Clinical Presentations of Major Depression by African Americans and Whites in Primary Medical Care Practice

Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 01/1997; 41(3):181-91. DOI: 10.1016/S0165-0327(96)00085-7
Source: PubMed


This study compared the psychiatric history and presenting clinical characteristics of 119 African American and 153 white patients assessed for and participating in a randomized control trial of treatments for major depression in primary care practice. African Americans and whites participated equally in the assessment process, and both groups presented with similar psychiatric treatment histories, severity of depression, level of psychosocial functioning, and severity of medical illness. However, racial differences were evident in the comorbidity of psychiatric disorders, severity of somatic symptoms, self-reported physical functioning, life stress, and health beliefs. Implications for the recognition of depression in African American primary care patients are discussed.

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    • "Consistent with this pattern, Adebimpe (1981) and Whaley (1998), among others, have also argued that depression is more often misdiagnosed among African- Americans than their European-American counterparts. African-American depressed patients in the United States have been reported to exhibit more worry, somatic complaints, and physical functioning impairments (Ayalon & Young, 2003; Adebimpe, 1981; Brown et al., 1996). Typical symptoms that have been found to be related to depression in African-American primary care patients are medically unexplained complaints of pain or numbness in the patient's chest, neck, head, arms, and stomach. "
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    ABSTRACT: Screening and detection are essential building blocks for prevention and early treatment of depression. Despite their critical role in early identification and treatment, primary care physicians fail to recognize depression in about half of their patients. Because depressed patients of color tend to seek treatment in primary care settings, the need for greater attention to, and understanding of, ethnic and racial disparities in general practitioners' ability to detect cases of depression is compelling. The purpose of this article is to discuss the screening and detection of depression among patients from different U.S. ethnic/racial and cultural groups. Specifically, the objective is to identify within- and between-culture factors that may impact on symptom presentation for African-Americans, Asians, Hispanic/Latinos, and Native Americans, and subsequently on the diagnosis of depression in primary care settings. Implications for the role of allied health professionals, especially social workers, in enhancing the cultural competence of primary care doctors are discussed.
    Journal of Ethnic & Cultural Diversity in Social Work 10/2012; 21(4):314-330. DOI:10.1080/15313204.2012.729180
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    • "In a study of older African Americans, the CES-D was found to have good internal consistency, with a¼0.86 (Foley et al., 2002). It should be noted that researchers have questioned the validity of the factor structure of the CES-D among African Americans, as it has been shown that African Americans tend to report more physical complaints in response to questions about depression (Brown et al., 1996). However, studies have found support for the validity of the four-factor structure across different samples of African Americans, those of low socioeconomic status (Nguyen et al., 2004), and African American women (Makambi et al., 2009; Rozario and Menon, 2010). "
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    ABSTRACT: Ethnic identity has been identified as a factor contributing to resilience and coping in African Americans. Ethnic identity includes positive feelings of ethnic affirmation and belonging, appreciation for one's ethnic identity, and increased ethnic behaviors. This study examines the role of ethnic identity in symptoms of anxiety and depression. Participants were an adult student and community sample (N=572), administered the Beck Anxiety Inventory (BAI), Center for Epidemiologic Studies of Depression Scale (CES-D), State Trait Anxiety Inventory-state portion (STAI-S), and Multigroup Ethnic Identity Measure (MEIM). Compared to European Americans, African Americans reported significantly greater depression and more negative state anxiety, as well as higher levels of ethnic identity. For African Americans, higher ethnic identity was correlated to reduced anxiety and depression, whereas this was not true for European Americans. Findings support the proposition that a strong, positive ethnic identity may serve a protective role among African Americans by moderating the relationship between discriminatory experiences and psychological well-being. An Afrocentric perspective may also contribute to reduced anxiety due to a greater emphasis on a present versus future-oriented worldview. Clinical implications and directions for future research are discussed.
    Psychiatry Research 04/2012; 199(1). DOI:10.1016/j.psychres.2012.03.049 · 2.47 Impact Factor
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    • "The psychometric properties of the original BDI ( Beck et al . , 1961 ) , along with its more recent version , the BDI - II ( Beck , Steer , & Brown , 1996 ) , have been evaluated extensively and have both been shown to be reliable and valid instruments for depression screening ( Beck , Steer , & Garbin , 1988 ) . The BDI has also exhibited good positive predictive value for detecting depression in general populations ( Lasa , Ayuso - Mateos , Vázquez - Barquero , Díez - Manrique , & Dowrick , 2000 ) and in women during pregnancy ( Holcomb , Stone , Lustman , Gavard , & Mostello , 1996 ) . "
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    ABSTRACT: Maternal depression is a major public health concern in the United States affecting mothers, children, and families. Many mothers experience depression, and exposure to maternal depression can put children at increased risk for psychopathology and poor psychosocial development. Early recognition of maternal depression is a critical step in promoting healthy development and preventing adverse outcomes in children and families. In this review, we examine some of the major barriers that mothers face in seeking help for depression; discuss optimal settings in which to implement maternal depression screening; review available depression screening tools for identifying mothers in need of care; discuss steps providers can take after screening; examine barriers to screening; and present information about promising initiatives developed to address these barriers.
    Families Systems & Health 03/2012; 30(1):1-18. DOI:10.1037/a0027602 · 1.13 Impact Factor
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