Sensitivity and specificity of Aboriginal-developed items to supplement the adapted PHQ-9 screening measure for depression: results from the Getting it Right study.

OBJECTIVE: To determine the psychometric properties of an Aboriginal and Torres Strait Islander-developed depressive symptom screening scale. DESIGN: Prospective diagnostic accuracy study. SETTING: Ten primary health care services or residential alcohol and other drug rehabilitation services in Australia that predominantly serve Aboriginal and Torres Strait Islander peoples. PARTICIPANTS: 500 adults (18 years or older) who identified as Aboriginal and/or Torres Strait Islander and were able to communicate sufficiently to respond to questionnaire and interview questions. Recruitment occurred between 25 March 2015 and 2 November 2016. MAIN OUTCOME MEASURE: Criterion validity of seven Aboriginal and Torres Strait Islander-developed items, using the adapted Patient Health Questionnaire 9 (aPHQ-9) and depression module of the Mini International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standards. RESULTS: The seven-item scale had good internal consistency (α = 0.83) and correlated highly with the aPHQ-9 (ρ = 0.76). All items were significantly associated with diagnosis of a current major depressive episode. Discriminant function and decision tree analysis identified three items forming a summed scale that classified 85% of participants correctly. These three items showed equivalent sensitivity and specificity to the aPHQ-9 when compared with the MINI-identified diagnosis of a current major depressive episode. CONCLUSION: Three items developed by and for Aboriginal and Torres Strait Islander people may provide effective, efficient and culturally appropriate screening for depression in Aboriginal and Torres Strait Islander health care contexts.

Management of Depression in Adults: A Review.

Importance: Approximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women. Observations: Major depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression. A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]). Conclusions and Relevance: Effective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success.

The more you need, the less you get: Intersectionality and the inverse care law in the Brazilian depression care cascade.

Substantial research has shown that the population distribution of major depressive disorder (MDD) is strongly influenced by race, gender, and socioeconomic position. However, a deeper understanding of inequities in access to care for MDD according to these social markers is yet to be reached. We use data from the 2019 Brazilian National Health Survey, which includes 87,187 respondents aged 18 years and over, to test two hypotheses derived from the inverse care law: women, Black, and low-education respondents have higher frequencies of MDD, but lower access to each step of the depression care cascade, including diagnosis by a health professional, regular healthcare visits, and access to specialised treatment (H1); low-education Black women show the highest MDD frequency and the lowest access to care across the entire cascade (H2). Partially supporting H1 and H2, our results reveal a bottleneck in the first step of the depression care cascade. While no racial inequities were observed in the MDD prevalence, Black individuals were less likely than whites to be diagnosed by a health professional (OR 0.74). Women (OR 2.64) and low-education (OR 1.18) were more likely to have probable MDD in relation to men and high-education respondents, respectively, but only women (OR 1.58) were more likely to be diagnosed. Low-education Black women were equally more likely to have probable MDD (OR 3.11) than high-education white men. Conversely, high-education white women emerged as the most likely to be diagnosed with MDD (OR 1.63). Our findings suggest the inverse care law applies to the depression care cascade in Brazil through indication that its healthcare system perpetuates a multilayered system of oppression that overlooks multiply marginalised individuals. We also show that adequate screening by health care professionals should mitigate the complex patterns of inequity revealed by our study.

Race, Ethnicity, and Clinical Features of Alcohol Use Disorder Among US Military Veterans: Results From the National Health and Resilience in Veterans Study.

BACKGROUND AND OBJECTIVES: Alcohol use disorder (AUD) is highly prevalent in US military veterans, though little is known about whether the psychiatric comorbidities and functional outcomes (ie, clinical features) of AUD differ across race/ethnic groups. We aimed to identify differences in the clinical features of veterans with AUD by race/ethnicity. METHODS: In a sample of veterans with AUD (n = 1212) from the nationally representative National Health and Resilience in Veterans Study, we compared the clinical features associated with AUD across racial/ethnic groups using analysis of covariance and logistic regression. RESULTS: Black veterans (n = 60, 34.0%) were less likely to screen positive for lifetime AUD compared with white (n = 1099, 42.7%) and Hispanic (n = 53, 41.5%) veterans. Among those with lifetime AUD, Hispanic veterans were more likely than white veterans to have lifetime and current mood or anxiety disorders (adjusted odds ratio range [AORR] = 2.21-2.52, P < .05). Black veterans were more likely than white veterans to have current mood and anxiety disorders (AORR = 2.01-3.07, P < .05). Hispanic veterans reported poorer functioning and quality of life than white and black veterans (Cohen's d range = 0.12-0.37, P < .05). DISCUSSION AND CONCLUSIONS: Black and Hispanic veterans with lifetime AUD may experience a higher disease burden relative to white veterans. Results underscore the importance of race/ethnicity-sensitive assessment, monitoring, and treatment of AUD for veterans. SCIENTIFIC SIGNIFICANCE: This is the first known study to examine differences by race/ethnicity in the clinical features of Veterans with AUD in a nationally representative sample. Findings suggest higher disease burden for racial/ethnic minority veterans. (Am J Addict 2021;30:26-33).

Polygenetic Risk Scores for Major Psychiatric Disorders Among Schizophrenia Patients, Their First-Degree Relatives, and Healthy Participants.

BACKGROUND: The genetic etiology of schizophrenia (SCZ) overlaps with that of other major psychiatric disorders in samples of European ancestry. The present study investigated transethnic polygenetic features shared between Japanese SCZ or their unaffected first-degree relatives and European patients with major psychiatric disorders by conducting polygenic risk score (PRS) analyses. METHODS: To calculate PRSs for 5 psychiatric disorders (SCZ, bipolar disorder [BIP], major depressive disorder, autism spectrum disorder, and attention-deficit/hyperactivity disorder) and PRSs differentiating SCZ from BIP, we utilized large-scale European genome-wide association study (GWAS) datasets as discovery samples. PRSs derived from these GWASs were calculated for 335 Japanese target participants [SCZ patients, FRs, and healthy controls (HCs)]. We took these PRSs based on GWASs of European psychiatric disorders and investigated their effect on risk in Japanese SCZ patients and unaffected first-degree relatives. RESULTS: The PRSs obtained from European SCZ and BIP patients were higher in Japanese SCZ patients than in HCs. Furthermore, PRSs differentiating SCZ patients from European BIP patients were higher in Japanese SCZ patients than in HCs. Interestingly, PRSs related to European autism spectrum disorder were lower in Japanese first-degree relatives than in HCs or SCZ patients. The PRSs of autism spectrum disorder were positively correlated with a young onset age of SCZ. CONCLUSIONS: These findings suggest that polygenic factors related to European SCZ and BIP and the polygenic components differentiating SCZ from BIP can transethnically contribute to SCZ risk in Japanese people. Furthermore, we suggest that reduced levels of an ASD-related genetic factor in unaffected first-degree relatives may help protect against SCZ development.

Depressive role impairment and subthreshold depression in older black and white women: race differences in the clinical significance criterion.

OBJECTIVES: We examined race differences in the DSM-IV clinical significance criterion (CSC), an indicator of depressive role impairment, and its impact on assessment outcomes in older white and black women with diagnosed and subthreshold depression. DESIGN: We conducted a secondary analysis of a community-based interview study, using group comparisons and logistic regression. SETTING: Lower-income neighborhoods in a Midwestern city. PARTICIPANTS: 411 community-dwelling depressed and non-depressed women ≥ 65 years (45.3% Black; mean age = 75.2, SD = 7.2) recruited through census tract-based telephone screening. MEASUREMENTS: SCID interview for DSM-IV to assess major depression and dysthymia; Center for Epidemiologic Studies-Depression Scale to define subthreshold depression (≥16 points); Mini-Mental State Examination, count of medical conditions, activities of daily living, and mental health treatment to assess health factors. RESULTS: Black participants were less likely than Whites to endorse the CSC (11.8% vs. 24.1%; p = .002). There were few race differences in depressive symptom type, severity, or count. Blacks with subthreshold depression endorsed more symptoms, though this comparison was not significant after adjustments. Health factors did not account for race differences in CSC endorsement. Disregarding the CSC-eliminated differences in diagnosis rate, race was a significant predictor of CSC endorsement in a logistic regression. CONCLUSIONS: Race differences in CSC endorsement are not due to depressive symptom presentations or health factors. The use of the CSC may lead to underdiagnosis of depression among black older adults. Subthreshold depression among Blacks may be more severe compared to Whites, thus requiring tailored assessment and treatment approaches.

Prevalence and factors associated with diagnosed depression among hospitalized cancer patients with metastatic disease.

PURPOSE: This study aimed to examine the factors associated with diagnosed depression among patients with a metastatic cancer. METHODS: We conducted a cross-sectional analysis of 39,223 hospital records from 2008 to 2013 National Inpatient Sample for patients with metastatic cancer. Diagnosed depression was defined using ICD-9-CM for major depression. Weighted, multivariable hierarchical regression model was used to examine the association between sociodemographic and clinical factors and depression among patients with a metastatic cancer. RESULTS: The prevalence of clinically diagnosed depression in patients with a metastatic cancer in our study sample was 7.3% (5.9% for males and 8.6% for females). The prevalence rate of diagnosed depression increased from 5.3 to 9.4% between 2008 and 2013. In multivariable analysis, patients were more likely to be diagnosed with depression if they were females (aOR = 1.44; 95% CI 1.25-1.66) compared to males; and had higher number of comorbidities (aOR = 1.11 per 1-unit increase in Elixhauser comorbidity score, 95% CI 1.07-1.15). In contrast, patients were less likely to be diagnosed with depression if they were blacks (aOR = 0.59; 95% CI 0.47-0.74) or other race (aOR = 0.58; 95% CI 0.47-0.72) compared with white patients. CONCLUSIONS: Women and individuals with more comorbidities were diagnosed with depression more frequently, whereas black patients were diagnosed less. Our findings could help providers to identify hospitalized patients with the higher risk of depression and screened patients with signs and symptoms of clinical depression.

Double-blind, placebo-controlled study of lurasidone monotherapy for the treatment of bipolar I depression.

AIM: Previous studies conducted primarily in the USA and Europe have demonstrated the efficacy and safety of lurasidone 20-120 mg/day for the treatment of bipolar I depression. The aim of the current study was to evaluate the efficacy and safety of lurasidone monotherapy for the treatment of bipolar I depression among patients from diverse ethnic backgrounds, including those from Japan. METHODS: Patients were randomly assigned to double-blind treatment for 6 weeks with lurasidone, 20-60 mg/day (n = 184) or 80-120 mg/day (n = 169), or placebo (n = 172). The primary end-point was change from baseline to Week 6 on the Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS: Lurasidone treatment significantly reduced mean MADRS total scores from baseline to Week 6 for the 20-60-mg/day group (-13.6; adjusted P = 0.007; effect size = 0.33), but not for the 80-120-mg/day group (-12.6; adjusted P = 0.057; effect size = 0.22) compared with placebo (-10.6). Treatment with lurasidone 20-60 mg/day also improved MADRS response rates, functional impairment, and anxiety symptoms. The most common adverse events associated with lurasidone were akathisia and nausea. Lurasidone treatments were associated with minimal changes in weight, lipids, and measures of glycemic control. CONCLUSION: Monotherapy with once daily doses of lurasidone 20-60 mg, but not 80-120 mg, significantly reduced depressive symptoms and improved functioning in patients with bipolar I depression. Results overall were consistent with previous studies, suggesting that lurasidone 20-60 mg/day is effective and safe in diverse ethnic populations, including Japanese.

Depression Illness Representations Among Arabs in Israel: a Qualitative Study Comparing Younger and Older Adults.

There has been a noticeable increase in the number of studies assessing perceptions regarding depression (illness representations) among people diagnosed with the disorder. However, these studies have examined mainly younger adults (ages 18 to 65), and very little is known about older adults. This study examined illness representations among younger and older Israeli Arabs with depression based on the Self-Regulation Model (SRM). A total of 12 Israeli Arabs (six younger adults aged 18-64 and six older adults aged 65+) diagnosed with depression took part in semi-structured, in-depth interviews. The majority of the participants in the younger group were female and married, compared to the older group which has a gender equal ratio, half of which are married. The data were analyzed thematically, guided by the SRM illness representations' dimensions (identity; timeline; cause; consequences; control/cure; cyclical and coherence; and emotional representations). Differences between younger and older adults were found in some of the illness representations. Older adults described depression as a chronic illness associated with somatic symptoms, and did not believe in psychological treatment. Younger adults did not perceive depression as chronic, reported cognitive and emotional symptoms, and believed in the efficacy of psychological treatment. Our findings indicated that participants' perceptions about depression appeared to be associated with their age, along with their unique cultural background as they are traditional but undergoing processes of modernization. This study stress the importance of illness representations in intervention programs tailored for different age groups, and considering their specific cultural needs.

Depression and cause-specific mortality in an ethnically diverse cohort from the UK: 8-year prospective study.

BACKGROUND: Depression is associated with increased mortality, however, little is known about its variation by ethnicity. METHODS: We conducted a cohort study of individuals with ICD-10 unipolar depression from secondary mental healthcare, from an ethnically diverse location in southeast London, followed for 8 years (2007-2014) linked to death certificates. Age- and sex- standardised mortality ratios (SMRs), with the population of England and Wales as a standard population were derived. Hazard ratios (HRs) for mortality were derived through multivariable regression procedures. RESULTS: Data from 20 320 individuals contributing 91 635 person-years at risk with 2366 deaths were used for analyses. SMR for all-cause mortality in depression was 2.55(95% CI 2.45-2.65), with similar trends by ethnicity. Within the cohort with unipolar depression, adjusted HR (aHRs) for all-cause mortality in ethnic minority groups relative to the White British group were 0.62(95% CI 0.53-0.74) (Black Caribbean), 0.53(95% CI 0.39-0.72) (Black African) and 0.69(95% CI 0.52-0.90) (South Asian). Male sex and alcohol/substance misuse were associated with an increased all-cause mortality risk [aHR:1.94 (95% CI 1.68-2.24) and aHR:1.18 (95% CI 1.01-1.37) respectively], whereas comorbid anxiety was associated with a decreased risk [aHR: 0.72(95% CI 0.58-0.89)]. Similar associations were noted for natural-cause mortality. Alcohol/substance misuse and male sex were associated with a near-doubling in unnatural-cause mortality risk, whereas Black Caribbean individuals with depression had a reduced unnatural-cause mortality risk, relative to White British people with depression. CONCLUSIONS: Although individuals with depression experience an increased mortality risk, marked heterogeneity exists by ethnicity. Research and practice should focus on addressing tractable causes underlying increased mortality in depression.

Racial/Ethnic Disparities in Receipt of Electroconvulsive Therapy for Elderly Patients With a Principal Diagnosis of Depression in Inpatient Settings.

OBJECTIVE: Electroconvulsive therapy (ECT) is underused despite being among the most effective treatments for older adults with severe, pharmacotherapy-resistant mood disorders. Furthermore, those in minority groups are even less likely to receive ECT. The objective of this study was to examine racial and ethnic disparities in the receipt of ECT in older adults. METHODS: We used survey-weighted log-binomial regression to generate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) that represented the associations between race/ethnicity and receipt of ECT during hospitalization at an ECT-available hospital. We used data from the 2002-2015 National Inpatient Sample, the largest all-payer inpatient database in the United States. The analysis was restricted to hospitalizations of adults aged 65-95 with depression as a principal diagnostic code. The primary exposure was patient race/ethnicity, and the primary outcome was receipt of ECT during hospitalization, restricted to ECT-available hospitals. RESULTS: Among the 685,939 patients included in the analysis, 45% received care at an ECT-available hospital, and among those, 17% received ECT. Non-Hispanic (NH) blacks were nearly half as likely to receive ECT as NH whites (aPR: 0.56 [0.47-0.81]; t: -6.42; df: 1,327; p < 0.001). Hispanics were nearly half as likely to receive ECT as NH whites (aPR: 0.57 [0.44-0.72]; t: -4.59; df: 1,327; p < 0.001). CONCLUSION: This national cross-sectional study of racial/ethnic disparities in receipt of ECT among depressed elderly patients confirms prior literature and reveals the potential worsening of disparities for racial/ethnic minorities blacks.

Getting it Right: validating a culturally specific screening tool for depression (aPHQ-9) in Aboriginal and Torres Strait Islander Australians.

OBJECTIVES: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people. DESIGN: Prospective observational validation study, 25 March 2015 - 2 November 2016. SETTING, PARTICIPANTS: 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions. MAIN OUTCOME MEASURES: Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard. RESULTS: 108 of 500 participants (22%; 95% CI, 18-25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40-68%), its specificity was 91% (95% CI, 88-94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85-0.92); with a cut-point of 10 points its sensitivity was 84% (95% CI, 74-91%) and its specificity 77% (95% CI, 71-83%). The aPHQ-9 was deemed acceptable by more than 80% of participants. CONCLUSIONS: Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good.

Testing a somatization hypothesis to explain the Black-White depression paradox.

PURPOSE: Epidemiologic studies document a lower prevalence of major depression in Blacks than Whites in the United States. This is paradoxical from the perspective of social stress theory. A long-standing claim in the (clinical) literature is that Blacks express depression more somatically than Whites. If true, the diagnostic algorithm may undercount depression in Blacks, since the screening symptoms privilege the psychological rather than somatic dimensions of depression. We test hypotheses that (1) Blacks express depression more somatically than Whites which (2) reduces their likelihood of endorsing screening symptoms, thereby undercounting Blacks' depression and explaining the Black-White depression paradox. METHODS: We use cross-sectional data collected in 1991-92 from the National Longitudinal Alcohol Epidemiologic Survey (n = 42,862) among Blacks and Whites endorsing at least one past-12-month depression symptom. We compare groups on depression somatization and test whether greater somatization in Blacks leads to lower endorsement of psychological screening symptoms, and therefore under-diagnosis. RESULTS: Blacks have higher mean depression somatization scores than Whites (0.28, SE 0.04 vs. 0.15, SE 0.02), t(122) = - 2.15, p = 0.03. This difference is small and driven by Blacks' higher endorsement of 1 somatic symptom (weight/appetite change) and Whites' greater propensity to endorse psychological symptoms. However, Blacks have the same odds as Whites of endorsing screening symptoms, before and after adjusting for somatization. CONCLUSIONS: We find minimal evidence that Blacks express depression more somatically than Whites. Furthermore, this small difference does not appear to inhibit endorsement of diagnostic depression screening symptoms among Blacks, and therefore does not resolve the Black-White depression paradox.

African Americans and Caribbean Blacks: Perceived neighborhood disadvantage and depression.

The purpose of this study was to advance a theoretical understanding of the effects of impoverished neighborhoods on mental health and to inform policy measures encouraging residents to leave such neighborhoods. To do this, we investigated whether individuals' perceived neighborhood disadvantage served as a risk factor for clinical depression in a nationally representative sample of African Americans and Caribbean Blacks. We performed logistic regression analysis on stratified socioeconomic status (SES) subsamples from the National Survey of American Life sample of 5,019 African Americans and Caribbean Blacks. The association between perceived neighborhood social disorder and past-year depression was statistically significant for low-SES individuals (at or below the federal poverty line; odds ratio [OR] = 1.73, 95% confidence interval [CI] [1.07, 2.81], p = 0.026) and at the boundary of significance for middle-SES individuals (between 100% and 300% of the poverty line; OR = 1.74, 95% CI [1.00, 3.02], p = 0.052), but not for high-SES individuals (at or above 300% of the poverty line). Results suggest, at least for low- and middle-income African Americans, perceived neighborhood social disorder is a risk factor for depression. U.S. housing policies aimed at neighborhood improvement and poverty de-concentration may benefit the mental health of low-income African Americans and Caribbean Blacks.

Perceived Discrimination and Major Depression and Generalized Anxiety Symptoms: In Muslim American College Students.

Prior research has found that Muslim Americans' discrimination experiences are associated with increased risk of mental health problems. However, few studies have included Muslim American college students or identified moderators of this relationship. Among a sample of Muslim American college students (N = 141), the current study found that perceived discrimination was positively associated with MD and GAD symptom severity. Having a strong Muslim American identity exacerbated the relationship between perceived discrimination and GAD symptoms. The findings support practices to reduce discrimination toward Muslim American college students and the need for outreach to students with a strong Muslim American identity.

Determinants of Mental Disorders in Syrian Refugees in Turkey Versus Internally Displaced Persons in Syria.

OBJECTIVES: To compare frequencies of some mental health disorders between Syrian refugees living in Turkey and internally displaced persons in Syria, and to identify factors associated with posttraumatic stress disorder and major depressive disorder. METHODS: We carried out a field survey in May 2017 among 540 internally displaced persons in Syria and refugees in Turkey. RESULTS: The study revealed that mental disorders were highly prevalent in both populations. Major depressive disorder was more frequent among refugees in Turkey than among internally displaced persons in Syria; other mental disorders, including posttraumatic stress disorder, were more prevalent in the latter than in the former. Posttraumatic stress disorder was also associated with postmigration factors. Major depressive disorder was more likely among refugees in Turkey. In addition, the likelihood of major depressive disorder was predicted by stopping somewhere else before resettlement in the current location. CONCLUSIONS: The resettlement locus and the context and type of displacement seem to be important determinants of mental health disorders, with postmigration factors being stronger predictors of conflict-related mental health. Internally displaced persons may benefit more from trauma-focused approaches, whereas refugees may derive greater benefit from psychosocial approaches.

Screening and follow-up for depression among Arab Americans.

BACKGROUND: The authors compared proportions and associations of depression screening, major depression, and follow-up care of Arab Americans compared to non-Hispanic whites, non-Hispanic blacks, Asians, and Hispanics. METHODS: Administrative data was electronically abstracted from a large health system in metropolitan Detroit among 97,918 adult patients in 2014 and 2015. A valid and reliable surname list was used to identify Arab Americans. Using chi-squares, we examined the relationship between race/ethnicity and depression screening, major depression, and follow-up care. We calculated odds ratios (OR) and 95% confidence intervals (CI) to examine the relationship between the main independent variable of race/ethnicity and the dependent variables of depression screening and major depression while controlling for confounders. RESULTS: Arab American women were 23% less likely to be screened for depression compared to non-Hispanic white women (OR = 0.77; 95% CI = 0.70, 0.86). The age- and sex-adjusted proportions of major depression were 5.5% for Arab Americans compared to 7.0% for Hispanics, 6.0% for non-Hispanic blacks, 5.9% for non-Hispanic whites, and 1.5% for Asians. Arab Americans with major depression were less likely to follow up with a behavioral specialist and more likely to follow up with a primary care physician compared to other racial and ethnic groups. CONCLUSIONS: Our study adds to the discourse on depression care among Arab Americans by highlighting the existing disparities related to adequate screening and appropriate management of depression. Future studies should include information about the influences of acculturation, culture, stigma, family, and religion on depression care.

Differences in the cognitive profile of depression between racial groups.

BACKGROUND: There is little research concerning whether race is associated with different clinical presentations of psychiatric disorders. Understanding the racial aspects of cognitive differences among depressed adults could help identify specific targets for depression treatment. METHODS: We recruited 59 participants (52.5% white, 47.5% African American), age 18 to 60, with a current diagnosis of major depressive disorder (MDD). All participants underwent a cognitive battery that included tasks assessing decision-making, response inhibition, working memory, and executive planning. Differences between white and African American groups were analyzed using analysis of variance or equivalent nonparametric tests. RESULTS: There were no differences in demographic variables of age, sex, and education, but white individuals reported a significantly earlier age of first depressive episode compared with African American individuals. The African American group, however, showed significantly lower quality of decision-making and less risk adjustment on the Cambridge Gambling Task, and made more errors on the Spatial Working Memory task. CONCLUSIONS: Our finding that specific cognitive domains differ as a function of racial differences in MDD might have differential prognostic and treatment implications.

Impact of culture on autobiographical life structure in depression.

OBJECTIVES: Distortions in autobiographical memory have been implicated in major depressive disorder (MDD). Those with MDD demonstrate a 'depressogenic' autobiographical life structure. Research has not examined how culture influences this process. We investigated whether Malay individuals (members of an interdependent culture) with MDD demonstrated a 'depressogenic' autobiographical life structure similar to that of British individuals (members of an independent culture) with MDD. DESIGN: A 2 (Culture; Malay, British) × 2 (Mood; depressed, control) cross-sectional design using a card sort task and self-report measures was used. METHODS: Malay individuals with MDD or no history of MDD completed the life-structure card-sorting task, which provided a novel method for investigating organizational structure of the life narrative. These data were compared to previously collected data in which British individuals with MDD or without MDD had completed the same task within the same experimental protocol. RESULTS: Pan-culturally those with MDD had greater negativity (i.e., used more negative attributes), negative redundancy (i.e., used the same negative attributes repeatedly across life chapters) and negative emodiversity (i.e., had greater variety and relative abundance of negative attributes), and reduced positive redundancy (i.e., used the same positive attributes repeatedly across chapters) in their structuring relative to controls. While the British MDD group had greater compartmentalization (i.e., the negative and positive attributes were clustered separately across different chapters) than British controls, the Malay MDD group had lower levels of compartmentalization than Malay controls. CONCLUSIONS: The findings suggest culture may shape aspects of the autobiographical life structure in MDD. PRACTITIONER POINTS: The majority of the literature investigating depression pertains to individuals from European Western cultures, despite recognition that depression ranks as one of the most debilitating diseases worldwide. This raises questions as to whether current depression models and interventions can be applied universally or whether they are limited to European Western groups. The current study found that pan-culturally those with MDD had similar structuring of their life story relative to controls. However, there were some cultural differences that need to be considered (e.g., Malay individuals provided less detailed, less elaborate and less emotionally diverse life stories and while the British MDD group had greater compartmentalization than British controls, the Malay MDD group had lower levels of compartmentalization than Malay controls). Limitations of the study included group differences in gender and mood at the time of testing. Cultural differences in the number of attributes used may have influenced findings. Only the Malay group completed the individualism-collectivism measure.

Identifying the role of sociodemographic factors in major depressive disorder and suicidality among Spanish-speaking Latino patients in a federally qualified health center.

Rates of suicide and major depressive disorder (MDD) are currently at the highest point in the history of the United States (US). However, these rates are not distributed evenly among the population and Latinos show disproportionately high rates of both suicide and MDD. Yet, past research has infrequently explored factors related to suicide and MDD in primary care settings that serve as the major community portal for mental health among the Latino population. Thus, the current study investigated sociodemographic variables (marital status, nativity, education, employment, primary language, age, and gender) in terms of their relations with suicidal ideation, suicide risk, MDD, and MDD symptom severity among Latino primary care patients in a Federally Qualified Health Center (N = 634, M age = 39.46, SD = 11.46, 87.1% female). Results indicated that gender and Nativity were associated with suicidal ideation, older age was associated with suicide risk, and higher education and having a partner were negatively associated with MDD and depressive symptom severity. These results provide novel insight into the role of sociodemographic factors predicting suicide and MDD among Latinos in primary care, and suggest greater scientific and clinical attention can be focused on certain sociodemographic factors to offset mental health disparities among this group.