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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Monday, March 5, 2007

Depression often disabling and untreated among blacks

Lifetime rates of major depression are higher among whites, but depression is more likely to be severe and disabling among African-Americans and Caribbean blacks, according to a study in the March issue of the Archives of General Psychiatry. Fewer than half of African-Americans and fewer than a quarter of Caribbean blacks got any kind of therapy for their major depression.

Data on treatment was not collected for whites, the article said, but the national average for treatment of major depression among adults is 57 percent.

"These data suggest that when blacks develop major depressive disorder, it is likely debilitating in impact and persistent in its course," wrote lead author David R. Williams of the Harvard School of Public Health. "These findings underscore the pressing need to understand the factors underlying racial differences in access and quality of mental health care and the urgency of implementing interventions to eliminate these disparities."

The researchers studied major depression among 6,082 people in the National Survey of American Life, the largest study of mental health in the U.S. black population. They looked at results from face-to-face interviews followed by telephone calls with 3,570 African-Americans, 1,621 Caribbean blacks and 891 non-Hispanic whites from 2001 through 2003.

More whites (17.9 percent) than African-Americans (10.4 percent) and Caribbean blacks (12.9 percent) said they had experienced major depression over their lifetimes, but among those who had, more African-Americans (56.5 percent) and Caribbean blacks (56 percent) reported episodes in the past 12 months compared with whites (38.6 percent.)

This is the first psychiatric epidemiologic study of blacks in the United States to include a large national sample of Caribbean-origin blacks, the authors said.

Kristin N. Javaras, a biostatistician who studies mental health data at the Harvard School of Public Health and McLean Hospital, said the study's findings are valuable because they confirm in a larger population work that had been done in smaller groups. Studying African-Americans and Caribbean blacks as separate groups was also important.

"They also assessed the severity of the depression and the percentage of people getting treatment," said Javaras, who was not involved in the study. "It suggests that perhaps black Americans have less access to treatment, which could explain the increased chronicity."

Study co-author Harold W. Neighbors said in an e-mail interview, "The most important next step is to figure out ways to get more black Americans (both African-Americans and Caribbean blacks) with depression into professional care."

Responsibility rests on both the consumer and professional side for decreasing barriers to care for depression, wrote Neighbors, director and research professor in the Program for Research on Black Americans at the University of Michigan's Institute for Social Research.

"More open and honest discussion among black Americans within smaller friendship networks about their struggles with depression should lift some of the social stigma associated with depression," he said. "But we also need more effective educational programs that will help mental health clinicians establish rapport with black patients and others from cultural backgrounds that differ from the prototypical patient who too often is a white American."

The article said more research needs to be done on the social support systems, including religious activities, and individual strengths, such as self-esteem, that may account for lower levels of lifetime major depression. Further work is also needed to understand why, when severe depression occurs, it is more persistent and disruptive among both African-Americans and Caribbean blacks, the authors said.

Dr. Timothy G. Benson, a psychiatrist at McLean Hospital who lectures on African-American health disparities, said he was excited to see the report put the issue back in the forefront. He was not involved in the study.

"This gives us a gauge to see that what we are doing right now is not sufficient. There is a significant gap in access to care," he said. "What I hope to see are more papers on strategies on how to eliminate these disparities."

Posted by Elizabeth Cooney at 04:00 PM
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