Department of Psychiatry, University of Michigan, 4250 Plymouth Road, SPC 5763, Ann Arbor, MI, 48109-2700, USA.
Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
J Racial Ethn Health Disparities. 2015 Dec;2(4):589-97. doi: 10.1007/s40615-015-0116-9. Epub 2015 May 15.
Previous research has identified a Black-White health paradox, which can be defined as less frequent depression despite a higher prevalence of chronic medical conditions among Blacks compared to Whites in the USA. Based on this paradox, we would expect weaker associations between chronic medical conditions and depression among Blacks than Whites. However, the literature on this topic is mostly cross-sectional and has provided findings that contradict the Black-White health paradox. The present longitudinal study extends prior research by assessing Black-White differences in reciprocal associations between number of chronic medical conditions and depressive symptoms over a 25-year period.
Data came from the Americans' Changing Lives Study that followed 1034 surviving Black and White respondents for 25 years from 1986 to 2011. Chronic medical conditions were measured based on a count of self-reported physician diagnoses including hypertension, diabetes, chronic lung disease, heart disease, stroke, cancer, and arthritis at baseline (1986) and follow-up (2011). Depressive symptoms were also measured at baseline and follow-up using a 10-item Center for Epidemiological Studies-Depression (CES-D) scale. Multi-group structural equation modeling was used to assess reciprocal associations between baseline and subsequent depressive symptoms and baseline and subsequent chronic medical conditions comparing Black and White respondents.
Among White but not Black respondents, a higher number of chronic medical conditions at baseline predicted a greater increase in depressive symptoms over 25 years of follow-up. Among Whites but not Blacks, individuals with more depressive symptoms at baseline developed more chronic medical conditions over time.
Findings documented Black-White differences in reciprocal associations between chronic medical conditions and depressive symptoms over time. Our study provides longitudinal evidence for the Black-White health paradox across mid and later life, as reciprocal associations between depression and chronic medical conditions were weaker for Blacks compared to Whites.
先前的研究已经确定了黑-白健康悖论，这可以定义为与美国的白人相比，黑人中尽管慢性疾病的患病率较高，但抑郁的发生率却较低。基于这一悖论，我们预计黑人中慢性疾病与抑郁之间的关联会比白人更弱。然而，关于这一主题的文献大多是横断面的，其研究结果与黑-白健康悖论相矛盾。本纵向研究通过评估在 25 年期间慢性疾病数量与抑郁症状之间的相互关联在黑人和白人之间的差异，扩展了先前的研究。
数据来自美国人生活变化研究，该研究从 1986 年到 2011 年对 1034 名幸存的黑人和白人受访者进行了 25 年的随访。慢性疾病的测量是基于自我报告的医生诊断的数量，包括基线（1986 年）和随访（2011 年）时的高血压、糖尿病、慢性肺病、心脏病、中风、癌症和关节炎。抑郁症状也在基线和随访时使用 10 项中心流行病学研究抑郁量表（CES-D）进行测量。多组结构方程模型用于评估黑人和白人受访者中基线和随后的抑郁症状以及基线和随后的慢性疾病之间的相互关联。
在白人而非黑人受访者中，基线时更多的慢性疾病预测了 25 年随访期间抑郁症状的更大增加。在白人中但不是在黑人中，基线时抑郁症状更多的个体随着时间的推移会发展出更多的慢性疾病。
研究结果记录了慢性疾病和抑郁症状随时间相互关联在黑人和白人之间的差异。我们的研究提供了从中年到晚年的黑-白健康悖论的纵向证据，因为与慢性疾病相比，黑人中抑郁和慢性疾病之间的相互关联较弱。
