MDD More Severe In Black Than White Patients

PsychiatryMatters.md News Watch, March 15, 2007

Black people are less likely to get major depression than White people, but when they do it tends to be more severe, persistent, and disabling, researchers report.

The study results also highlight the need to improve treatment among Black patients with major depressive disorder (MDD).

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The researchers estimated the prevalence, persistence, and treatment of depression as well as its disabling characteristics in 3570 African Americans, 1621 Caribbean Blacks, and 891 non-Hispanic White people participating in the National Survey of American Life. All the participants were at least 18 years old.

White patients had the highest lifetime prevalence of MDD, at 17.9%, followed by Caribbean Blacks, at 12.9%, and African Americans, at 10.4%. However, 12-month MDD estimates were similar across the three groups.

Despite having a lower prevalence of MDD, Black patients of both ethnicities were significantly more likely than White patients to have chronic MDD. The ratio of patients with 12-month MDD in the sample of lifetime cases indicated chronic MDD for 56.5% of African Americans and 56.0% of Caribbean Blacks, compared with 38.6% of White patients.

Reporting the findings in the Archives of General Psychiatry, the team stresses the burden of MDD on Black patients.

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More Black than White patients reported severe or very severe impairment in their daily activities, at 74.4% versus 63.6%. While this did not reach statistical significance, significant differences were seen when daily activities were divided into home, work, relationship, and social domains.

Social function appeared to be the domain most affected, with 55.4% of Black patients, compared with 34.2% of White patients, reporting high levels of impairment.

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Results From the National Survey of American Life

Context Little is known about the relationship between race/ethnicity and depression among US blacks.

Objective To estimate the prevalence, persistence, treatment, and disability of depression in African Americans, Caribbean blacks, and non-Hispanic whites in the National Survey of American Life.

Design A slightly modified adaptation of the World Health Organization World Mental Health version of the Composite International Diagnostic Interview.

Setting National household probability samples of noninstitutionalized African Americans, Caribbean blacks, and non-Hispanic whites in the United States conducted between February 2, 2001, and June 30, 2003.

Participants A total of 3570 African Americans, 1621 Caribbean blacks, and 891 non-Hispanic whites aged 18 years and older (N = 6082).

Main Outcome Measures Lifetime and 12-month diagnoses of DSM-IV major depressive disorder (MDD), 12-month mental health services use, and MDD disability as quantified using the Sheehan Disability Scale and the World Health Organization’s Disability Assessment Schedule II.

Results Lifetime MDD prevalence estimates were highest for whites (17.9%), followed by Caribbean blacks (12.9%) and African Americans (10.4%); however, 12-month MDD estimates across groups were similar. The chronicity of MDD was higher for both black groups (56.5% for African Americans and 56.0% for Caribbean blacks) than for whites (38.6%). Fewer than half of the African Americans (45.0%) and fewer than a quarter (24.3%) of the Caribbean blacks who met the criteria received any form of MDD therapy. In addition, relative to whites, both black groups were more likely to rate their MDD as severe or very severe and more disabling.

Conclusions When MDD affects African Americans and Caribbean blacks, it is usually untreated and is more severe and disabling compared with that in non-Hispanic whites. The burden of mental disorders, especially depressive disorders, may be higher among US blacks than in US whites.

Author Affiliations Departments of Sociology (Dr Williams), Epidemiology (Dr Williams), Psychiatry (Dr Nesse), and Psychology (Dr Jackson), Institute for Social Research (Drs Williams and Jackson and Mss Abelson and Sweetman), and Department of Health Behavior and Health Education, School of Public Health (Dr Neighbors), University of Michigan, Ann Arbor; and Institute of Gerontology and Department of Family Medicine, Wayne State University, Detroit, Mich (Dr González). Dr Williams is currently at the Harvard School of Public Health, Boston, Mass.

[Editor’s Note: The complete article can be downloaded here. (Subscription required.)]

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