1-0.2)). Specifically, regarding the receipt of pharmacotherapy, an interaction effect was detected between types of identifying providers and patients' race/ethnicity. The analysis stratified by race/ethnicity found Whites received comparable treatment regardless being PCP-Is or PSY-Is, while for Hispanics, being first identified by a PCP was associated with lower likelihood of receiving treatment as compared to being first identified by a psychiatrist. Further analysis stratified by provider types showed that a significant racial/ethnic variation in medication utilization was observed in PCP-Is, but not in PSY-Is.

CONCLUSION

For adolescents with MDD, being first diagnosed by a psychiatrist was associated with higher treatment rate and reduced racial/ethnic variation in the utilization of pharmacotherapy.

Effects of programmed exercise on depressive symptoms in midlife and older women: A meta-analysis of randomized controlled trials

OBJECTIVE

To perform a systematic review and meta-analysis to clarify the effect of programmed exercise on depressive symptoms (DSs) in midlife and older women.

METHODS

We carried out a structured search of PubMed-Medline, Web of Science, Scopus, Embase, Cochrane Library and Scielo, from database inception through June 29, 2017, without language restriction. The search included the following terms: "depression", "depressive symptoms", "exercise", "physical activity", "menopause", and "randomized controlled trial" (RCTs) in midlife and older women. The US, UK and Australian Clinical Trials databases were also searched. We assessed randomized controlled trials (RCTs) that compared the effect of exercise for at least 6 weeks versus no intervention on DSs as the outcome (as defined by trial authors). Exercise was classified according to duration as "mid-term exercise intervention" (MTEI; lasting for 12 weeks to 4 months), and "long-term exercise intervention" (LTEI; lasting for 6-12 months). Mean changes (±standard deviations) in DSs, as assessed with different questionnaires, were extracted to calculate Hedges' g and then used as the effect size for meta-analysis. Standardized mean differences (SMDs) of DSs after intervention were pooled using a random-effects model.

RESULTS

Eleven publications were included for analysis related to 1943 midlife and older women (age range 44-55 years minimum to 65.5±4.0 maximum), none of whom was using a hormone therapy. Seven MTEIs were associated with a significant reduction in DSs (SMD=-0.44; 95% CI -0.69, -0.18; p=0.0008) compared with controls. The reduction in DSs was also significant in six LTEIs (SMD=- 0.29; 95% CI -0.49; -0.09; p=0.005). Heterogeneity of effects among studies was moderate to high. Less perceived stress and insomnia (after exercise) were also found as secondary outcomes.

CONCLUSION

Exercise of low to moderate intensity reduces depressive symptoms in midlife and older women.

Clinical characteristics of patients with tinnitus evaluated with the Tinnitus Sample Case History Questionnaire in Japan: A case series

Background

The Tinnitus Sample Case History Questionnaire was determined as a standardized questionnaire for obtaining patient case histories and for characterizing patients into subgroups at the Tinnitus Research Initiative in 2006. In this study, we developed a Japanese version of this questionnaire for evaluating the clinical characteristics of patients with tinnitus. The Japanese version of the questionnaire will be available for evaluating treatments for tinnitus and for comparing data on tinnitus in research centers.

Aims/Objectives

To evaluate the clinical characteristics of patients with tinnitus in Japan using a newly developed Japanese version of Tinnitus Sample Case History Questionnaire.

Study design

This was a prospective study based on patient records.

Setting

University hospitals, general hospitals, and clinics.

Subjects and methods

We collected patient data using a Japanese translated version of the Tinnitus Sample Case History Questionnaire. In total, 584 patients who visited our institutions in Japan between August 2012 and March 2014 were included (280 males and 304 females; age 13–92 years; mean age, 60.8). We examined patients after dividing them into two groups according to the presence or absence of hyperacusis. The collected results were compared with those from the Tinnitus Research Initiative database.

Results

Compared with the TRI database, there were significantly more elderly female patients and fewer patients with trauma-associated tinnitus. There was a statistically lower ratio of patients with hyperacusis. We found that patients with tinnitus in addition to hyperacusis had greater tinnitus severity and exhibited higher rates of various complications.

Conclusion

The Japanese version of the Tinnitus Sample Case History Questionnaire developed in this study can be a useful tool for evaluating patients with tinnitus in Japan. The results of this multicenter study reflect the characteristics of patients with tinnitus who require medical care in Japan. Our data provides a preliminary basis for an international comparison of tinnitus epidemiology.

Electroconvulsive Therapy (ECT) and Race: A Report of ECT Use and Sociodemographic Trends in Texas

OBJECTIVES

Minimal research on race and other sociodemographic disparities in patients receiving electroconvulsive therapy (ECT) exists. One previously noted national trend reveals whites receiving ECT disproportionately more than other races. The aim of this study is to determine whether a county ECT program demonstrates similar disparities observed at the state and national levels.

METHODS

This study examined 21 years of ECT data, between 1993 and 2014, provided by the Texas Department of State Health Services, focusing on race, sex, age, and payer source and 2.5 years of the same variables from a Harris County hospital ECT program. In addition, population demographic data for Harris County and the state of Texas during the same period were obtained from the Department of State Health Services Web site.

RESULTS

Despite an overall decrease in the population of whites countywide and statewide, whites continue to use more ECT than African Americans, Latinos, and Asians in both Harris County and Texas. However, the rates of ECT use in minorities increased overall. Both countywide and statewide, ECT was used more than twice as often in women than men. Statewide, elderly patients (>65 years old) saw decreases in ECT use, and there was an increase in private third-party payer source.

CONCLUSIONS

Electroconvulsive therapy remains underused among African Americans, Latinos, and Asians. Hypotheses and areas for future study include cultural beliefs, stigma, patient and provider knowledge of ECT, and access to care. Despite this, the general use of ECT in Texas has increased overall, and minority use is slowly on the rise.

The identification of symptom-based subtypes of depression: A nationally representative cohort study

BACKGROUND

In recent years, researchers have used various techniques to elucidate the heterogeneity in depressive symptoms. This study seeks to resolve the extent to which variations in depression reflect qualitative differences between symptom categories and/or quantitative differences in severity.

METHODS

Data were used from the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face survey of the adult general population. In a subsample of respondents with a lifetime key symptom of depression at baseline and who participated in the first two waves (n=1388), symptom profiles at baseline were based on symptoms reported during their worst lifetime depressive episode. Depressive symptoms and DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview 3.0. Three latent variable techniques (latent class analysis, factor analysis, factor mixture modelling) were used to identify the best subtyping model.

RESULTS

A latent class analysis, adjusted for local dependence between weight change and appetite change, described the data best and resulted in four distinct depressive subtypes: severe depression with anxiety (28.0%), moderate depression with anxiety (29.3%), moderate depression without anxiety (23.6%) and mild depression (19.0%). These classes showed corresponding clinical correlates at baseline and corresponding course and outcome indicators at follow-up (i.e., class severity was linked to lifetime mental disorders at baseline, and service use for mental health problems and current disability at follow-up).

LIMITATIONS

Although the sample was representative of the population on most parameters, the findings are not generalisable to the most severely affected depressed patients.

CONCLUSIONS

Depression could best be described in terms of both qualitative differences between symptom categories and quantitative differences in severity. In particular anxiety was a distinguishing feature within moderate depression. This study stresses the central position anxiety occupies in the concept of depression.

MENTAL HEALTH DISORDERS SUBSEQUENT TO GESTATIONAL DIABETES MELLITUS DIFFER BY RACE/ETHNICITY

INTRODUCTION

The relationship between gestational diabetes mellitus (GDM) and postpregnancy mental health disorders has been inconsistently reported. Additionally, race/ethnicity data are limited. We sought to elucidate the intersection of these relationships.

METHODS

We analyzed 18,109 women aged 18-40 with self-reported race/ethnicity. Women with (n = 659) and without (n = 14,461) GDM were followed for a median of 4.4 (interquartile range 1.4-6.8) and 4.0 (1.5-6.4) years, respectively, for incident mental health disorders. Multivariable repeated measures analyses were conducted to examine associations between GDM and postpregnancy mental health disorders, race/ethnicity, and the interaction of these factors.

RESULTS

Women with compared to women without GDM were older (mean ± standard deviation, 32 ± 5 vs. 30 ± 5 years; P < .001) and had higher body mass index (29.0 ± 7.2 vs. 25.3 ± 5.2 kg/m(2) ; P < .001). GDM was associated with increased risk for depression and anxiety after adjusting for age and pregnancy complications; however, loss of significance in the fully adjusted model for depression (odds ratio [95% CI]: 1.29 [0.98, 1.70]; P = .064) and anxiety (1.14 [0.83, 1.57], P = .421) suggested that clinical and socioeconomic factors influence this relationship. Hispanic compared to white women had a greater risk for depression (1.40 [1.15, 1.72]; P = .001), even after multivariable adjustment. The interaction between GDM and race was evident in complication-adjusted but not fully adjusted models.

CONCLUSIONS

The incidence of mental health disorders subsequent to GDM was attenuated after adjustment for clinical and socioeconomic factors. Moreover, race/ethnicity influenced this relationship. Further investigation is warranted to clarify potential underlying mechanisms.

Depression among Asian-American Adults in the Community: Systematic Review and Meta-Analysis

OBJECTIVES

In this systematic review, we provide an overview of the literature on depression among Asian-Americans and explore the possible variations in depression prevalence estimates by methodological and demographic factors.

METHODS

Six databases were used to identify studies reporting a prevalence estimate for depression in Asian-American adults in non-clinical settings. Meta-analysis was used to calculate pooled estimates of rates of depression by assessment type. Statistical heterogeneity was assessed for subgroup analyses by gender, age, ethnicity, and other participant characteristics.

RESULTS

A total of 58 studies met the review criteria (n = 21.731 Asian-American adults). Heterogeneity across the studies was considerably high. The prevalence of major depression assessed via standardized clinical interviews ranged between 4.5% and 11.3%. Meta-analyses revealed comparable estimated prevalence rates of depression as measured by the Center for Epidemiologic Studies Depression Scale (35.6%, 95% CI 27.6%-43.7%) and the Geriatric Depression Scale (33.1%, 95% CI 14.9%-51.3%). Estimates varied by Asian racial/ethnic group and other participant characteristics. Estimates of depression among special populations, which included maternity, caregivers, and homosexuals, were significantly higher than estimates obtained from other samples (58.8% vs 29.3%, p = .003). Estimates of depression among Korean and Filipino-Americans were similar (33.3%-34.4%); however, the estimates were twice as high as those for Chinese-Americans (15.7%; p = .012 for Korean, p = .049 for Filipino).

CONCLUSION

There appears to be wide variability in the prevalence rates of depression among Asian-Americans in the US. Practitioners and researchers who serve Asian-American adults need to be sensitive to the potential diversity of the expression of depression and treatment-seeking across Asian-American subgroups. Public health policies to increase Asian-American access to mental health care, including increased screening, are necessary. Further work is needed to determine whether strategies to reduce depression among specific Asian racial/ethnic groups is warranted.