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Perceived discrimination can lead to higher depression rates in blacks
Perceived racial discrimination in the health care setting may interfere with patient care.
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Depression among blacks with diabetes may have something to do with perceived discrimination.
Julie Wagner, PhD, and Gina Abbott, PhD, both with the University of Connecticut Health Center, looked at perceived discrimination, depressive symptoms and depression care in blacks with diabetes. Their data, published in Diabetes Care, demonstrated that discrimination was associated with higher depressive symptoms, the likelihood of clinically significant symptoms and patient-reported, physician-diagnosed depression.
“African-Americans experience racism in their daily lives and this is related to depression. When they perceive racism in their health care, it can interfere with the patient-provider relationship,” Wagner, assistant professor in the department of behavioral sciences and community health, told Endocrine Today.
Two questionnaires used
Wagner and Abbott evaluated 102 blacks with diabetes (mean age 56), whom they recruited from American Diabetes Association health fairs between 2004 and 2006. Most of the participants were women (74.2%), had type 2 diabetes (88.3%) and suboptimal glycemic control.
The researchers’ data come from two main questionnaires: the Schedule of Racist Events (SRE), which measures the frequency and stressfulness of racial discrimination situations, such as salary, housing and treatment by store clerks; and the Center for Epidemiological Studies Depression, which measures depressive symptoms.
Depression and discrimination
The participants in this study had an average total lifetime discrimination score of 34.7 on the SRE; 6% responded that they had never experienced any discrimination. According to the researchers, these data represented comparable rates of discrimination compared with a large, representative sample of blacks that do not have diabetes.
Higher scores in the SRE questionnaire were independent predictors of depressive symptoms. Higher SRE score was also an independent predictor of patient-reported, physician-diagnosed depression (1.06 OR; 95% CI, 1.00-1.18).
Perceived discrimination was also associated with not taking antidepressants, according to the researchers, whereas higher socioeconomic status and HbA1c levels were more likely to predict the likelihood of taking antidepressants.
“Individuals who perceived discrimination in their health care system may have had more depressive symptoms, but those same individuals may have been less trusting of providers or the medications they recommended,” Wagner said.
Women considered discrimination more stressful than men did. However, the rates of frequency of discrimination were similar among both sexes.
Although data from other prospective studies show that perceived discrimination at baseline predicts depression at follow-up, this temporal order cannot be determined from Wagner’s cross-sectional study. It is possible that depressed individuals perceive more discrimination, according to Wagner.
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Improving care
“African-Americans have inherited a legacy of racism in medical care, among other settings. Although few health care providers today deliberately provide suboptimal care to their patients based on criteria such as race, it nonetheless remains true that minorities receive lower quality health care than whites,” Wagner said. Historical events and current disparities may lead to mistrust of the medical community.
Interventions may be able to improve the mental health of minorities by decreasing discriminatory interactions and helping patients cope psychologically, Wagner said.
Some recommended interventions include:
- Pursue cultural competence/sensitivity training to avoid behaviors that patients may be perceived as discriminatory.
- Establish and strengthen social relationships with individuals from different backgrounds.
- Gain personal, as well as professional, insight into the lives and health of minorities.
- Encourage patients to use healthy coping strategies to deal with discrimination when they encounter it, such as social support, spiritual practice and problem solving.
“We would like our patients to live in ideal environments, but they don’t. Even though the situation for African-Americans has improved considerably during the past several decades, and it continues to improve, minorities are still likely to encounter discrimination,” Wagner said. “This is related to patient mental health, and the patient-provider relationship.” –by Katie Kalvaitis
For more information:
- Wagner J, Abbott G. Depression and depression care in diabetes. Diabetes Care. 2007;30:364-365.