There are limited data on depressive symptoms and antidepressant use in ethnically diverse, urban elderly.
Analysis of depressive symptom and antidepressant use data from an epidemiological survey of dementia in an ethnically diverse, urban, elderly community.
21.5% (N=566) reported clinically significant depressive symptoms. Severity was inversely associated with socioeconomic status. 7.5% (N=194) reported antidepressant medication use. Multiple logistic regression analysis adjusting for severity and other covariates showed that men and African Americans had nearly half the odds of using antidepressants. Antidepressant use was more frequent among Hispanics, those with more severe depression and more medical illness.
Combined sample; CES-D not validated in Hispanics and inner-city African Americans; depressive symptoms assessed at one time-point; lack of complete income data; geographically restricted.
In this elder sample, taking into account depressive symptom severity and other confounds, antidepressant use is nearly half as likely among men and African Americans.
Depressive symptoms; antidepressant use; epidemiology; ethnicity; gender; help-seeking
To compare rates of discussion and treatment for depression among African Americans and Whites with diabetes.
Measures of diabetes status, depressive symptoms, and history of discussing and being treated for depression were collected from 56 adults with depressive symptoms accompanying diabetes who were drawn from a larger study of type 2 diabetes.
Analyses adjusted for confounders and multiple tests indicated that relative to Whites, African Americans were 6–12 times less likely to have ever: discussed depression with anyone (p=.007), discussed depression with their primary care physician (p=.008), been prescribed an antidepressant (p=.002), and they were 25 times less likely to have seen a psychiatrist (p=.003). There were no significant differences in discussing depression with clergypersons, or family members/friends.
Compared to their White counterparts, African Americans with depressive symptoms accompanying diabetes are unlikely to discuss depression with healthcare professionals, be prescribed antidepressant medication, or be seen by a psychiatrist. Minority diabetes patients' medical and psychiatric outcomes may improve if healthcare providers more actively initiate these discussions, provide culturally-tailored education about the nature of depression and its management, incorporate patient preferences into treatment plans, and establish relationships with persons more likely to learn about African American patient symptoms.
Depression; Treatment Seeking; Disparities; Diabetes
High type 2 diabetes prevalence, associated with recent cultural changes in diet and physical activity, characterizes the U.S. territory of American Samoa. Comorbid diabetes and depression rates are high worldwide and contribute to negative diabetes outcomes; these rates have not been assessed in American Samoa. In this study, six focus groups (FGs) were conducted with 39 American Samoan adults with diabetes; questions on perceptions of diabetes and depressive symptoms were included. Thirteen healthcare staff interviews were conducted to gain further insight into diabetes care in American Samoa. FGs and healthcare staff interviews were translated, transcribed, and entered into NVivo 8 to facilitate analysis. Thematic analysis showed that diabetes patients saw depressive symptoms as directly contributing to high blood sugar. However, these symptoms were rarely mentioned spontaneously, and providers reported they seldom assess them in patients. Many patients and healthcare staff believed the best ways to respond to feelings of depression involved relaxing, leaving difficult situations, or eating. Staff also discussed cultural stigma associated with depression and the importance of establishing rapport before discussing it. In conclusion, healthcare providers in American Samoa need training to increase their awareness of depressive symptoms' negative impact on diabetes management in patients who screen positive for depression. All providers must approach the subject in a supportive context after establishing rapport. This information will be used for cultural translation of a community health worker and primary care-coordinated intervention for adults with diabetes in American Samoa, with the goal of creating an effective and sustainable intervention.
Depression; Type 2 diabetes; American Samoa; health care interventions; health beliefs
To examine ethnic differences in depressive symptoms and antidepressant treatment in a cohort of patients undergoing diagnostic coronary angiography.
Coronary heart disease (CHD) is the leading cause of mortality in the US, with an excess of mortality in African Americans. Traditional risk factors occur more frequently among African Americans but do not fully account for this increased risk. Elevated depressive symptoms have been shown to be associated with higher morbidity and mortality in CHD patients.
A consecutive series of 864 patients (727 Caucasians, 137 African Americans) completed the Beck Depression Inventory (BDI) to assess depressive symptoms. Data describing cardiovascular risk factors and type of medications including antidepressants were obtained from chart review at the time of study enrollment.
There was no difference in the severity of depressive symptoms between Caucasians (p =.50); the prevalence of elevated depressive symptoms also was similar for African Americans (35%) and Caucasians (27%) (p =.20). However, the rate of antidepressant use was 21% for Caucasians but only 11.7% for African Americans (p =.016). The odds ratio for ethnicity (African American vs. Caucasian) in predicting antidepressant use was 0.43 (95% CI=0.24–0.76, p=0.004) after adjustment for BDI scores.
African Americans with CHD are less likely to be treated with anti-depressant medications compared to Caucasians, despite having similar levels of depression. The ethnic differences in the psychopharmacological management of depression suggests that more careful assessment of depression, especially in African Americans, is necessary to optimize care of patients with CHD.
African-Americans; depression; coronary disease; ethnicity
Primary care is the principle setting for depression treatment; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended standard of care. Older African Americans are at high risk for depression due to elevated rates of chronic illness, disability and socioeconomic distress. There is an urgent need to develop and test new depression treatments that resonate with minority populations that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness.
Beat the Blues (BTB) is a single-blind parallel randomized trial to assess efficacy of a non-pharmacological intervention to reduce depressive symptoms and improve quality of life in 208 African Americans 55+ years old. It involves a collaboration with a senior center whose care management staff screen for depressive symptoms (telephone or in-person) using the Patient Health Questionnaire (PHQ-9). Individuals screened positive (PHQ-9 ≥ 5) on two separate occasions over 2 weeks are referred to local mental health resources and BTB. Interested and eligible participants who consent receive a baseline home interview and then are randomly assigned to receive BTB immediately or 4 months later (wait-list control). All participants are interviewed at 4 (main study endpoint) and 8 months at home by assessors masked to study assignment. Licensed senior center social workers trained in BTB meet with participants at home for up to 10 sessions over 4 months to assess care needs, make referrals/linkages, provide depression education, instruct in stress reduction techniques, and use behavioral activation to identify goals and steps to achieve them. Key outcomes include reduced depressive symptoms (primary), reduced anxiety and functional disability, improved quality of life, and enhanced depression knowledge and behavioral activation (secondary). Fidelity is enhanced through procedure manuals and staff training and monitored by face-to-face supervision and review of taped sessions. Cost and cost effectiveness is being evaluated.
BTB is designed to bridge gaps in mental health service access and treatments for older African Americans. Treatment components are tailored to specific care needs, depression knowledge, preference for stress reduction techniques, and personal activity goals. Total costs are $584.64/4 months; or $146.16 per participant/per month.
OBJECTIVE: Trauma exposure is high in African Americans who live in stressful urban environments. Posttraumatic stress disorder (PTSD) and depression are common outcomes of trauma exposure and are understudied in African Americans. African Americans are more likely to seek treatment for psychiatric disorders in a primary care setting. Our study evaluated trauma exposure, PTSD and major depression in African Americans attending primary care offices. METHOD: Six-hundred-seventeen patients (96% African Americans) were surveyed for trauma exposure in the waiting rooms of four primary care offices. Those patients reporting significant traumatic events were invited to a research interview. Of the 403 patients with trauma exposure, 279 participated. RESULTS: Of the 617 participants, 65% reported > or = 1 clearly traumatic event. The most common exposures were transportation accidents (42%), sudden unexpected death of a loved one (39%), physical assault (30%), assault with a weapon (29%) and sexual assault (25%). Lifetime prevalence of PTSD and a major depressive episode (MDE) among those with trauma exposure (n=279) was 51% and 35%, respectively. The percent of lifetime PTSD cases (n=142) with comorbid MDE was 46%. Lifetime PTSD and MDE in the trauma-exposed population were approximately twice as common in females than males, whereas current PTSD rates were similar. CONCLUSIONS: Our rate of PTSD (approximately 33% of those screened) exceeds estimates for the general population. Rates of MDE comorbid with PTSD were comparable to other studies. These findings suggest the importance of screening African Americans for PTSD, in addition to depression, in the primary care setting.
CONTEXT: African-American women are disproportionately affected by obesity and its related diseases. How psychological and psychosocial factors that affect this population differ across weight categories remains poorly understood. PURPOSE: To determine whether poor mental health and family functioning are associated with obesity in African-American women. METHODS: African-American women patients aged 21-65 years were interviewed at three primary care centers. Four well-established assessment tools were used to measure general mental and physical health status, family functioning, depressive symptoms and anxiety levels. Demographics, health behaviors and family and personal histories of overweight were assessed. RESULTS: Among 113 patients, after controlling for age and parity, obese women had significantly higher anxiety levels, poorer perception of their physical health, more often were overweight as a child, had overweight parents or siblings and experienced more psychosocial problems in their family growing up, compared to overweight and normal weight women. CONCLUSIONS: The observed findings of poor mental health, perception of physical health and family function in obese African-American women support a need for clinical attention and further study.
The purpose of this study is to examine predictors of physician-patient race concordance and the effect of race concordance on patients' satisfaction with their primary physicians among African American patients. The specific research question is, do African American patients express greater satisfaction with their care when they have an African American physician? Using the Commonwealth Fund, Minority Health Survey, we conduct multivariate analysis of African American respondents who have a usual source of care (n = 745). More than 21% of African American patients reported having an African American physician. Patient income and having a choice in the selection of the physician were significant predictors of race concordance. And, patients who were race concordant reported higher levels of satisfaction with care compared with African American patients that were not race concordant.
Ethnic minorities traditionally receive less care for depression than do white populations; we examine ethnic minority care for depression in a large cross-national primary care sample.
This is a cross-sectional study of identification and treatment of depression among diverse primary care patients, using self-report of symptoms and care.
One thousand four hundred and ninety-eight depressed primary care patients participating in four large studies of quality improvement for depression care are examined at baseline.
Primary care providers recommend depression treatments for Latino and African-American patients as frequently as they do for white patients. However, Latino and African-American patients are less likely to take antidepressant medications (adjusted odds ratio [OR], 0.30; 95% confidence interval [CI], 0.21 to 0.42 and adjusted OR, 0.56; 95% CI, 0.36 to 0.87, respectively) and Latinos are less likely to obtain specialty mental health care (adjusted OR, 0.50; 95% CI, 0.36 to 0.75).
Primary care providers are now able to recognize depression and recommend treatment for Latino and African-American patients, with this care recommended at equal rates to that of white patients. However, Latino and African-American patients remain less likely to obtain appropriate care, such as antidepressant medications or specialty care. New approaches to improving access to appropriate care for Latino and African-American primary care patients are needed.
disparities; depression; primary care; African Americans; Latinos; ethnic minorities
To describe diabetes self-care behaviors, diabetes-related distress, depressive symptoms, and diabetes-related needs among rural African American women with type 2 diabetes ages 21–50.
A cross-sectional survey, including questionnaires and a single, open-ended question, was used to assess constructs of interest.
Taking medication was the most frequently reported (5.5 days/week) self-care activity and exercise the least (3.0 days/week). Nearly half (44%) reported worrying about diabetes complications. Approximately one-third (31%) felt guilty about inconsistent self-care or fearful about living with diabetes. Seventy percent had a depression score suggestive of significant depressive symptomatology. Most diabetes-related concerns were about diet (34%) (i.e., what to eat), exercise (30%), taking medications (10%), and finances (8%).
Future research should explore specific diabetes self-care barriers/enablers and interventions should provide women with diabetes education, barrier management, and psychological support. Innovative delivery strategies are needed to provide this support in resource-limited rural communities.
Diabetes self-care; African American; women; diabetes; rural; depression
Depressive symptomatology during pregnancy has been associated with negative health outcomes for both the mother and child. This study examines the potential associations between depression and depressive symptoms in poor women and African-American women and their lifelong experiences of discrimination.
Data from 2,731 African-American and White participants in the Pregnancy Outcomes and Community Health (POUCH) Study were analyzed. Multiple regression analyses were used to investigate relations between depressive symptoms and total discrimination, and between depressive symptoms and three discrimination types (gender, race, and socioeconomic).
Initial results showed that African-American women had greater levels of depressive symptoms than White women. Self-reported total discrimination and discrimination types were each positively associated with depressive symptomatology in all women. After adjusting for sociodemographic characteristics (maternal age, education, employment status, partner status, and Medicaid status) and examining significant interactions, the race difference in depressive symptomatology was evident only in employed women. The addition of total discrimination to the multi-covariate model eliminated race differences in the adjusted mean level of depressive symptoms. When the three discrimination types were modeled simultaneously with all other covariates, only gender and economic discrimination remained positively associated with depressive symptoms in African-American and White women.
These results should be cautiously interpreted due to: 1) the study design; i.e., ascertainment of maternal discrimination and depressive symptoms at a single time point; and 2) limitations of the discrimination measure. Despite these limitations, the study points to potential links between lifetime discrimination and depressive symptoms in pregnancy.
depression; depressive symptoms; discrimination; race; pregnancy; race comparison; mental health
Chronic kidney disease affects one in nine Americans. Diabetes and hypertension account for nearly three quarters of all kidney failure cases. Disproportionate rates of chronic kidney disease, diabetes, and hypertension have been observed among African Americans. More than 70% of all kidney failure cases caused by diabetes and hypertension could have been prevented or delayed with healthy lifestyles and medications.
Approximately 14% of the population living in Michigan is African American. Despite this small proportion, 47% of patients on dialysis and 45% of those on the kidney transplant waiting list are African American. Risk of end-stage kidney failure is 4 times greater among African Americans than among whites.
The National Kidney Foundation of Michigan developed the Healthy Hair Starts with a Healthy Body (Healthy Hair) campaign to educate African American men and women about their disease risks and to motivate prevention behaviors. The campaign trains African American hair stylists to promote healthy behaviors with their clients through a "health chat" and by providing diabetes and hypertension risk assessment information and incentives.
Since 1999, Healthy Hair has trained nearly 700 stylists and reached more than 14,000 clients in eight Michigan cities. Information collected through a client "Chat Form" suggests a number of positive behavioral results.
With nearly 60% of clients indicating that they have taken steps to prevent diabetes, hypertension, and chronic kidney disease or to seek a physician's advice, the Healthy Hair program appears to be effective in the short term in prompting attention to healthy behaviors and increasing risk awareness.
To examine racial/ethnic differences in the prevalence of depressive symptoms and in provider recognition of depression among Latino, Asian, and non-Hispanic white patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS
Patients (n = 1,209) with type 2 diabetes were recruited from five university-affiliated primary care clinics for an observational study.
Vietnamese American (133, 59.4%) and Mexican American (351, 50.2%) patients were more likely to report symptoms consistent with clinical depression (Center for Epidemiological Studies Depression [CES-D] scale score ≥22) than non-Hispanic whites (119, 41.6%; F [2, 1206] = 8.05, P < 0.001). Despite comparable diabetes care, Vietnamese and Mexican patients with high depressive symptoms were less likely to be diagnosed and treated than non-Hispanic whites (all P values < 0.001). Minority patients who reported low levels of trust in their provider were less likely to have been diagnosed or treated for depression (adjusted odds ratio 0.65, 95% CI 0.44–0.98, P < 0.05).
Innovative strategies are needed to improve recognition of depressive symptoms in minority patients.
The study compared depressive and associated psychopathological symptoms in 17 African-American, 19 Asian-American, 22 Mexican-American and 41 Non-Hispanic White patients with unipolar major depressive disorder. Overall, severity of depression was comparable among the groups both on clinician-rated and subject-rated measures. However, ethnic-minority groups were more likely to experience diurnal variation of mood, with worsening in the evening. Furthermore, Asian-Americans and Mexican-Americans reported greater severity of anxiety and somatic symptoms. The findings suggest that clinicians should be aware of potential differences in symptom presentation when assessing and treating depressed patients from different ethnic groups.
anxiety; cross-cultural; depression; ethnicity; psychopathology; somatization
Focusing on the reported growing use of firearms to complete suicide among African Americans, this article analyzes the 1993 National Mortality Followback Survey to examine the association of firearm suicide with race, education, geographic region, access to a firearm, depressive symptoms, and mental health service utilization on decedents aged 15 years and older. After controlling for demographic, socioeconomic, and clinical variables, the analysis indicates that African American men were twice as likely as White men to use a firearm to complete suicide. The findings suggest the importance for clinicians to screen for the presence of firearms in depressed African Americans and to reduce their access to firearms. In addition, clinicians, social workers, and public health professionals should consider racial differences in correlates of firearm suicide when designing prevention and intervention initiatives.
black suicide; firearms; risk factors; mortality
African-Americans are more likely than Caucasians to access healthcare through the emergency department (ED); however, the reasons behind this pattern are unclear. The objective is to investigate the effect of race, insurance, socioeconomic status, and perceived health on the preference for ED use.
This is a prospective study at a tertiary care ED from June to July 2009. Patients were surveyed to capture demographics, healthcare utilization, and baseline health status. The primary outcome of interest was patient-reported routine place of healthcare. Other outcomes included frequency of ED visits in the previous 6 months, barriers to primary care and patient perception of health using select questions from the Medical Outcomes Study Short Form 36 (SF-36).
Two hundred and ninety-two patients completed the survey of whom 58% were African-American and 44% were uninsured. African-Americans were equally likely to report 3 or more visits to the ED, but more likely to state a preference for the ED for their usual place of care (24% vs. 13%, p < 0.01). No significant differences between groups were found for barriers to primary care, including insurance. African-Americans less often reported comorbidities or hospitalization within the previous 6 months (23% vs. 34%, p = 0.04). On logistic regression modeling, African-Americans were more than 2 times as likely to select the ED as their usual place of healthcare (OR 2.24, 95% CI 1.22 – 4.08).
African-Americans, independent of health insurance, are more likely than Caucasians to designate the ED as their routine place of healthcare.
We examined the relationship between parental efficacy and depressive symptoms in a diverse sample of low income mothers. The sample consisted of 607 European American, African American, and Hispanic mothers who participated in The Early Steps Project, a multi-site, longitudinal, preventative intervention study. Parental efficacy was found to be significantly associated with depressive symptoms in the entire sample of low income mothers. Ethnicity moderated results, however, such that parental efficacy was significantly associated with depressive symptoms for European American mothers but was not for the African American and Hispanic mothers. Ethnic differences in the various categories of depressive symptoms (i.e., total, somatic, and psychological) were also explored, with the results showing that African American mothers reported higher levels of depressive symptoms than both European American and Hispanic mothers in each of the categories. The theoretical and clinical implications of these results are discussed.
Parental efficacy; Depressive symptoms; Low income; Mothers; Ethnicity
Individuals with diabetes are at higher risk for depression than the general population. Although depression can be treated with antidepressant medications, patients with diabetes and comorbid depression often go untreated. The goal of this study was to examine racial disparities in the treatment of depression with antidepressant medication in the southeastern U.S.
RESEARCH DESIGN AND METHODS
Cross-sectional data were collected at baseline from 69,068 participants (71% African American, 60% female, and 82% with incomes <$25,000) recruited from community health centers and enrolled in the Southern Cohort Community Study (SCCS). The SCCS is a prospective epidemiological cohort study designed to explore causes of health disparities in adults aged 40–79 years. Binary logistic regression was used to identify factors associated with antidepressant use among those with diabetes (n = 14,279).
Individuals with diagnosed diabetes (14,279) were classified with no depressive symptoms (54.7%), or with mild (24.2%), moderate (12.8%), or severe depressive symptoms (8.3%). After controlling for sex, age, insurance, income, education, BMI, smoking status, alcohol consumption, and level of depression, African Americans with diabetes were much less likely to report taking antidepressant medication than whites (adjusted odds ratio 0.32 [95% CI 0.29–0.35], P < 0.0001).
Antidepressant use is much less common among African Americans than among whites with diabetes. Reasons for racial disparities in treatment of depressive symptoms are unclear but may include a combination of differential diagnosis and treatment by health professionals as well as cultural differences in seeking help for emotional distress.
Although research has shown positive associations among post-traumatic stress disorder (PTSD), depressive symptoms, and suicidal ideation, the nature of these relations is unclear, especially in African American women. This study examined the associations among these comorbid psychological difficulties in a sample of 136 low-income, African American women. Specifically, the goal of this investigation was to ascertain if overall depressive symptoms, as well as both the cognitive-affective and somatic components of depression, mediated the PTSD-suicidal ideation link. Results from bootstrapping analyses revealed that overall depressive symptoms and the cognitive-affective components of depression, but not the somatic components, mediated the PTSD-suicidal ideation link.
African American; PTSD; Depression; Suicidal ideation and attempts
Depressive disorders are common, and it is important to understand the factors that contribute to racial disparities in depression treatment. This primary care study of veterans with subsyndromal depression examined two hypotheses: that African Americans would be less likely than Caucasians to believe that medication is beneficial in depression treatment and would be more likely to believe that counseling or psychotherapy is beneficial.
Primary care patients with subsyndromal depression were referred to the Philadelphia Department of Veterans Affairs Behavioral Health Laboratory and asked about past experiences and attitudes toward depression treatment.
Among 111 African-American and 95 Caucasian participants, logistic regression analyses determined that African Americans were less likely to view medication as beneficial (odds ratio=.44). No racial differences were found in participants’ attitude toward counseling or psychotherapy.
The findings support the premise that clinicians treating patients with subsyndromal depressive syndromes should take into account racial differences in attitudes toward treatment.
The association between experiences of adverse life events and adolescent depressive symptoms has been well documented. However, this association is not consistently observed in urban and low income African American youth. In addition, mechanisms linking life event stress and African American adolescents' depressive symptoms have received little attention. This study examined past year violent and nonviolent life events assessed in 6th grade as predictors of 7th grade depressive symptoms among a community epidemiologically defined sample of 447 (47% girls) urban African American adolescents. Depressive symptoms were assessed twice, at a 1-year interval, and initial depressive symptoms were controlled in the analyses. Control-related beliefs were examined as mediators of the association between life events and depressive symptoms, and gender was examined as a moderator of the association between control-related beliefs and depressive symptoms. Associations among study variables were examined in a series of models, from general to more specific. A model in which nonviolent and violent life events were examined separately and control and contingency beliefs examined as one latent variable was the most informative about the etiology of depressive symptoms in a sample of urban, African American youth. Implications of the findings for preventive interventions and future research are discussed.
Prevalence of both diabetes mellitus and obstructive sleep apnea (OSA) is high among general population. Both of these conditions are associated with significant morbidity. OSA affects approximately 25% of men and 9% of women, and its prevalence is even higher among obese, Hispanics, African American and diabetic patients. Diabetes on the other hand besides having high prevalence in general population has even higher prevalence among ethnic populations as Hispanics and African American. Despite the availability of several simple screening tools for OSA, as Berlin questionnaire, STOP-BANG questionnaire, NAMES Criteria, the utility for screening of OSA among the diabetic population remains marginal. This in turn can lead to significant morbidity and complications related to OSA as well as worsening of diabetes mellitus and increase in diabetic complications due to untreated sleep related breathing disorder. It is therefore imperative for the primary care giver to screen for OSA among the diabetic population as a part of their routine evaluation to prevent worsening of diabetes, and its cardiovascular, renal, ophthalmologic and neurological complications.
Obstructive sleep apnea and diabetes mellitus; Obstructive sleep apnea screening; Obstructive sleep apnea and metabolic syndrome
The purpose of this study was to determine the perception of risk for the development of cardiovascular disease (CVD) in a population of urban, low socioeconomic status (SES) patients with type-2 diabetes but no known CVD and to identify factors associated with perceived risk.
This cross-sectional study enrolled 143 patients, predominantly middle-aged African American women, at urban community clinics. Demographic and socioeconomic characteristics, medical history, health behavior, depressive symptoms, and perception of risk for CVD were measured.
Seventy-five percent of participants perceived that they had a 50% or smaller risk of developing CVD. Increased levels of perceived risk for the development of CVD were significantly and independently associated with increased depressive symptoms, poorer perception of general health, and higher intake of dietary fat.
Comprehensive care for urban, poor, diabetic patients calls for effective communication of CVD risk and adequate treatment of depressive symptoms and traditional CVD risk factors.
Diabetes; cardiovascular disease; primary care; prevention
A history of childhood sexual abuse (CSA) has been associated with adult depression, but data on abuse severity and disclosure are scant, particularly among low income ethnic minorities. CSA often co-occurs with other adversities, which also increase the risk of depression. This study examined the peri-trauma variable of abuse severity and the post-trauma variables of disclosure and self-blame as predictors of current depression symptoms in 94 low-income African American and Latina women with histories of CSA. After controlling for non-sexual childhood adversity and adult burden (i.e., chronic stress), severe CSA overall was associated with higher depression scores, especially among Latinas who disclosed their abuse. Depression symptoms among African American women were highest in those who disclosed and reported high levels of self-blame at the time of the incident. The link between depression and specific peri- and post-CSA factors in minority women may help guide future interventions.
Shared decision-making (SDM) between patients and their physicians is associated with improved diabetes health outcomes. African-Americans have less SDM than Whites, which may contribute to diabetes racial disparities. To date, there has been little research on SDM among African-Americans.
We explored the barriers and facilitators to SDM among African-Americans with diabetes.
Qualitative research design with a phenomenological methodology using in-depth interviews (n = 24) and five focus groups (n = 27). Each interview/focus group was audio-taped and transcribed verbatim, and coding was conducted using an iterative process. Participants: We utilized a purposeful sample of African-American adult patients with diabetes. All patients had insurance and received their care at an academic medical center.
Patients identified multiple SDM barriers/facilitators, including the patient/provider power imbalance that was perceived to be exacerbated by race. Patient-related factors included health literacy, fear/denial, family experiences and self-efficacy. Reported physician-related barriers/facilitators include patient education, validating patient experiences, medical knowledge, accessibility and availability, and interpersonal skills.
Barriers/facilitators of SDM exist among African-Americans with diabetes, which can be effectively addressed in the outpatient setting. Primary care physicians, particularly academic internists, may be uniquely situated to address these barriers/facilitators and train future physicians to do so as well.
shared decision-making; patient-provider communication; diabetes; African-Americans