Depression Risk Evaluation Works Better Among Whites Than Blacks

A new study finds that standard ways of assessing depression risk may not work as well among black adults as white adults. The study, published Frontiers in Public Health, presents results from a new analysis of long-term data from the Americans’ Changing Lives study.

Investigators Ehsan Moazen-Zadeh, MD, of the Medicine and Health Promotion Institute in Tehran, Iran, and Shervin Assari, MD, MPH, of the University of Michigan, studied 2205 white adults and 1156 black adults who took a standard depression screening test, the Center for Epidemiologic Studies Depression Scale (CES-D), at the beginning of their involvement in the study.

Fifteen years later, the subjects underwent a much more detailed interview meant to assess their mental health, and investigators compared the association between depressive symptoms and subsequent risk of Major Depressive Disorder (MDD) among black and white study subjects. Worldwide, MDD is among the 4 conditions with the highest contribution to years of life lost due to disability.

The CES-D is one of the most widely used survey instruments, asking a range of questions about emotions, appetite, sleep, and energy levels. The question of whether the CES-D provides comparable results for whites and blacks in clinical and community settings has been the subject of debate, with some studies implying that CES-D scores may differently represent true depression in whites and blacks.

Although study subjects who scored high on depressive symptoms at the beginning of the study were, in fact, more likely to meet the definition of having MDD at the later date, the research yielded a surprise: white participants whose answers on the initial screening suggested a risk for depression were more likely to have MDD at the time of the later interview. But this was not the case for black study subjects, and the difference remained even after the researchers corrected for differences in participants’ social, economic, and physical health.

For black participants, the factor that did seem to predict later depression was study subjects’ self-rated health. Blacks whose self-reported health status was worse at the start were more likely to have MDD 15 years later on.

Dr Assari noted that their findings question the universal applicability of a tool that has been developed and validated for whites.

“The results also have major implications for screening and treatment of depression in black communities,” he said.

The authors said their work does not undercut the validity of the CES-D in measuring the risk of depression reliably: the test was more reliable in blacks than whites at each time point, but its use in predicting long-term risk of depression in blacks may be lower.