Medicine and Health Promotion Institute, Tehran, Iran; Mental Health Research Center, Tehran Psychiatric Institute, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Front Public Health. 2016 Feb 17;4:13. doi: 10.3389/fpubh.2016.00013. eCollection 2016.
Black-White differences are shown in psychosocial and medical correlates of depressive symptoms and major depressive disorder (MDD). The current longitudinal study compared Blacks and Whites for the association between baseline depressive symptoms and subsequent risk of MDD after 15 years.
Data were obtained from the Americans' Changing Lives (ACL) Study that included 3,361 individuals (2,205 Whites and 1,156 Blacks) from 1986 to 2001. Baseline depressive symptoms measured using an 11-item Center for Epidemiological Studies-Depression (CES-D) in 1986 were predictors. The outcome of 12-month MDD was measured using the Composite International Diagnostic Interview (CIDI) in 2001. Covariates such as baseline socio-demographics (SES), financial difficulty, chronic medical conditions (CMC), and self-rated health (SRH) were measured in 1986. Logistic regression models were used to evaluate the association between baseline CES-D score and CIDI-based MDD after 15 years net of demographics, SES, CMC, and SRH. The models were applied in the pooled sample, as well as in Blacks and Whites. Data on reliability and factor structure of CES-D based on ethnicity were also reported.
In the pooled sample, we found an interaction between race and baseline depressive symptoms, suggesting a stronger effect of baseline depressive symptoms on the subsequent risk of MDD for Whites compared with that of Blacks. Such an interaction was significant net of socioeconomic and health status. Based on our ethnic-specific models, among Whites but not Blacks, baseline CES-D score was predictive of the subsequent risk of MDD after 15 years, net of SES and health at baseline. Black-White differences in the predictive role of CES-D scores on MDD could not be attributed to the ethnic differences in the reliability of the CES-D, which was even higher for Blacks compared with those of Whites. Loadings of the CES-D positive affect items were reverse among Blacks compared to Whites.
Black-White differences exist in the association between baseline depressive symptoms and subsequent risk of MDD >15 years. Ethnic differences in the longitudinal link between baseline CES-D and subsequent risk of MDD may explain some of the Black-White differences in social, psychological, and medical correlates of depressive symptoms and depression. Future research is still needed to compare Blacks and Whites for factor structure of the CES-D.
黑人和白人在抑郁症状和重度抑郁症（MDD）的社会心理和医学相关因素方面存在差异。本纵向研究比较了黑人与白人在 15 年后，基线抑郁症状与随后 MDD 风险之间的关联。
数据来自美国人生活变化（ACL）研究，该研究于 1986 年至 2001 年期间纳入了 3361 名参与者（2205 名白人，1156 名黑人）。使用 1986 年的 11 项中心流行病学研究抑郁量表（CES-D）测量基线抑郁症状，作为预测指标。2001 年使用复合国际诊断访谈（CIDI）测量 12 个月 MDD 的结局。1986 年还测量了基线社会人口统计学（SES）、经济困难、慢性疾病（CMC）和自我报告健康（SRH）等协变量。使用逻辑回归模型评估了基线 CES-D 评分与 15 年后 CIDI 为基础的 MDD 之间的关联，调整了人口统计学、SES、CMC 和 SRH。该模型应用于混合样本以及黑人与白人中。还报告了基于种族的 CES-D 的可靠性和因子结构的数据。
在混合样本中，我们发现种族与基线抑郁症状之间存在交互作用，这表明与黑人相比，白人的基线抑郁症状对随后发生 MDD 的风险的影响更大。这种交互作用在调整 SES 和基线健康状况后仍然显著。基于我们的特定于种族的模型，在白人中，但不在黑人中，基线 CES-D 评分可预测 15 年后随后发生 MDD 的风险，调整基线 SES 和健康状况后。不能将 CES-D 评分对 MDD 的预测作用中的黑人和白人之间的差异归因于 CES-D 的可靠性的种族差异，因为黑人的 CES-D 可靠性甚至高于白人。与白人相比，黑人的 CES-D 积极影响项目的负荷呈反向。
在基线抑郁症状与随后 15 年以上的 MDD 风险之间存在黑人和白人之间的差异。基线 CES-D 与随后发生 MDD 之间的纵向联系的种族差异可能解释了抑郁症状和抑郁症的社会心理和医学相关因素中黑人和白人之间的一些差异。仍需要对黑人和白人进行比较，以比较 CES-D 的因子结构。
