Depression May Affect Blacks More Severely Than Whites

BOSTON, March 6 -- Depression tends to be more severe and persistent in blacks than in whites, according to a national epidemiologic study.

Furthermore, less than half of African Americans with depression receive any form of treatment, reported David R. Williams, Ph.D., of the Harvard School of Public Health here, in the March issue of Archives of General Psychiatry.

However, the lifetime prevalence of depression is higher among whites than blacks, Dr. Williams and colleagues said.

"These findings come from the largest psychiatric epidemiologic study of blacks in the United States and the first to include a large national sample of Caribbean-origin blacks," the investigators said.

Dr. Williams and colleagues analyzed data from face-to-face or telephone interviews with 3,750 African Americans, 1,621 Caribbean blacks, and 891 whites. The interviews were conducted from 2001 to 2003 as part of the National Study of American Life, a project sponsored by the National Institute of Mental Health. The samples were nationally representative, the investigators said.

The lifetime prevalence of a major depressive disorder was highest among whites (17.9%) followed by Caribbean blacks (12.9%), and African Americans (10.4%) (P

For those with severe or very severe depression, the numbers were about the same: only 48.5% of African Americans and 22% of Caribbean blacks in this category reported receiving treatment.

A chief limitation of the study was its reliance on self-reports. "We do not know the extent to which cultural factors could affect the willingness of respondents to either admit or recall the presence of symptoms during their lifetime," the investigators said.

The investigators did not speculate about why depression might be more persistent or severe in blacks, noting only that previous research has indicated blacks tend to lack access to quality health care. As far as the current study, "the data are cross-sectional, and it is not possible to identify causal associations among the factors examined," they added.

Nevertheless, "these data suggest that when blacks develop major depressive disorder, it is likely debilitating in impact and persistent in its course. It is important to find out why blacks who develop this illness have a poorer prognosis than their white counterparts," the investigators said.

"These findings underscore the pressing need to understand the factors underlying racial differences in access and quality of mental health care and the urgency of implanting interventions to eliminate these disparities," they concluded.