Caregiving, residence, race, and depressive symptoms.

The objective of this study is to evaluate the psychological responses to caregiving between black and white dementia caregivers measured by self-reports of depressive symptoms evaluating the impact of sub-components of the Center for Epidemiologic Studies Depression Scale (CES-D) and residential arrangements of the caregiving dyad. The method included 87 intergenerational family caregivers enrolled in the Duke Caregiver Study (50 white and 37 black). Total CES-D and the four sub-components were modeled as dependent measures in separate linear regressions. Three models were examined. The first model tested race, living arrangements, and their interaction. The second model adjusted for age, gender, education, income, health status, cultural justification for caregiving, crime concerns, systolic blood pressure, diastolic blood pressure, and glycosylated hemoglobin. A third model added adjustment for caregiver burden. The results showed that there was a significant race by residence interaction for CES-D, somatic symptoms and depressive affect such that when the dyads are living apart-with the care recipient in their own home or in an institutional setting-whites reported more depressive symptoms than blacks. When the dyads lived together, this was reversed, and blacks reported higher depressive symptoms than whites. To conclude, all the parameters such as race, living arrangements, and the components of depression need to be taken into account to understand the impact of caregiving on the emotional health of caregivers.

Hostile behaviors predict cardiovascular mortality among men enrolled in the Multiple Risk Factor Intervention Trial.

BACKGROUND: Hostility is associated with incident coronary disease in most large population-based studies, but little is known about its association with cardiovascular disease (CVD) mortality in high-risk individuals. The aim of this study was to assess the association of hostility with CVD mortality in the subsequent 16 years in the Multiple Risk Factor Intervention Trial (MRFIT) participants and to explore the influence of hostility in the subset that had a nonfatal CVD event during the trial. METHODS AND RESULTS: We coded the Structured Interview responses of 259 men who died of CVD during the 16 years of follow-up and 259 matching living control subjects. Signs of hostility were assessed by use of the Interpersonal Hostility Assessment Technique. Matching was based on center, intervention group, age, race, and interviewer; covariates included study entry diastolic blood pressure, cholesterol, smoking status, and nonfatal CVD event during the trial. High-hostile men were more likely to die of CVD than were low-hostile men. Adjusted odds ratio (OR) and 95% confidence intervals (CIs) were 1.61, 1.09 to 2.39. After the trial, high-hostile men who also had a nonfatal event during the trial were particularly likely to die of CVD, OR, 5.06, 1.42 to 8.22, compared with low-hostile men without a nonfatal event during the trial. CONCLUSIONS: Hostility may be a risk factor for CVD mortality among high-risk men. Interventions aimed at anger management and stress reduction along with risk factor modification may be useful for hostile patients.

Community recruitment process by race, gender, and SES gradient: lessons learned from the Community Health and Stress Evaluation (CHASE) Study experience.

Recruitment of community participants for clinical research studies is a challenging task. When possible, community-based recruitment efforts should involve members of the targeted community in the planning, community preparation, and actual recruitment process. It becomes even more difficult to recruit study participants from the community when the research involves an invasive procedure, or when diverse target groups require that a variety of recruitment methods be used. The Community Health and Stress Evaluation (CHASE) Study was designed to determine the role of psychosocial and biobehavioral factors in the etiology of coronary heart disease. It involved both an invasive medical procedure (a spinal tap) and the collection of survey and medical information from Black and White persons in different socioeconomic status (SES) groups. Interestingly, we experienced the greatest difficulty in recruiting lower SES white persons, while groups that typically are "difficult to find" (such as Blacks) were actually easiest to recruit for the study. This paper describes the background of the CHASE study, the community recruitment methods used, and the results of the recruitment efforts by race, gender and SES gradient. We present an evaluation of the community recruitment component, why we think differences occurred, and the lessons learned from the experiences that may be applied to similar studies.