Inequities along the Depression Care Cascade in African American Women: An Integrative Review

Perez, Nicole Beaulieu; Lanier, Yzette; Squires, Allison

doi:10.1080/01612840.2020.1853289

Cited by 9 publications

(11 citation statements)

References 35 publications

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“…This may follow from the well-established finding that in the United States, White Americans are far more likely than Black Americans to be screened and treated for depression. 10,38 Because a number of antidepressants are efficacious analgesics (ie, tricyclic antidepressants and serotonin–norepinephrine reuptake inhibitors), it may be that White former professional ASF players who are depressed are more frequently managed with these medications, which tends to reduce the intensity of their pain; interestingly, however, although we do not have data on antidepressant treatment, White participants in this study were actually less likely than Black participants to report taking medication for their pain. Collectively, in this sample, the potential social and economic advantages of working as a professional athlete (which are not universal and which do not necessarily accrue equally to White and Black former players) did not seem to erase race-related disparities in pain.…”

Section: Discussionmentioning

confidence: 77%

Race differences in pain and pain-related risk factors among former professional American-style football players

Edwards¹,

Tan

Dairi³

et al. 2023

Pain

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The burden of pain is unequal across demographic groups, with broad and persisting race differences in pain-related outcomes in the United States. Members of racial and ethnic minorities frequently report more pervasive and severe pain compared with those in the majority, with at least some disparity attributable to differences in socioeconomic status. Whether race disparities in pain-related health outcomes exist among former professional football players is unknown. We examined the association of race with pain outcomes among 3995 former professional American-style football players who self-identified as either Black or White. Black players reported more intense pain and higher levels of pain interference relative to White players, even after controlling for age, football history, comorbidities, and psychosocial factors. Race moderated associations between several biopsychosocial factors and pain; higher body mass index was associated with more pain among White but not among Black players. Fatigue and psychosocial factors were more strongly related to pain among Black players relative to White players. Collectively, the substantial social and economic advantages of working as a professional athlete did not seem to erase race-related disparities in pain. We highlight an increased burden of pain among elite Black professional football players and identify race-specific patterns of association between pain and biopsychosocial pain risk factors. These findings illuminate potential future targets of interventions that may serve to reduce persistent disparities in the experience and impact of pain.

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Section: Discussionmentioning

confidence: 77%

Race differences in pain and pain-related risk factors among former professional American-style football players

Edwards¹,

Tan

Dairi³

et al. 2023

Pain

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“…The cultural context in which depressive symptoms are conceptualized further underscores the need for holistic assessments of psychological concerns-which include depressive symptoms, anxiety, and emotional distress-and for providers to seek to understand patients' perceptions and beliefs about these symptoms. Requisite to these essential tasks is the need for providers and institutions-which remain predominantly White and male-to address biased perceptions and policies that result in expressed racism and microaggressions toward AA clients (Gary et al, 2018) and the perpetuation of long-standing inequities with mental healthcare access (Perez et al, 2021). Nurses and other primary care providers-often the point of entry for referral to mental health services-must be supported on a system and policy level to have the time required to provide holistic patient care.…”

Section: Implications For Clinical Practice and Future Researchmentioning

confidence: 99%

Latent Class Analysis of Depressive Symptom Phenotypes Among Black/African American Mothers

et al. 2022

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Background: Depression is a growing global problem with significant individual and societal costs. Despite their consequences, depressive symptoms are poorly recognized and undertreated because wide variation in symptom presentation limits clinical identification-particularly among African American (AA) women-an understudied population at an increased risk of health inequity.Objectives: The aims of this study were to explore depressive symptom phenotypes among AA women and examine associations with epigenetic, cardiometabolic, and psychosocial factors.Methods: This cross-sectional, retrospective analysis included self-reported Black/AA mothers from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study (data collected in 2015-2020). Clinical phenotypes were identified using latent class analysis. Bivariate logistic regression examined epigenetic age, cardiometabolic traits (i.e., body mass index ≥ 30 kg/m 2 , hypertension, or diabetes), and psychosocial variables as predictors of class membership.Results: All participants were Black/AA and predominantly non-Hispanic. Over half of the sample had one or more cardiometabolic traits. Two latent classes were identified (low vs. moderate depressive symptoms). Somatic and self-critical symptoms characterized the moderate symptom class. Higher stress overload scores significantly predicted moderate-symptom class membership.Discussion: In this sample of AA women with increased cardiometabolic burden, increased stress was associated with depressive symptoms that standard screening tools may not capture. Research examining the effect of specific stressors and the efficacy of tools to identify at-risk AA women are urgently needed to address disparities and mental health burdens.

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“…5,6 AAW also experience a greater proportion of depression that is considered chronic or severe compared to other racial/ethnic groups. [7][8][9] However, AAW are often poorly represented in studies aimed to elucidate biological correlates in CM illness and depressive symptoms.…”

Section: Introductionmentioning

confidence: 99%

Associations Between DNA Methylation Age Acceleration, Depressive Symptoms, and Cardiometabolic Traits in African American Mothers From the InterGEN Study

Perez

Vorderstrasse

et al. 2022

Genet Epigenet

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Background: African American women (AAW) have a high risk of both cardiometabolic (CM) illness and depressive symptoms. Depressive symptoms co-occur in individuals with CM illness at higher rates than the general population, and accelerated aging may explain this. In this secondary analysis, we examined associations between age acceleration; depressive symptoms; and CM traits (hypertension, diabetes mellitus [DM], and obesity) in a cohort of AAW. Methods: Genomic and clinical data from the InterGEN cohort (n = 227) were used. Age acceleration was based on the Horvath method of DNA methylation (DNAm) age estimation. Accordingly, DNAm age acceleration (DNAm AA) was defined as the residuals from a linear regression of DNAm age on chronological age. Spearman’s correlations, linear and logistic regression examined associations between DNAm AA, depressive symptoms, and CM traits. Results: DNAm AA did not associate with total depressive symptom scores. DNAm AA correlated with specific symptoms including self-disgust/self-hate (−0.13, 95% CI −0.26, −0.01); difficulty with making decisions (−0.15, 95% CI −0.28, −0.02); and worry over physical health (0.15, 95% CI 0.02, 0.28), but were not statistically significant after multiple comparison correction. DNAm AA associated with obesity (0.08, 95% CI 1.02, 1.16), hypertension (0.08, 95% CI 1.01, 1.17), and DM (0.20, 95% CI 1.09, 1.40), after adjustment for potential confounders. Conclusions: Associations between age acceleration and depressive symptoms may be highly nuanced and dependent on study design contexts. Factors other than age acceleration may explain the connection between depressive symptoms and CM traits. AAW with CM traits may be at increased risk of accelerated aging.

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Inequities along the Depression Care Cascade in African American Women: An Integrative Review

Cited by 9 publications

References 35 publications

Race differences in pain and pain-related risk factors among former professional American-style football players

Race differences in pain and pain-related risk factors among former professional American-style football players

Latent Class Analysis of Depressive Symptom Phenotypes Among Black/African American Mothers

Associations Between DNA Methylation Age Acceleration, Depressive Symptoms, and Cardiometabolic Traits in African American Mothers From the InterGEN Study

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