Defense Date

2010

Document Type

Thesis

Degree Name

Master of Public Health

Department

Epidemiology & Community Health

First Advisor

Robin Matsuyama

Abstract

Objective: Depression is a common psychiatric condition, and despite the availability of effective treatments, this condition is largely under-recognized and undertreated, particularly among African Americans. One reason for this discrepancy may be that depressive symptoms often co-occur with physical health conditions, which can influence both the reporting of depressive symptomology, willingness to seek care, and the type of healthcare provider sought. The purpose of this study was to explore the relationship between treatment-seeking characteristics and diagnostic attributions of depression among community-dwelling African American adults. Methods: Data come from the National Survey of American Life, a nationally representative sample of African Americans, Caribbean blacks and non-Hispanic whites. Analysis is limited to African Americans (N = 3,432), of whom 64% were women. Lifetime history of Major Depressive Disorder (MDD) was assessed using the Composite International Diagnostic Inventory (CIDI). Participants were categorized into four diagnostic groups: Never MDD, MDD never attributed to physical health problems (e.g., typical depression), MDD sometimes attributed to physical health problems (e.g., complicated depression), and MDD always attributed to physical health problems (e.g., physical depression). Whether or not care was sought for depression, and the type of healthcare provider seen, was assessed by self-report. Multinomial logistic regression was used to assess the cross-sectional relationship between treatment-seeking characteristics and diagnostic type of depression. Models were adjusted for age, sex, insurance status, health behaviors, and comorbid health conditions. Results: 441 (12.8%) of the sample met CIDI criteria for MDD, and of these 66.7% were classified as typical depression, 18.1% were complicated depression, and 15.2% were physical depression. In fully-adjusted models, seeking treatment from a mental health professional was significantly associated with diagnosis of complicated depression (Odds ratio (OR): 5.53; 95% Confidence Interval (CI): 2.27 – 13.43) as opposed to typical depression. In adjusted analysis treatment-seeking from a family doctor was significantly associated with diagnosis of physical depression (OR: 2.94; 95% CI: 1.20 – 7.19) as opposed to typical depression. Seeking care from three or more different types of healthcare providers was significantly associated with diagnosis of complicated depression (OR: 2.10; 95% CI: 1.13 – 3.92) relative to typical depression. There was no significant relationship between seeing multiple providers and physical depression. Conclusions: Type of healthcare provider sought for care for depressive symptoms is significantly related to how those depressive symptoms are diagnosed. These findings are consistent with the hypothesis that healthcare providers influence whether depressive symptomology is attributed to physical health problems. However, this study cannot definitively differentiate the role of personal choice in seeking particular types of care providers from differences in assessment and attribution of depressive symptomology by types of providers. Future research is necessary to determine the factors related to both choosing a care provider when experiencing psychiatric symptoms and how different types of providers assess depressive symptoms and confer diagnosis.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

May 2010

Included in

Epidemiology Commons

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