Blacks and Whites - NCBI

Symptoms of Depression among Blacks and Whites

Rhonda J. Jones-Webb, DrPH, and Lonnie R. Snowden, PhD

Introduction Numerous epidemiological studies of the past 20 years have compared Blacks and Whites on symptoms of depression.'-'0 Generally, findings from this research suggest that Blacks report higher levels of symptoms than Whites in gross comparisons, but that after adjustment for sociodemographic differences, Blacks report equal or even lower levels of symptoms. "I Similarly, studies in which depression has been represented as a diagnostic category rarely have found clear-cut evidence of race-related differences.2-'4 Focusing on differences in levels of depression, this research tells us little about racial differences in patterns of sociodemographic risk. Only a handful of investigators have focused on demographic variables and studied their interaction with race. NeffI5 found that symptoms of depression occurred with greater intensity among rural Blacks than among rural Whites but found no such difference between urban Blacks and Whites. Kessler and Neighbors'6 reported greater distress among Blacks than among Whites at lower levels of income but not at higher levels. Ulbrich et al.'7 presented a comparable finding. On the other hand, Somervell et al.,'2 using diagnostic categories, fadled to uncover an income-by-race interaction. Several investigators of sociodemographic risk have compared Blacks and Whites on a range of variables using the Center for Epidemiological Studies Depression Scale (CES-D). Comstock and Helsing18 found racial differences in the association between depression and marital status, education, income, and gender. However, neither Eaton and Kessler'9 nor Roberts et al.20 replicated these findings, and none of these investigators directly tested the possibility of interaction.

The purpose of this study was to explore racial differences in patterns of sociodemographic risk. Assuming that risk factors are universal can prove misleading. Widowhood, for example, is widely recognized as placing surviving spouses at risk; yet loneliness, a contributing factor,21 may be less problematic among elderly Blacks than among Whites because Blacks are more likely to live with others, especially family members.22 In the event of such a difference, relationship-building interventions that are useful for Whites might disrupt established patterns of interaction among Blacks. Data for the study were taken from a national probability sample that included large numbers of Blacks and Whites. This permitted equally sensitive statistical tests to be conducted for both races and provided results that can be confidently generalized to the nation. This combination of advantages has not been present in any study reported previously. A range of sociodemographic risk factors were considered, and several were of particular concern. Black households are larger than those of Whites, and the Black church has been widely viewed as a powerful force for community cohesion.23 Moreover, compared with Whites, single Black adults are more likely to live with others,23 and poor and unemployed Rhonda J. Jones-Webb is with the School of Public Health at the University of Minnesota, Minneapolis. Lonnie R. Snowden is with the University of California and the Center for Research on the Organization and Financing of Care for the Severely Mentally Ill, Berkeley. Requests for reprints should be sent to Rhonda Jones-Webb, DrPH, University of Minnesota, Division of Epidemiology, 1300 S Second St, Ste 300, Minneapolis, MN 55454. This paper was submitted to the Journal May 17, 1991, and accepted with revisions September 15, 1992.

February 1993, Vol. 83, No. 2

Symptoms of Depression among Bblak and Whites

Blacks are more likely to live in highly concentrated poverty areas. These differences in social circumstances may translate into differences in stress and support. Therefore, religious preference, marital status, and socioeconomic and employment status represented a special focus of the study.

Medhods Sample This research is based on data from the 1984 National Alcohol Survey, which was designed to study dring patterns and drinkingproblems, such as depressive symptoms, in the general population. The sampling procedures used in the National Alcohol Survey have been descnrbed in detailby Herd.24 Briefly, survey respondents comprised a multistage probability sample ofhouseholds in the 48 contiguous United States. Housing units were randomly selected from listing sheets, and only one respondent aged 18 or over was selected from each household for inter-

viewing. Various sampling techniques were used to ensure a large, representative sample of the Black population. For example, Blacks were oversampled at various stages of sample selection (e.g., within block groups, listing areas, and in neighborhoods). A total of 1947 Black and 1777 White adults were interviewed. Interviews were conducted in the respondent's home by means of a standardized questionnaire. The response rate was 75.9% for Blacks and 73.2% for Whites. The demographic characteristics of the sample can be found in Herd.24

Measures Depression. Depressive symptoms were measured with the Center for Epi-

demiological Studies Depression Scale. Because studies have shown a good level of agreement between a cutoff point of 16 and a clinical diagnosis of depression,25-27 16 was adopted for the present study.27 The reliability and validity ofthis scale has been demonstrated in Black and White populations.28-N In the present study, alpha coefficients for both Blacks and Whites were .88. To determine whether the factor structure of the depression scale was similar for National Alcohol Survey Blacks and Whites, a preliminary factor analysis was conducted (principal components, VARIMAX rotation). Results suggested February 1993, Vol. 83, No. 2

that the scale performed similarly among Blacks and Whites and paralleled previous research that used more rigorous con-

firmatory procedures.28

Sociodemographic vanables. In the present study, sex, age, marital status, religious preference, social class, employment status, regional location, and urbanicity were the major demographic variables of interest. As noted earlier, previous studies have found these variables

to be associated with depressive symp-

tomatology in Black and White populations. The social class scale used in the study distinguishes among six groups based on a composite of educational status, household income, and the mainwage

earner's occupational status.30 Classes I and II, upper class and upper middle class, were combined for Blacks owing to the small number of Blacks in Class I. To American Journal of Public Health

241

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agnostic or identified with a non-Western religion, unemployed, and living in the Northcentral region or the West. Sex, marital status, employment status, and social class were correlated with depressive symptoms for Whites; religious preference, urbanicity, and region were not. In the White sample, rates of depression appeared highest for females and for respondents who were under age 50, unmarried, unemployed, and in the lower social classes.

Multivanate Analysis

make for comparable analyses, Classes I and II were also collapsed for Whites.

Resuks Bivaiate Analysis Both chi-square (scale score . 16 vs scale score < 16) and one-way analysis of variance (actual scale score) were conducted at first to examine bivariate relationships between sociodemographic variables and symptoms of depression in the Black and White samples. These and subsequent analyses were weighted to adjust for the oversample of Black households. The two analyses yielded similar 242 American Journal of Public Health

findings, indicating that there was little conceptual difference between depression as a category and depression as a continuous dimension. Because analysis of variance and related procedures are not well suited to the analysis of badly skewed distributions, only the results from the chisquare analyses are reported. Table 1 presents results from the chisquare analysis. All sociodemographic indicators except urbanicity were associated with symptoms of depression for Blacks. Rates of depressive symptoms appeared to be highest for females and for respondents who were between 30 and 39 years of age, in the lower social classes,

Logistic regression was used next to determine whether bivariate relationships would remain after adjustment for other demographic predictors. Table 2 presents the full logistic model for the Black sample. As Table 2 indicates, groups at greatest risk were females; persons under age 40 and especially between 30 and 39; persons who were widowed, separated, or divorced; and non-Catholics. Depression also was prevalent in the lower class; among retired people, homemakers, and others not in regular labor market jobs; among those living in smaller communities; and among those living in the Northcentral and Western regions. Given the importance of social class as a risk factor for symptoms of depression, the model in Table 2 was reanalyzed using the various components of our social class measure: income, education, and occupational status. The results from this analysis were similar to those in the final model presented in Table 2 with one exception: in the revised model, marital status was not associated with an increased risk of depressive symptoms. Table 2 also presents the full logistic model for the White sample. Groups at greatest risk were females; those aged 18 to 29; the widowed, separated, or divorced; members of the lower social classes; homemakers and the unemployed; and those who lived in small and mid-sized urban communities. The model in Table 2 also was reanalyzed by using the components of social class. This rised model did not differ significantly from that presented in Table 2. In a direct test of racial differences, a logistic model was evaluated on the full sample of Black and White subjects. The model included terms to test the interactions between the races and all other sociodemographic variables. This analysis, equivalent to a test of Black-White differences in comparable parameter estimates, is summarized in Table 2. Blacks aged 30 February 1993, Vol. 83, No. 2

Symptoms of Depreion among Bblc and Whites to 39 belonging to non-Western religious groups and living in the West were at greater risk than corresponding groups of Whites; Blackswho were widowed, members of the middle and lower middle class, and unemployed were at less risk than corresponding groups of Whites.

Disussion The findings from the present study demonstrate that there are both simnilarities and differences in risk factors for depressive symptoms in Black and White populations. For both races, gender, marital status, age, employment status, social class, and urbanicity were associated with increased risk of depression. Women, both Black and White, were more likely to be depressed than men and were at comparable levels of increased risk. Being formerly married also was an indicator of risk in the two populations, although widowhood proved a greater indicator for Whites than for Blacks. As previously noted, elderly Blacks are more likely than Whites to live with family and others22; greater social involvement may serve to mitigate the effects of losing a spouse. Although age, employment, and socioeconomic status were associated with depressive symptoms in both populations, there were differences in categories at risk. Blacks aged 30 to 39 were at significantly greater risk than Whites. This finding may reflect differences between Blacks and Whites in the timing of their exposure to stress during the life span. In a supplemental analysis, the relationship between stress, age, and depression was examined to test this hypothesis. The results of chi-square analysis showed that, among Blacks who reported high levels of stress and depression, 58% were between 30 and 39 years of age. For Whites with these characteristics, only 20% were between these ages. Unemployed Whites were at significantly greater risk but unemployed Blacks were not. This finding may reflect differential patterns of participation in the labor market. Blacks are especially vulnerable to economic downturns; they are prone to suffer episodes of unemployment and remain unemployed for longer periods.23

Lengthy joblessness produces a psychological adjustment to being out of work,31 a position that Blacks find themselves in more than Whites. Another explanatory factor may lie in the greater concentration of unemployed Blacks in certain locales;


witnessing widespread unemployment may reduce the sense of stigma and a tendency to blame oneself for one's plight. Social class and race were found to interact but in a manner that differed from that found in other studies. Middle-class and lower middle-class Blacks were relatively low in level of risk. Avoiding the extreme poverty that befalls almost a third of the Black population may lead to a relative sense of well-being. The relationship between social class and distress among Blacks seems complex. Neighbors32 reported a negative relationship between socioeconomic status and distress for certain stressors and a positive relationship for others. Such conflicting pattems could produce a relatively modest association overall of the kind observed in the present study. Blacks who were agnostic or Protestant were at increased risk for depressive symptoms compared with Blacks who were Catholic. Those who identified with a non-Western religion were at especially great risk and differed significantly from their White counterparts. Given the historical role of the church in Black culture,23 it is easy to understand how religious identification may provide a protective function for African Americans. More surprising is the special importance of Catholicism to Blacks. The scarcity of data on religious preference and depressive symptoms makes it difficult to determine what aspects of Catholicism might be more effective in maintaining moral and mental health than those of other denominations. More research should be conducted to help us understand how specific religious beliefs and practices affect mental health, especially among Blacks. Regional location also was associated with symptoms of depression for Blacks only. Blacks in the Northcentral and Western regions had a higher risk of depressive symptoms than Blacks living in other parts of the country. In this study, region may function as a proxy for economic conditions or may reflect differences in community cohesiveness or migration patterns. The findings suggest that, although sociocultural, socioeconomic, and socialecological variables are important in understanding the risk for depression in both Black and White populations, the relative contribution and patterning of these factors sometimes differ for the two groups. 0

Acknowledgments The survey was implemented by the Alcohol Research Group, Institute ofEpidemiology and Behavioral Medicine, Medical Research Institute of San Francisco, through a subcontract with the Institute of Survey Research, Temple University. Fundingforthe studywasprovided by the National Institute of Alcoholism and Alcohol Abuse through Grants AA06050 and AA05595.

References 1. Antunes G, Gordon C, Gaitz C, Scott J. Ethnicity, socioeconomic status and the etiology of psychological distress. Sociol Soc Res. 1974;58:361-368. 2. Carr LG, Krause N. Social status, psychiatric symptomatology and response bias. J Heath Soc Behav. 1978;19:86-91. 3. Dohrenwend B, Dohrenwend B. Social Status and Psychological Disorder. New York, NY: Wiley; 1969. 4. Frerichs R, Aneshensel CS, Clark VA: Prevalence of depression in Los Angeles County. Am J EpidemioL 1981;113:691699. 5. Ilfeld FW. Psychological status of community residents along major demographic di-

mensions.Arch GenPsychoL 1978;35:716-

724. 6. Kaplan GA, Roberts RE, Camacho TE, Coyne JC. Psychosocial predictors of depression. Am J EpidemioL 1987;125:206220. 7. Mirowsky J, Ross CE. Minority status, ethnic culture, and distress: a comparison of Blacks, Whites, Mexicans, and Mexican-Americans. Am J SocioL 1980;86:479495. 8. Warheit GJ, Holzer CC, Arey SS. Race and mental illness: an epidemiological update. J Health Soc Behav. 1975;16:243256. 9. Warheit GJ, Holzer CE III, Schwab J. An analysis of social class and racial differences in depressive symptomatology. J Health Soc Behav. 1973;14:291-299. 10. Yancey WL, Rigsby KC, McCarthy JD. Social position and self evaluation: the relative importance of race. Am J Sociol

1972;78:338-359. 11. Neighbors HW. The distribution of psychiatric morbidity in Black Americans: review and suggestions for research. Community Ment Health J. 1984;20:169-181. 12. Somervell RD, Leaf PJ, Weissman MM, Blazer DG, Bruce ML. The prevalence of major depression in Black and White adults in five United States communities. Am J

EpiemioL 1989;130:725-735. 13. Vernon SW, Roberts RE. Use of the SADS-RDC in a tri-ethnic community survey. Arch Gen PsychoL 1982;39:47-52. 14. Weissman M, Myers JK Affective disorders in a US urban community: the use of the research diagnostic criteria in an epidemiological survey. Arch Gen Psychiatry.

1978;35:1304-1311. 15. Neff JA. Race differences in psychological distress: the effects of SES, urbanicity, and measurement strategy. Am J Comunit PsycoL 1984;12:337-351. 16. Kessler R, Neighbors HW. Anew perspective on the relationships among race, social

American Journal of Public Health 243

Jan and Snowden

17.

18. 19. 20.

21.

class and psychological distress. J Health Soc Behav. 1986;27:107-115. Ulbrich PM, Warheit GJ, Zimmennan RS. Race, socioecononic status, and psychological distress: an examination of dfferential vulnerability. J Health Soc Behav. 1989;30:131-146. Comstock GW, Helsing KJ. Symptoms of depression in two communities. Psychol Med. 1976;6:551-563. EatonW, KesslerK. Rates of symptoms of depression in a national sample. Am JEpidemioL 1981;114:528-538. Roberts RE, Stevenson JM, Breslow L. Symptoms of depression among Blacks and Whites in an urban community.JNerv Ment Dis. 1981;169:774-779. Lopata HV, Heinemann GF, BaumJ. Loneliness: antecedents and coping strategies in the lives of widows. In: Peplau LA, Perman D,eds.Lc :nesn:A SowebookofCw(rn They RePwac and 7hep. New York, NY: Wiley Interscience; 1982:14-26.

244 American Journal of Public Health

22. Mitchell JS, RegisterJC. An exploration of family interaction among the elderly by race, socioeconomic status, and residence. Geantologist. 1984;24:48-54. 23. National Research Council. A Common Destiny: Blacks and American Society. Washington, DC: National Academy Press; 1989. 24. Herd D. Subgroup differences in drinking patterns among Black and White men: results from a national survey. J Stud AlcohoL 1990;51:221-232. 25. Ensel WM. Measuring depression: the CES-D scale. In: Linn N, Dean A, Ensel WM, eds. Social Suppor4 Life Events and Depression. Orlando, Fla: Academic Press, Inc; 1986:51-70. 26. Radloff LS, Locke B. The Community Mental HealthAssemnt Suvey and the CES-D Scale, ed. Weissman M, Myers J, Ross C. New Brnswick, NJ: Rutgers University Press; 1986:177-189. 27. Weissman MM, Sholomskas D, Pottinger

28.

29.

30.

31.

32.

M, Prusoff B, Locke B. Assessing depressive symptoms in five psychiatric populations: a validation study. Am JEpidemioL 1977;106:203-214. Aneshensel CS, Clark VA, Frerichs RR. Race, ethnicity and depression: a confirmatory analysis.JPers SocPsychoL 1983; 44:385-398. Roberts RE. Reliability of the CES-D scale in different ethnic contexts. PsychiatrRes. 1980;2:125-134. Knupfer G, Room R. Age, sex and social class as factors in amount of drinking in a metropolitan community. Soc Pmblemr. 1969;12:224-240. Kasl JV. Mortality and the business cycle: some questions about research strategies when utilizing macro, social and ecological data. Am J Public Healh 1979;69:784788. Neighbors HW. Socioeconomic status and psychological stress in adult Blacks. Am J EpidemioL 1986;124:779-792.
