Exploring Depression Symptoms And Their Association With Perceived Stress And Locus Of Control In A Sample Of African Americans And Whites Who Share Similar Socioeconomic And Neighborhood Background.
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Type of WorkText
DepartmentPublic Health and Policy
ProgramDoctor of Public Health
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Depression is a public health problem that affects one's feelings, thinking and action, causing significant suffering and disability. It is estimated that by the year 2020, major depression will be second only to ischemic heart disease worldwide in the amount of disability experienced by sufferers. While Whites have been found to have higher odds of elevated depressive symptoms, African Americans suffer lower-than-threshold depressive symptoms, consistent with Dysthymia, a long lasting form of depressive disorder, which nonetheless contributes tremendously to the disproportionate burden associated with depression. Research has shown that both high stress and low internal locus of control are associated with elevated depressive symptoms among Whites and African Americans. However, prior studies are affected by uncontrolled confounding of socio-demographic characteristics and neighborhood environment. The present dissertation research sought to test the following hypotheses: 1) African Americans will have lower odds of elevated depressive symptoms as compared to Whites, after controlling for demographic characteristics (SES, age, gender and marital status) and other potential confounders; 2) African Americans will have higher scores of somatic or physical symptoms of depression as compared to Whites, after controlling for severity of non somatic depression symptoms; and, 3) There will be subgroup variation by race/ethnicity in the association between high stress, low internal locus of control and scores on depressive symptoms, after controlling for demographic characteristics. Data from the Community Health Urban Project, a cross sectional survey of residents of Southwest Baltimore was used for this study (n=1436). Elevated Depressive Symptoms was measured using the Patient Health Questionnaire-9 (PHQ-9), which maps to criteria for depression in the Diagnostic and Statistical Manual-IV of the American Psychiatric Association. The independent variables for the study included race, gender, age, socioeconomic status (SES), locus of control and perceived stress. Logistic regression analyses were conducted using STATA software Version 8.0. Depressive symptoms affected 12.3% of Whites and 7.1% of African Americans. A regression analysis on race showed that the odds of elevated depressive symptoms among African Americans were 50% less, relative to Whites 0.56 (95% CI=0.38-0.82, p=0.003), adjusting for all the measured demographic variables. In addition, the analysis showed that while 7.8% of White participants suffered somatic depression nearly every day, for African Americans, the rate was lower (3.3%). In other words, African Americans had lower scores on somatic depressive symptoms than Whites when all the measured demographic variables and severity of non somatic symptoms are controlled for. The analyses on the association between high stress and low internal locus of control and scores on depressive symptoms showed a significant interaction by race. White participants with low internal locus of control and high or low stress had 1.7 times higher odds of having elevated depressive symptoms as compared to African Americans in the same category (low internal with high or low stress). The findings from this study suggest that while Whites have an increased association with elevated depressive symptoms, African Americans suffer lower-than-threshold depressive symptoms, suggesting the possible occurrence of Dysthymia. The findings call for researchers in depression to look beyond currently rigidly defined approaches as well as to measure the full range of depressive symptoms among the various racial/ethnic groups. The low endorsement of anhedonia and dysphoria among African Americans calls attention to the high degree of stigma associated with mental health that prevails among this racial/ethnic group. Further studies are needed to disentangle the degree to which lower symptom endorsement is an artifact of stigma or other measurement issues.