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Identification of and Beliefs About Depressive Symptoms and Preferred Treatment Approaches Among Community-Living Older African Americans

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Objective

To examine older African American's recognition of and beliefs about depressive symptoms, preferred symptom management strategies, and factors associated with willingness to use mental health treatments. Differences between the depressed and nondepressed and men and women were examined.

Design

Cross-sectional survey.

Setting

Home, senior center.

Participants

A total of 153 senior center members (56 male, 97 female) 55 years and older.

Measurements

Using a depression vignette, participants indicated if the person was depressed and their endorsement of items reflecting beliefs, stigma, symptom management, and willingness to use treatments (yes/no). A 9-item Patient Health Questionnaire assessed current symptomatology.

Results

Overall, 24.2% reported depressive symptoms (≥5); 88.2% correctly identified the person in the vignette as depressed. Most (≥75%) endorsed active symptom management strategies, preference for treatment in physician and therapist offices, and willingness to take medications, seek therapy, see doctor, and attend support groups; less than 33% viewed depression as stigmatizing, whereas 48% viewed depression as normal aging. Logistic regressions revealed lower education, higher physical function, and feeling okay if community knew of depression diagnosis were associated with willingness to see physician if feeling depressed; being married and believing antidepressant medications are beneficial were related to willingness to use medications. Different associations emerged for depressed/nondepressed and men and women.

Conclusions

Overall, this older African American sample had positive attitudes and beliefs and endorsed traditional treatment modalities suggesting that beliefs alone are unlikely barriers to underutilization of mental health services. Because different factors were associated with willingness to seek physician help and use medications and factors differed for depressed/nondepressed and by sex, interventions should be tailored.

Section snippets

OBJECTIVES

Depression, one of the most common and debilitating conditions in late life, continues to be underdetected and undertreated, particularly among older African Americans.1, 2, 3 In primary care, the principal setting for depression treatment with older adults, providers are less likely to spend time on mental health concerns, identify symptomatology, or offer treatment options to African Americans compared with whites.3, 4, 5 A recent national probability survey6 shows that most older African

Sample

Participants were recruited between September 2008 and August 2009 using advertisements in a Philadelphia senior center membership newsletter, Center in the Park. Eligible participants were community-living, self-identified as African American, and willing to participate in up to a 2 hour face-to-face interview. Individuals were excluded with cognitive impairment (6-item Mini-Mental State Examination telephone screen) and if in assisted living. Interested Center in the Park members contacted an

RESULTS

Overall, participants were on average 73.0 (SD = 7.8) years of age, were primarily female, single, with most having high school education or higher and reporting minimal difficulty paying for basics. Participants had an average of 5.5 (SD = 2.8) health conditions, and reported having some functional difficulty and pain. Also, this sample reported minimal use of religious/spiritual coping strategies. (Table 1)

As to sex differences, a smaller percentage of women were married than men (Pearson χ2 [

DISCUSSION

The key findings of this study are that for the sample overall, most participants recognized depressive symptoms (88.2%), endorsed active symptom management strategies (>80%), were willing to take medications (69.3%) and engage in other mental health treatments (≥75% for individual therapy, support groups, and seeing a doctor) if depressed. Only a third endorsed negative help-seeking strategies (35% would wait for feelings to pass). Although we did not have specific hypotheses regarding

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  • Cited by (0)

    This research was conducted by Dr. Gitlin and the research team while at the Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University.

    The authors thank the In Touch Mind Body & Spirit Team at Center in the Park, Executive Director and co-investigator, Lynn Fields Harris, Associate Director and co-investigator Renee Cunningham, and project manager, Delores Palmer.

    This work was supported in part by funds from the National Institute of Mental Health (grants R24 MH074779, RO1 MH079814).

    The authors declare no conflicts of interest.

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