Chirag M Vyas1, Charles F Reynolds2, Macarius Donneyong3, David Mischoulon1, Grace Chang4, Nancy R Cook5, JoAnn E Manson6, Olivia I Okereke7. 1. Department of Psychiatry (CMV, DM, OIO), Massachusetts General Hospital and Harvard Medical School, Boston, MA. 2. Department of Psychiatry (CFR), UPMC, and University of Pittsburgh School of Medicine, Pittsburgh, PA. 3. College of Pharmacy (MD), The Ohio State University, Columbus, OH. 4. Department of Psychiatry (GC), VA Boston Healthcare System and Harvard Medical School, Boston, MA. 5. Division of Preventive Medicine, Department of Medicine (NRC, JAEM), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (NRC, JAEM, OIO), Harvard T.H. Chan School of Public Health, Boston, MA. 6. Division of Preventive Medicine, Department of Medicine (NRC, JAEM), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (NRC, JAEM, OIO), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine (JAEM, OIO), Brigham and Women's Hospital and Harvard Medical School, Boston, MA. 7. Department of Psychiatry (CMV, DM, OIO), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology (NRC, JAEM, OIO), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine (JAEM, OIO), Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Electronic address: Olivia.Okereke@MGH.HARVARD.EDU.
Abstract
OBJECTIVES: To determine associations between geographic region and late-life depression (LLD) severity, item-level symptom burden, and treatment; to evaluate whether racial/ethnic disparities in LLD, previously observed in the overall sample, vary by region. METHODS: We included 25,502 VITAL (Vitamin D and Omega-3 Trial) participants and administered the Patient Health Questionnaire-8 for depressive symptoms; participants also reported medication and/or counseling care for depression. Multivariable regression analyses were performed. RESULTS: Despite overall lower LLD severity and item-level symptom burden in the Midwest versus Northeast, higher LLD severity and item-level burden were observed among minorities, especially Black and Hispanic adults, compared to non-Hispanic whites in this region. Racial/ethnic disparities in item-level symptoms (e.g., anhedonia, sadness, psychomotor changes) varied by region. There were no significant differences in depression care by region; furthermore, regional variation was not observed in racial disparities in care: e.g., among those with clinician/physician-diagnosed depression, Blacks versus non-Hispanic whites had greater than 50% lower odds of treatment in all regions. CONCLUSION: LLD varied by geographic region. Furthermore, magnitudes of racial/ethnic disparities in LLD severity and item-level symptom burden, but not depression care, differed by region.
OBJECTIVES: To determine associations between geographic region and late-life depression (LLD) severity, item-level symptom burden, and treatment; to evaluate whether racial/ethnic disparities in LLD, previously observed in the overall sample, vary by region. METHODS: We included 25,502 VITAL (Vitamin D and Omega-3 Trial) participants and administered the Patient Health Questionnaire-8 for depressive symptoms; participants also reported medication and/or counseling care for depression. Multivariable regression analyses were performed. RESULTS: Despite overall lower LLD severity and item-level symptom burden in the Midwest versus Northeast, higher LLD severity and item-level burden were observed among minorities, especially Black and Hispanic adults, compared to non-Hispanic whites in this region. Racial/ethnic disparities in item-level symptoms (e.g., anhedonia, sadness, psychomotor changes) varied by region. There were no significant differences in depression care by region; furthermore, regional variation was not observed in racial disparities in care: e.g., among those with clinician/physician-diagnosed depression, Blacks versus non-Hispanic whites had greater than 50% lower odds of treatment in all regions. CONCLUSION: LLD varied by geographic region. Furthermore, magnitudes of racial/ethnic disparities in LLD severity and item-level symptom burden, but not depression care, differed by region.
Authors: Tresha A Gibbs; Mayumi Okuda; Maria A Oquendo; William B Lawson; Shuai Wang; Yonette Felicity Thomas; Carlos Blanco Journal: Am J Public Health Date: 2012-12-13 Impact factor: 9.308