Geography, race/ethnicity impact late-life depression severity

Severity in symptoms of late-life depression may be linked to geography, as well as racial/ethnic disparities depending on location, according to a cohort study published in The American Journal of Geriatric Psychiatry.

“U.S. geographic regions have diverse racial/ethnic distributions, and region may serve as a proxy for shared social and health determinants, such as socio-economic, neighborhood and community factors relevant to depression risk,” Chirag M. Vyas, MBBS, MPH, of the department of psychiatry at Massachusetts General Hospital, and colleagues wrote. “Prior literature has suggested significant differences in depression prevalence rates across the U.S. after accounting for sociodemographic characteristics. However, a comprehensive analysis, incorporating numerous covariates, of the role of geographic region in [late-life depression] is lacking; yet, data from such analyses may have substantial implications for [late-life depression] prevention.”

Researchers sought to assess whether geographic region correlated with late-life depression severity, item-level symptom burden and treatment among older adults. In addition, they aimed to evaluate whether disparities in late-life depression were tied to either race or ethnicity, and whether these varied by location.

Vyas and colleagues analyzed data from 25,871 men aged 50 years or older, and women aged 55 years or older who participated in the VITamin D and OmegA-3 TriaL Depression Endpoint Prevention study. Participants were from all four major geographic regions within the U.S. and were given the Patient Health Questionnaire-8. Further, they disclosed prescribed medications and/or mental health counseling for depression. Vyas and colleagues performed multivariable regression analyses.

Results showed lower late-life depression severity and item-level symptom burden in the Midwest compared with the Northeast; however, participants from underrepresented racial/ethnic groups, particularly Black and Hispanic participants, had higher late-life depression severity and item-level symptom burden compared with non-Hispanic white participants in this region.

In the Northeast, Black participants and those who selected “other” as their racial/ethnic group reported up to 30% higher depression severity when measured against non-Hispanic white participants. In the Midwest, Black participants and Hispanic participants had 23% and 99% higher symptom severity than non-Hispanic white participants, respectively. Conversely, the researchers did not observe disparities in depression severity levels along racial or ethnic lines among participants from either the Southeast or West.

Disparities along racial or ethnic lines with respect to symptoms such as anhedonia, sadness or other psychomotor difficulties varied by geographic region. Further, data displayed no significant differences in depression care in each of the four regions, and the researchers did not observe regional variation in regard to any racial disparities in depression treatment or care.

“Future depression prevention studies may need to account for geographic region as an explanatory factor when addressing racial/ethnic disparities in [late-life depression],” Vyas and colleagues wrote.